The Influence of Different Alimentary and Biliopancreatic Limb Lengths in Gastric Bypass Patients

• Published in: Obesity surgery Vol. 31; no. 2; pp. 481 - 489
• Main Authors: Smelt, H. J. M., Van Rijn, S., Pouwels, S., Aarts, M. P. W., Smulders, J. F.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2021; Springer Nature B.V
• Subjects: Avitaminosis; Biliopancreatic Diversion - adverse effects; Body Mass Index; Comparative studies; Gastric Bypass - adverse effects; Gastrointestinal surgery; Humans; Medicine; Medicine & Public Health; Obesity, Morbid - surgery; Original Contributions; Patients; Retrospective Studies; Small intestine; Surgery; Surgical outcomes; Vitamin deficiency; Weight control; Weight Loss; Excess weight loss; Biliopancreatic limb; Gastric bypass; Weight loss; Malabsorption; Alimentary limb; Total weight loss
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-020-05028-8

Purpose
The aim of this study was to compare the effect of two different limb lengths after RYGB on weight loss, postoperative gastro-intestinal complications, and vitamin deficiencies.
Materials and Methods
A retrospective analyses of 100 patients after RYGB with 2 different limb lengths were done. Group A (50 patients) had a biliopancreatic limb (BPL) of 75 cm and an alimentary limb (AL) of 150 cm. Group B (50 patients) had a BPL of 150 cm and an AL of 75 cm. The effect on weight loss, body mass index, excess weight loss (EWL), total weight loss (TWL), and postoperative complications was analyzed up to 2 years postoperatively.
Results
Patients with a longer BPL achieved significantly more %EWL compared to a shorter BPL 2 years postoperatively (82.8 ± 31.2 versus 93.8 ± 15.1;
p
 = 0.038). A significant difference was also seen in %TWL after 1 year (30.3 ± 10.1 versus 37.4 ± 6.9;
p
< 0.01) and 2 years (31.6 ± 7.5 versus 35.6 ± 8.6;
p
 = 0.022), both in favor of group B. However, patients with a longer BPL (group B) showed significant more diarrhea and steatorrhea compared to group A (
p
< 0.01).
Conclusion
BPL of 150 cm is associated with more %EWL and %TWL 2 years after RYGB. However, it is accompanied by an increase of diarrhea and steatorrhea to disadvantage off group B. Future studies need to focus on further tailoring BPL and AL lengths to achieve the best possible outcomes for patients with morbid obesity.