title: Biliopancreatic Diversion for Severe Obesity: Long-Term Effectiveness and Nutritional Complications.
abstract: BACKGROUND
  Bariatric surgery is currently the treatment of choice for those patients with severe obesity, but the procedure of choice is not clearly established. We describe weight loss and nutritional parameters in severely obese patients after biliopancreatic diversion for 10 years of follow-up.
  
  
  METHODS
  Patients were followed by the same multidisciplinary team, and data are shown for 10 years. Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire, data regarding the evolution of obesity-related diseases, and nutritional parameters are reported.
  
  
  RESULTS
  Two hundred ninety-nine patients underwent biliopancreatic diversion, 76.1 % women, initial BMI 50.1 kg/m(2) (7.2). Weight loss was maintained throughout 10 years with EWL% around 65 % and EBMIL% around 70 %. More than 80 % of the patients showed EWL higher than 50 %. Blood pressure, glucose metabolism, and lipid profile clearly improved after surgery. Mean nutritional parameters remained within the normal range during follow-up. Protein malnutrition affected less than 4 % and anemia up to 16 %. Fat-soluble vitamin levels decreased along the time, with vitamin D deficiency in 61.5 % of patients. No significant differences were found either in nutritional parameters or weight loss regarding gastrectomy or gastric preservation, or common limb length longer or shorter than 55 cm
  
  
  CONCLUSIONS
  Biliopancreatic diversion is an effective surgical procedure in terms of weight loss, quality of life, and evolution of obesity-related diseases. Nutritional deficiencies are less frequent than feared for a malabsorptive procedure, but must be taken into account, especially for fat-soluble vitamins.
authors.affiliation: High Risk Obesity Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava s/n, Edificio Administrativo Ala Sur, 2ª planta, 24008, León, Spain. mdballesteros@telefonica.net.
authors.forename: María D
authors.identifier: http://orcid.org/0000-0002-5729-9926
authors.initials: MD
authors.lastname: Ballesteros-Pomar
authors.affiliation: High Risk Obesity Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava s/n, Edificio Administrativo Ala Sur, 2ª planta, 24008, León, Spain. gonzalezdefrancisco@gmail.com.
authors.forename: Tomás
authors.initials: T
authors.lastname: González de Francisco
authors.affiliation: High Risk Obesity Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava s/n, Edificio Administrativo Ala Sur, 2ª planta, 24008, León, Spain. anaurifon@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Urioste-Fondo
authors.affiliation: High Risk Obesity Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava s/n, Edificio Administrativo Ala Sur, 2ª planta, 24008, León, Spain. luisghg19@gmail.com.
authors.forename: Luis
authors.initials: L
authors.lastname: González-Herraez
authors.affiliation: High Risk Obesity Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava s/n, Edificio Administrativo Ala Sur, 2ª planta, 24008, León, Spain. calleja.alicia@gmail.com.
authors.forename: Alicia
authors.initials: A
authors.lastname: Calleja-Fernández
authors.affiliation: High Risk Obesity Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava s/n, Edificio Administrativo Ala Sur, 2ª planta, 24008, León, Spain. avcyo@hotmail.com.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Vidal-Casariego
authors.affiliation: High Risk Obesity Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava s/n, Edificio Administrativo Ala Sur, 2ª planta, 24008, León, Spain. vicsim77@gmail.com.
authors.forename: Vicente
authors.initials: V
authors.lastname: Simó-Fernández
authors.affiliation: High Risk Obesity Unit, Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Altos de Nava s/n, Edificio Administrativo Ala Sur, 2ª planta, 24008, León, Spain. isicano@picos.com.
authors.forename: Isidoro
authors.initials: I
authors.lastname: Cano-Rodríguez
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000209:etiology*; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D014808:Vitamin D Deficiency / Q000209:etiology; D015431:Weight Loss
keywords: Bariatric surgery; Biliopancreatic diversion; Long-term; Nutritional complications; Severe obesity