Biliopancreatic Diversion Shows Durable Weight Loss but High Long-Term Morbidity

Bariatric surgery remains the most effective clinical intervention for achieving sustained weight loss and the remission of metabolic comorbidities in patients with severe obesity [1, 2, 3, 4]. While Roux-en-Y gastric bypass and sleeve gastrectomy are widely utilized, hypoabsorptive techniques like biliopancreatic diversion often result in greater weight reduction, with meta-analytic data showing a 7.31 kg/m² higher loss in body mass index compared to gastric bypass [5, 6]. However, these profound physiological alterations carry a significant risk of chronic micronutrient deficiencies, including zinc deficiency in 26.1% of patients alongside the depletion of copper and fat-soluble vitamins [7, 8, 5]. Despite established mid-term efficacy, clinical data regarding safety and all-cause mortality beyond the second postoperative decade remain scarce, although the Swedish Obese Subjects trial reported an adjusted hazard ratio of 0.71 for overall mortality at 20 years [9, 10]. To address this knowledge gap, researchers now provide a 50-year perspective on the original cohort of 85 patients who underwent biliopancreatic diversion, offering critical insights into the lifelong consequences of surgically induced malabsorption [9].