Abnormal calcium, 25(OH)vitamin D, and parathyroid hormone after biliopancreatic diversion; correction through elongation of the common tract and reduction of the gastric pouch.
BACKGROUND
Biliopancreatic diversion (BPD) is a surgical technique burdened, in some instances, by clinical evidence of malabsorption and intractable diarrhoea.


OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Istituto di Ricovero e Cura a Carattere Scientifico Multimedica, Milano, Italy. Electronic address: valerio.ceriani@multimedica.it.
Valerio
V
Ceriani
Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.
Francesco
F
Cetta
Istituto di Ricovero e Cura a Carattere Scientifico Multimedica, Milano, Italy.
Ferdinando
F
Pinna
Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milano, Italy.
Antonio E
AE
Pontiroli
D000328:Adult; D000704:Analysis of Variance; D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D002118:Calcium / Q000378:metabolism*; D016022:Case-Control Studies; D003404:Creatinine / Q000378:metabolism; D005260:Female; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D008286:Malabsorption Syndromes / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control; D008297:Male; D009767:Obesity, Morbid / Q000378:metabolism / Q000601:surgery; D010281:Parathyroid Hormone / Q000378:metabolism*; D011183:Postoperative Complications / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control; D012086:Reoperation; D012709:Serum Albumin / Q000378:metabolism; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000378:metabolism; D015431:Weight Loss / Q000502:physiology
D010281:Parathyroid Hormone; D012709:Serum Albumin; D014807:Vitamin D; C104450:25-hydroxyvitamin D; D003404:Creatinine; D002118:Calcium
25(OH)vitamin D; Bariatric surgery; Biliopancreatic diversion; Calcium; Gastric pouch; Parathyroid hormone; Surgical techniques