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Gastric By-pass with Fixed 230-cm-Long Common Limb and Variable Alimentary and Biliopancreatic Limbs in Morbid Obesity

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Abstract

Background

Morbid obesity is a disease of increasing prevalence. Diet and exercise are not effective for excess weight loss (EWL) in most patients; therefore, different bariatric surgery procedures based in restriction or malabsorption, or a combination of both, i.e., the Roux-en-Y gastric by-pass (RYGBP) hybrid operation, have been established. Here, we report the outcome of a modified RYGBP operation in 565 obese patients.

Methods

Our modified RYGBP operation consisted of a pouch smaller than 25 cc, a fixed common limb of 230 cm, and the rest of the small bowel redistributed among the alimentary channel (60%) and the biliopancreatic channel (40%).

Results

A large variation in the whole length of small bowel was observed (380–820 cm). EWL was gradually increasing from month 1 after surgery (20.1%) to month 12 (70.1%); this value was maintained in the 2–8-year follow-up period. No differences in fecal protein and carbohydrate loss, before and after surgery, were seen; in contrast, three- to tenfold-higher lipid loss was produced after surgery. Long-term complications were scarce (28 patients with chronic anemia, 3 patients with flatulence, and 8 patients with mild diarrhea).

Conclusions

Gastric pouch smaller than 25 cc and measurement of the entire small bowel length during RYGBP surgery, leaving a 230-cm length of common limb and redistributing the remaining 60% in the alimentary channel and 40% in the biliopancreatic channel produced sustained EWL with few secondary nutrient deficits along an 8-year follow-up period.

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Acknowledgment

We thank the help of Dr. Antonio M. G de Diego for statistical analysis and critically reviewing the manuscript.

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Authors and Affiliations

  1. Hospital de Yecla General surgery Hospital Mesa del Castillo Obesity Surgery Unit, Circular, 9, 30.008, Murcia, Spain

    José Hernández-Martínez

  2. Hospital de Basurto, Bilbao, Spain

    Miguel Ángel Calvo-Ros

Authors
  1. José Hernández-Martínez
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  2. Miguel Ángel Calvo-Ros
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Correspondence to José Hernández-Martínez.

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Hernández-Martínez, J., Calvo-Ros, M.Á. Gastric By-pass with Fixed 230-cm-Long Common Limb and Variable Alimentary and Biliopancreatic Limbs in Morbid Obesity. OBES SURG 21, 1879–1886 (2011). https://doi.org/10.1007/s11695-011-0432-z

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