The role of total alimentary limb length in Roux-en-Y gastric bypass: a systematic review

Wang, Alice; Poliakin, Lauren; Sundaresan, Naresh; Vijayanagar, Vilok; Abdurakhmanov, Alexander; Thompson, Kyle J.; McKillop, Iain H.; Barbat, Selwan; Bauman, Roc; Gersin, Keith S.; Kuwada, Timothy S.; Nimeri, Abdelrahman

doi:10.1016/j.soard.2021.08.022

Cited by 25 publications

(5 citation statements)

References 44 publications

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“…Our experience of OAGB with a constant biliary loop of 150 cm in patients with BMI > 50 showed results comparable to those published by Eskandaros [2]. It has been demonstrated that the increase of the biliary loop dangerously increases the risk of malnutrition by decreasing the total alimentary limb length (TALL) [3,4]. Our experience with 106 patients who underwent single anastomosis duodeno-ileal bypass (SADI) showed, on the one hand, the systematic manipulation of the whole intestine starting from the cecum can be responsible for iatrogenic perforation and, on the other hand, despite a short common intestinal loop, the results on weight loss can be disappointing [5].…”

supporting

confidence: 84%

One Anastomosis Gastric Bypass: Weight Loss Results Are Not a Function of the Biliary Limb Length!

Liagre

Martini

2022

OBES SURG

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supporting

confidence: 84%

One Anastomosis Gastric Bypass: Weight Loss Results Are Not a Function of the Biliary Limb Length!

Liagre

Martini

2022

OBES SURG

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“…Endoscopic BD in the case of Roux-en-Y reconstruction is usually challenging considering the length of the afferent limb usually does not allow papilla or bilio-digestive anastomosis identification with standard endoscopes [ 19 ]. However, the length of the afferent limb is extremely variable and usually not known by the endoscopist [ 20 ]. This is probably the reason why almost one third of the participant centers declared that they try, as a first attempt, BD with a forward-viewing scope such as pediatric colonoscope or short enteroscope in order to try to reach the papilla.…”

Section: Discussionmentioning

confidence: 99%

Italian Survey on Endoscopic Biliary Drainage Approach in Patients with Surgically Altered Anatomy

Mauro,

Binda,

Fugazza

et al. 2024

Medicina

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Background and Objectives: Biliary drainage (BD) in patients with surgically altered anatomy (SAA) could be obtained endoscopically with different techniques or with a percutaneous approach. Every endoscopic technique could be challenging and not clearly superior over another. The aim of this survey is to explore which is the standard BD approach in patients with SAA. Materials and Methods: A 34-question online survey was sent to different Italian tertiary and non-tertiary endoscopic centers performing interventional biliopancreatic endoscopy. The core of the survey was focused on the first-line and alternative BD approaches to SAA patients with benign or malignant obstruction. Results: Out of 70 centers, 39 answered the survey (response rate: 56%). Only 48.7% of them declared themselves to be reference centers for endoscopic BD in SAA. The total number of procedures performed per year is usually low, especially in non-tertiary centers; however, they have a low tendency to refer to more experienced centers. In the case of Billroth-II reconstruction, the majority of centers declared that they use a duodenoscope or forward-viewing scope in both benign and malignant diseases as a first approach. However, in the case of failure, the BD approach becomes extremely heterogeneous among centers without any technique prevailing over the others. Interestingly, in the case of Roux-en-Y, a significant proportion of centers declared that they choose the percutaneous approach in both benign (35.1%) and malignant obstruction (32.4%) as a first option. In the case of a previous failed attempt at BD in Roux-en-Y, the subsequent most used approach is the EUS-guided intervention in both benign and malignant indications. Conclusions: This survey shows that the endoscopic BD approach is extremely heterogeneous, especially in patients with Roux-en-Y reconstruction or after ERCP failure in Billroth-II reconstruction. Percutaneous BD is still taken into account by a significant proportion of centers in the case of Roux-en-Y anatomy. The total number of endoscopic BD procedures performed in non-tertiary centers is usually low, but this result does not correspond to an adequate rate of referral to more experienced centers.

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“…This can be achieved by measuring the bowel length and ensuring adequate bowel length for nutrient absorption. A total alimentary limb (the sum of Roux limb and common channel) of more than four to five meters is adequate to avoid malnutrition [79].…”

Section: Bowel Length Adjustmentsmentioning

confidence: 99%

Revisional Bariatric Surgery

Alqahtani¹,

Almayouf²

2023

Bariatric Surgery - Past and Present

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Metabolic surgery is considered a valuable tool in treating obesity compared to the non-surgical approach. Its effectiveness is evident in the form of weight loss, eliminating obesity-related comorbidities, and improving quality of life. Hence, the rate of metabolic surgery conducted worldwide has risen dramatically, parallel to the increasing rates of obesity. Unfortunately, there are drawbacks to metabolic surgeries. Weight regain/insufficient weight loss is feared by the patient and bariatric surgeon and can occur with nonadherence to a healthy lifestyle and dietary habits. Long-term complications related to metabolic surgery are possible following any metabolic surgery (e.g., chronic reflux, malnutrition, and fistula). Revisional surgery is the most effective approach to combat these drawbacks, and therefore a bariatric surgeon should be familiar with it. This chapter will discuss the indication of revisional surgery, the preoperative workup, the surgical techniques, and the outcome of revisional surgery. The chapter will focus on the most commonly performed metabolic surgery, that is, laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic one anastomosis gastric bypass. By the end of this chapter, the reader will be able to: (1) Define metabolic surgery failure and indications of the revision. (2) Be able to approach the patient preoperatively and formulate a plan. (3) Be knowledgeable about the main operative steps. (4) Be aware of the predicted outcome of revisional surgery.

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The role of total alimentary limb length in Roux-en-Y gastric bypass: a systematic review

Cited by 25 publications

References 44 publications

One Anastomosis Gastric Bypass: Weight Loss Results Are Not a Function of the Biliary Limb Length!

One Anastomosis Gastric Bypass: Weight Loss Results Are Not a Function of the Biliary Limb Length!

Italian Survey on Endoscopic Biliary Drainage Approach in Patients with Surgically Altered Anatomy

Revisional Bariatric Surgery

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