Roux-en-Y gastric bypass: limb length and weight loss

Abstract

BackgroundRoux-en-Y gastric bypass is a surgical technique widely used in the treatment of obesity. It is unclear, however, if the length of the biliopancreatic and alimentary limb interferes with the magnitude of weight loss.AimTo evaluate if the length of these limbs is related to the percentage of weight loss one year after surgery.MethodOne hundred and twenty obese people underwent surgery between 2009 and 2011. Patients were inserted into four groups: A) biliopancreatic limb with 50 cm length and alimentary limb with100 cm length; B) biliopancreatic limb with 50 cm length and alimentary limb with 150 cm length; C) biliopancreatic limb with 100 cm length and alimentary limb with100 cm length; D) biliopancreatic limb with 100 cm length and alimentary limb with150 cm length. Age, gender, body mass index and the percentage of total weight loss were analyzed. Data were collected preoperatively and one year after surgery. The groups were compared and weight loss compared between groups.ResultsThe follow-up occurred in 78.3% of the sample. The composition of the groups was similar, with no statistical significance. The average age was 43 years in groups A, C and D and 42 years in group B. The female gender predominated in all groups (about 60% of the sample). The mean body mass index was 46 kg/m2 for groups A, C and D and 42 kg/m2 in group B. The percentage of weight loss was 33% for group A and 34% for groups B, C and D. There was no significant difference among groups.ConclusionDifferent lengths of the biliopancreatic and alimentary limbs did not affect the percentage of total weight loss.

The role of alimentary and biliopancreatic limb length in outcomes of Roux-en-Y gastric bypass.

“…Despite the invention of new bariatric surgical procedures, RYGB has been considered as a gold standard procedure which is malabsorptive and restrictive [10,15]. The impact of BPL and AL lengths on RYGB outcomes is still controversial regarding appropriate limb lengths [6,8,10,11,[15][16][17][18], de-spite the established relationship between patients' height and total small bowel length [15].…”

“…The role of alimentary and biliopancreatic limb length in outcomes of Roux-en-Y gastric bypass limb (AL) length on the outcomes of RYGB patients [6][7][8][9][10][11], and there is not yet any consensus on the appropriate length of the BPL, AL, and common limb. Previous studies have reported contradictory results in efficacy of these limb lengths to achieve the best results in weight loss outcomes and the prevention of nutritional complications.…”

MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass

“…In the current form of the RYGB (Fig. 1A), a gastric sleeve pouch is created of approximately 20-30 mL volume using a 36-42 French bougie with an alimentary limb of approximately 120-150 cm in length and a biliary limb of approximately 50-100 cm in length, depending on the individual technique (86). Both gastrojejunal and jejuno-jenunal anastomosis can be created using stapler devices and sutures.…”

The influence of total bowel length on gastric bypass outcomes

“…Many studiesconcur that the CL length and AL length do not affect the amount of potential weight loss that a patient can achieve [25][26][27][28] though Tran et al [29] has suggested the use of a distal bypass is an effective revision for a failed loss of weight on a standard bypass. There is certainly a range of results on whether proximal or distal bypasses have more pronounced effects on the metabolic and endocrine systems as reported by Risstad et al [9] and Ramos et al [30] Distal bypasses may also be related to increased rates of complication.…”