Background: Biliopancreatic diversion (BPD) is a surgical technique burdened, in some instances, by clinical evidence of malabsorption and intractable diarrhoea.
Objectives: To compare calcium metabolism together with weight in patients undergoing BPD versus BPD followed by revisional surgery because of side effects of BPD or ineffectiveness of BPD.
Setting: University hospital.
Methods: Twenty-seven patients underwent BPD. After a median period of 48 months, they underwent revisional surgery (elongation of the common limb from 50 to 200 cm and reduction of the gastric pouch from 500 to 40 mL) and were observed for a total period of 120 months; 40 patients only underwent BPD (controls) and were observed for an identical period.
Results: At baseline, 24 patients (8 revisional surgery and 16 controls) had increased parathyroid hormone (PTH) levels, and only 3 patients had normal 25(OH)vitamin D levels; calcium declined, even within normal limits, and PTH increased in the revisional surgery group. After revisional surgery, patients experienced a further decrease of weight, together with a reduction of PTH levels, an increase of 25(OH)vitamin D levels, and an increase of calcium levels. Weight loss was inverserly associated with an increase of 25(OH)vitamin D and directly associated with change of PTH.
Conclusion: This study suggests that it is possible to control effects of BPD on calcium metabolism through a revisional procedure leading to lesser malabsorption and to greater restriction of the gastric pouch. It should be considered in the presence of significant side effects due to excessive malabsorption.
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