Background

The vertical sleeve gastrectomy (VSG) currently accounts for almost 60% of all bariatric surgeries in the US. Unfortunately, more than 50% of patients experience some degree of weight recidivism. The biliopancreatic diversion with duodenal switch (BPD-DS) is a highly malabsorptive procedure with better long-term weight loss. It isn’t clear if patients have greater vitamin deficiencies.

Methods

18 patients underwent elective laparoscopic revisions of VSG to BPD-DS. Electronic health records were reviewed retrospectively. Postoperative nutrition labs were performed that included vitamin A, D, E, K, thiamine, folate, B12, ferritin, PTH, copper, zinc and selenium levels. Weight and comorbidity data were also collected.

Results

No mortalities were seen. One patient experienced an upper gastrointestinal bleed that was managed non-operatively. Mean initial BMI was 45.78 kg/m2. Mean BMI change was 9.1 kg/m2 at 6 months and 13.2 kg/m2 at one year. Mean excess weight loss was 68% at one year. Follow-up varied between 6 and 36 months. Mean albumin levels at 12 months were 3.8 g/dL and 3.5 at 18 months. Four patients had vitamin D deficiencies and one patient had vitamin A deficiency at 1 year. Iron deficiencies were seen in 5 patients at one year postoperatively.

Conclusions

Conversion of VSG to BPD-DS is a reliable option to treat patients with obesity. Complications were minimal. Vitamin deficiencies were mild and treated with oral supplements. Thorough preoperative education along with intensive nutritional and psychological counseling will be crucial to ensure success.