Biliopancreatic diversion requires multiple vitamin and micronutrient adjustments within 2 years of surgery.
BACKGROUND
Malabsorptive bariatric procedures require multiple vitamin supplements, especially regarding fat-soluble vitamins. The exact amount required to maintain normal serum concentrations is still largely unknown. Based on the initial postoperative prescription, we assessed the number of adjustments and the amount of vitamins/micronutrients to normalize the biological markers 2 years after the biliopancreatic diversion with duodenal switch (BPD/DS).


METHODS
A total of 112 consecutive patients had a laparoscopic BPD/DS between February 2007 and November 2010 for a body mass index of 53.1±5.9 kg/m² at a private hospital. Complete blood checks with vitamin status were obtained at each of the 3-month interval visits during the 1(st) postoperative year as well as twice during the 2(nd) year.


RESULTS
Initially, all of the patients were prescribed daily 25,000 International units (IU) of vitamin A, 1000 mg of calcium, multivitamins, and 1900 IU of vitamin D3. Significant adjustments were necessary 3.6±1.1 times during this period. A total of 80% of the patients required added vitamin A, vitamin D, as well as calcium, zinc, and iron. After 2 years,≥20% of patients exhibited vitamin A and iron deficiency with low prealbumin or micropenic anemia. Seventy percent had vitamin D deficiency and 50% secondary hyperparathyroidism.


CONCLUSIONS
The initial prescription was insufficient to cover the requirements after BPD/DS. At least 3000 mg of calcium with 7000 IU of vitamin D, 50,000 IU of vitamin A, 40 mg of zinc, and 200 mg of iron must be prescribed to start with. The trend toward a decrease in 25 OH vitamin D and hyperparathyroidism remains difficult to control although it can result from increased bone turnover during the early postoperative period.
Société de Chirurgie Viscérale, Clinique de l'Anjou, 142, avenue de Lattre de Tassigny, 49000 Angers, France. Electronic address: ptopart@gmail.com.
Philippe
P
Topart
Société de Chirurgie Viscérale, Clinique de l'Anjou, 142, avenue de Lattre de Tassigny, 49000 Angers, France.
Guillaume
G
Becouarn
Service d'endocrinologie-nutrition, CHU, 4, rue Larrey, 49100, Angers, France.
Agnès
A
Sallé
UTNC, hôpital Larrey, 1, avenue du Pr. Jean Poulhès TSA 50032, 31059 Toulouse cedex 9, France.
Patrick
P
Ritz
D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D003677:Deficiency Diseases / Q000517:prevention & control; D019587:Dietary Supplements; D004386:Duodenum / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008286:Malabsorption Syndromes / Q000517:prevention & control; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage*; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D014815:Vitamins / Q000008:administration & dosage*
D018977:Micronutrients; D014815:Vitamins
Biliopancreatic diversion; Malabsorption; Vitamins