The importance of the biliopancreatic limb length in gastric bypass: A systematic review

Zorrilla-Nunez, Luis F.; Campbell, Anthony; Giambartolomei, Giulio; Menzo, Emanuele Lo; Szomstein, Samuel; Rosenthal, Raúl J.

doi:10.1016/j.soard.2018.10.013

Cited by 60 publications

(41 citation statements)

References 38 publications

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“…However, recent study suggests that pouch size does not play a critical role in weight regain unless the pouch is very large [33]. There is also a growing evidence suggesting that the differences in the total alimentary limb length (TALL) and the length of the biliopancreatic (BPL) could play a role [34,35]. At the time of the current study, the standard procedure at our institution was RYGB performed without consideration of total bowel length and TALL (a point seen today as a shortcoming).…”

Section: Discussionmentioning

confidence: 99%

Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?

et al. 2019

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Background Revisional gastric bypass (R-RYGB) surgery is utilized for the management of inadequate weight loss or weight regain observed after some cases of bariatric surgeries. Data on the mid-term effectiveness of primary gastric bypass (P-RYGB) compared with R-RYGB (e.g., post sleeve gastrectomy/gastric banding) are controversial. Methods Retrospective chart review of all patients who received P-RYGB and R-RYGB (January 2011-June 2015) at our center. One hundred twenty patients who underwent P-RYGB and 34 R-RYGB who completed 18 months follow-up were included. We compared the effectiveness of P-RYGB with R-RYGB by assessing four anthropometric, two glycemic, and four lipid parameters, as well as the control of type 2 diabetes (T2DM), hypertension, dyslipidemia (remission, improvement, persistence, relapse, de novo), mortality and complications rates. Results A comparison of the effectiveness of P-RYGB with R-RYGB at 18 months revealed no significant differences in patients' age, gender, and preoperative BMI between groups. However, patients who received P-RYGB had lower mean weight (P = 0.001) and BMI (P < 0.001), reflected by a higher mean delta BMI (P = 0.02), total weight loss percentage (TWL%) (P < 0.0001) and excess weight loss percentage (EWL%) (P < 0.0001). No differences in glycemic parameters, lipid profiles, control of T2DM, hypertension, and dyslipidemia were observed. No death is reported and complication rates were comparable. Conclusions Although R-RYGB effectively addressed inadequate weight loss, weight regain, and recurrence of comorbidities after restrictive bariatric surgery, R-RYGB resulted in inferior weight loss compared with P-RYGB. Neither procedure differed in their clinical control of T2DM, hypertension, and dyslipidemia. Both procedures exhibited comparable complication rates.

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Section: Discussionmentioning

confidence: 99%

Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?

et al. 2019

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“…The hormonal secretion profile of LBPL-GB patients is characterized by an increase during fast and postprandial GLP-1, together with a decrease in insulin, compared with S-GB [4]. Several mechanisms have been proposed: (1) food going to the ileum could affect tolerance itself and, thus, a change alimentary behavior; (2) Creating a BPL of 200 cm influences more (or at least differently influences) hormonal and immunological factors; and (3) limb lengthening creates a shorter common channel, mimicking malabsorptive effects of surgeries like SADI or duodenal switch [4,5,15]. A recent study in rodents concluded that longer BPL leads to Roux limb hypertrophy, less glucose absorption but greater utilization, and sustained high incretin levels.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies about limb lengths and the attempt to achieve greater outcomes exist; however, heterogeneity prevails as 3 limbs can be manipulated (alimentary, biliopancreatic, and common), apart from different combinations and anatomical variants [4]. Some observational (and some prospective) studies have revealed better weight loss with longer biliopancreatic limbs (BPLS), even with different common channel lengths; nevertheless, randomized clinical trials are scarce [5]. Because there is a higher risk of nutritional complications, an equilibrium between surgical "aggressiveness" and safety should be established.…”

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confidence: 99%

Long versus short biliopancreatic limb in Roux-en-Y gastric bypass: short-term results of a randomized clinical trial

Zerrweck

Herrera

Sepúlveda

et al. 2021

Surgery for Obesity and Related Diseases

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“…Відомі численні спроби встановити "ідеальну" довжину біліопанкреатичної петлі, спираючись на баланс між втратою надлишку маси тіла, компенсацією супутніх метаболічних порушень та нутритивною недостатністю [2,16,34].…”

Section: вступunclassified

Effect of biliopancreatic loop length mini gastric bypass on metabolic disorders resolution and nutritional deficiency

Tyvonchyk

Moskalenko

Vinogradov

2019

Rep. of Vinnytsia Nation. Med. Univ.

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Recently, the International Federation of Obesity Surgery (IFSO) has recognized gastric bypass surgery as one of the major bariatric / metabolic surgeries. However, the issue of nutritional deficiency after mini-shunting, which leads to repeated surgical interventions for deficient states, remains debatable. Efforts to balance the loss of excess body weight, compensation for concomitant metabolic disorders and nutritional insufficiency make the issue of the “ideal” length of the biopancreatic loop relevant. Therefore, the purpose of the study was to compare the bariatric and metabolic effects of mini-shunting of the stomach depending on the length of the biliary pancreatic loop. The study included 42 patients (24 women (57.1%) and 18 men (42.9%)), aged 24 to 65 years, with a body mass index (BMI) of 40 kg / m2 and above, with a mini-gastric bypass with minimally invasive access. The operation consisted of forming a long gastric reservoir along the small curvature of the stomach with the imposition of a semi-manual anastomosis with a loop of the small intestine 200–250 cm from the ligament of the Trinity. The length of the biopancreatic loop was selected according to the body mass index (200 cm — <45 kg / m2 (23 patients), 250+ cm — ˃45 kg / m2 (15 patients)) and the nature of the concomitant metabolic disorders. Anthropometric, laboratory and instrumental research methods were used. The level of HbA1c and the level of triglycerides were determined. The results were evaluated at 1, 3, 6, 9 and 12 months after surgery. Statistical processing of data was performed using StatPlus 6 Profesional. Postoperative complications were diagnosed in 3 (7.2%) patients. An early complication of Twisted pouch, which required repeated surgery, was observed in 1 (2.4%) patient. Late complications (peptic ulcer of gastroenteroanastomosis and insufficient weight loss) were found in 2 (4.8%) patients. The average percentage of excess body weight loss in the 200 cm and 250 cm group was 70.1 ± 0.8% and 71.8 ± 0.6% (p>0.05), respectively; type 2 diabetes mellitus was diagnosed in 5 (83.3%) and 7 (87.5%) patients, respectively; dyslipidemia compensation was achieved in 3 (50%) and 5 (71.4%) patients, respectively; hypocalcaemia was detected in 1 (12.5%) and 3 (27.3%) patients, respectively; decreased levels of iron were diagnosed in 1 (12.5%) and 2 (18.2%) patients, respectively. Thus, the results obtained indicate that as the length of the loop increases, the metabolic effect increases, but the risk of electrolyte exchange disorders may increase.

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The importance of the biliopancreatic limb length in gastric bypass: A systematic review

Cited by 60 publications

References 38 publications

Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?

Is Revisional Gastric Bypass as Effective as Primary Gastric Bypass for Weight Loss and Improvement of Comorbidities?

Long versus short biliopancreatic limb in Roux-en-Y gastric bypass: short-term results of a randomized clinical trial

Effect of biliopancreatic loop length mini gastric bypass on metabolic disorders resolution and nutritional deficiency

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