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A short or a long Roux limb in gastric bypass surgery: does it matter?

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Abstract

Background

The Roux-en-Y gastric bypass (RYGB) still remains the gold standard in bariatric surgery. However, no consensus exists on the optimal limb lengths to induce maximum weight reduction. The aim of the present study was to assess the effect of a longer alimentary limb (AL) length on weight reduction after RYGB.

Methods

A retrospective analysis of a prospectively collected database of patients who underwent a primary laparoscopic RYGB between January 2001 and March 2011 was performed. Patients received a short AL (SAL; 100 cm) or a long AL (LAL; 150 cm). Primary outcome was weight loss, and secondary outcomes were short- and long-term complication rates.

Results

A total of 768 patients received a RYGB during the study period. Of these, 730 consecutive patients were included for long-term analysis and had a mean follow-up (FU) of 37 ± 26 [range 0–120] months; 360 (47 %) patients received a SAL RYGB. Overall %TBWL was 33 ± 9 % after 2 years (FU 74 %) and 28 ± 12 % after 5 years (FU 20 %). No significant differences in %TBWL were found between SAL RYGB and LAL RYGB during the study period. The 30-day mortality rate was 0.13, 9 % overall short-term complication rate and 19 % cumulative long-term complication rate. No differences in complications were found between SAL and LAL RYGB patients.

Conclusion

Lengthening of the alimentary limb from 100 to 150 cm did not affect post-RYGB weight loss. Overall complication rates were low and comparable in this series of RYGB patients.

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References

  1. Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N (2015) Bariatric surgery worldwide 2013. Obes Surg 25:1822–1832

    Article  CAS  PubMed  Google Scholar 

  2. Sjostrom L (2013) Review of the key results from the Swedish Obese Subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med 273:219–234

    Article  CAS  PubMed  Google Scholar 

  3. Brolin RE, Kenler HA, Gorman JH, Cody RP (1992) Long-limb gastric bypass in the superobese. A prospective randomized study. Ann Surg 215:387–395

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bruder SJ, Freeman JB, Brazeau-Gravelle P (1991) Lengthening the Roux-Y limb increases weight loss after gastric bypass: a preliminary report. Obes Surg 1:73–77

    Article  CAS  PubMed  Google Scholar 

  5. Brolin RE, LaMarca LB, Kenler HA, Cody RP (2002) Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg Off J Soc Surg Alimentary Tract 6:195–203 Discussion 204–195

    Article  Google Scholar 

  6. Choban PS, Flancbaum L (2002) The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial. Obes Surg 12:540–545

    Article  PubMed  Google Scholar 

  7. Ciovica R, Takata M, Vittinghoff E, Lin F, Posselt AM, Rabl C, Stein HJ, Campos GM (2008) The impact of Roux limb length on weight loss after gastric bypass. Obes Surg 18:5–10

    Article  PubMed  Google Scholar 

  8. Feng JJ, Gagner M, Pomp A, Korgaonkar NM, Jacob BP, Chu CA, Voellinger DC, Quinn T, Herron DM, Inabnet WB (2003) Effect of standard versus extended Roux limb length on weight loss outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Endosc 17:1055–1060

    Article  CAS  PubMed  Google Scholar 

  9. Gleysteen JJ (2009) Five-year outcome with gastric bypass: Roux limb length makes a difference. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 5:242–247 Discussion 247–249

    Article  Google Scholar 

  10. Inabnet WB, Quinn T, Gagner M, Urban M, Pomp A (2005) Laparoscopic Roux-en-Y gastric bypass in patients with BMI < 50: a prospective randomized trial comparing short and long limb lengths. Obes Surg 15:51–57

    Article  PubMed  Google Scholar 

  11. Lee S, Sahagian KG, Schriver JP (2006) Relationship between varying Roux limb lengths and weight loss in gastric bypass. Curr Surgery 63:259–263

    Article  Google Scholar 

  12. MacLean LD, Rhode BM, Nohr CW (2001) Long- or short-limb gastric bypass? J Gastrointest Surg Off J Soc Surg Alimentary Tract 5:525–530

    Article  CAS  Google Scholar 

  13. Murr MM, Balsiger BM, Kennedy FP, Mai JL, Sarr MG (1999) Malabsorptive procedures for severe obesity: comparison of pancreaticobiliary bypass and very very long limb Roux-en-Y gastric bypass. J Gastrointest Surg Off J Soc Surg Alimentary Tract 3:607–612

    Article  CAS  Google Scholar 

  14. Pinheiro JS, Schiavon CA, Pereira PB, Correa JL, Noujaim P, Cohen R (2008) Long-long limb Roux-en-Y gastric bypass is more efficacious in treatment of type 2 diabetes and lipid disorders in super-obese patients. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 4:521–525 Discussion 526–527

    Article  Google Scholar 

  15. Suter M, Donadini A, Romy S, Demartines N, Giusti V (2011) Laparoscopic Roux-en-Y gastric bypass: significant long-term weight loss, improvement of obesity-related comorbidities and quality of life. Ann Surg 254:267–273

    Article  PubMed  Google Scholar 

  16. Suter M, Paroz A, Calmes JM, Giusti V (2006) European experience with laparoscopic Roux-en-Y gastric bypass in 466 obese patients. Br J Surg 93:726–732

    Article  CAS  PubMed  Google Scholar 

  17. Freeman JB, Kotlarewsky M, Phoenix C (1997) Weight loss after extended gastric bypass. Obes Surg 7:337–344

    Article  CAS  PubMed  Google Scholar 

  18. Sarhan M, Choi JJ, Al Sawwaf M, Murtaza G, Getty JL, Ahmed L (2011) Is weight loss better sustained with long-limb gastric bypass in the super-obese? Obes Surg 21:1337–1343

    Article  PubMed  Google Scholar 

  19. Valezi AC, Marson AC, Merguizo RA, Costa FL (2014) Roux-en-Y gastric bypass: limb length and weight loss. Arquivos brasileiros de cirurgia digestiva: ABCD = Brazilian archives of digestive surgery 27(Suppl 1):56–58

  20. NIH conference (1991) Gastrointestinal surgery for severe obesity consensus development conference panel. Ann Intern Med 115:956–961

    Article  Google Scholar 

  21. Christou NV, Look D, Maclean LD (2006) Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg 244:734–740

    Article  PubMed  PubMed Central  Google Scholar 

  22. Higa K, Ho T, Tercero F, Yunus T, Boone KB (2011) Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surgery Obes Relat Dis Off J Am Soc Bariatr Surg 7:516–525

    Article  Google Scholar 

  23. Orci L, Chilcott M, Huber O (2011) Short versus long Roux-limb length in Roux-en-Y gastric bypass surgery for the treatment of morbid and super obesity: a systematic review of the literature. Obes Surg 21:797–804

    Article  PubMed  Google Scholar 

  24. van de Laar A, de Caluwe L, Dillemans B (2011) Relative outcome measures for bariatric surgery. Evidence against excess weight loss and excess body mass index loss from a series of laparoscopic Roux-en-Y gastric bypass patients. Obes Surg 21:763–767

    Article  PubMed  Google Scholar 

  25. Mahawar KK, Kumar P, Parmar C, Graham Y, Carr WR, Jennings N, Schroeder N, Balupuri S, Small PK (2016) Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg 26:660–671

    Article  PubMed  Google Scholar 

  26. Homan J, Betzel B, Aarts EO, Dogan K, van Laarhoven KJ, Janssen IM, Berends FJ (2015) Vitamin and mineral deficiencies after biliopancreatic diversion and biliopancreatic diversion with duodenal switch—the rule rather than the exception. Obes Surg 25:1626–1632

    Article  PubMed  Google Scholar 

  27. Sovik TT, Karlsson J, Aasheim ET, Fagerland MW, Bjorkman S, Engstrom M, Kristinsson J, Olbers T, Mala T (2013) Gastrointestinal function and eating behavior after gastric bypass and duodenal switch. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 9:641–647

    Article  Google Scholar 

  28. Homan J, Betzel B, Aarts EO, van Laarhoven KJ, Janssen IM, Berends FJ (2015) Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis Off J Am Soc Bariatr Surg 11:771–777

    Article  Google Scholar 

  29. Tran DD, Nwokeabia ID, Purnell S, Zafar SN, Ortega G, Hughes K, Fullum TM (2016) Revision of Roux-En-Y gastric bypass for weight regain: a systematic review of techniques and outcomes. Obes Surg 26:1627–1634

    Article  PubMed  Google Scholar 

  30. Kalarchian MA, Marcus MD, Courcoulas AP, Lutz C, Cheng Y, Sweeny G (2016) Structured dietary intervention to facilitate weight loss after bariatric surgery: a randomized, controlled pilot study. Obesity. doi:10.1002/oby.21591

    PubMed  Google Scholar 

  31. McGrice M, Don Paul K (2015) Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions. Diabetes, Metab Syndr Obes Targets Ther 8:263–274

    Article  Google Scholar 

  32. Montesi L, El Ghoch M, Brodosi L, Calugi S, Marchesini G, Dalle Grave R (2016) Long-term weight loss maintenance for obesity: a multidisciplinary approach. Diabetes, Metab Syndr Obes Targets Ther 9:37–46

    Google Scholar 

  33. Beckman LM, Beckman TR, Earthman CP (2010) Changes in gastrointestinal hormones and leptin after Roux-en-Y gastric bypass procedure: a review. J Am Diet Assoc 110:571–584

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Lee WJ, Ser KH, Lee YC, Tsou JJ, Chen SC, Chen JC (2012) Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg 22:1827–1834

    Article  PubMed  Google Scholar 

  35. Rubino F, Forgione A, Cummings DE, Vix M, Gnuli D, Mingrone G, Castagneto M, Marescaux J (2006) The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 244:741–749

    Article  PubMed  PubMed Central  Google Scholar 

  36. Rubino F, Gagner M, Gentileschi P, Kini S, Fukuyama S, Feng J, Diamond E (2004) The early effect of the Roux-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg 240:236–242

    Article  PubMed  PubMed Central  Google Scholar 

  37. Nergaard BJ, Leifsson BG, Hedenbro J, Gislason H (2014) Gastric bypass with long alimentary limb or long pancreato-biliary limb—long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg 24:1595–1602

    Article  PubMed  PubMed Central  Google Scholar 

  38. Peterli R, Steinert RE, Woelnerhanssen B, Peters T, Christoffel-Courtin C, Gass M, Kern B, von Fluee M, Beglinger C (2012) Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg 22:740–748

    Article  PubMed  PubMed Central  Google Scholar 

  39. Leifsson BG, Gislason HG (2005) Laparoscopic Roux-en-Y gastric bypass with 2-m long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients. Obes Surg 15:35–42

    Article  PubMed  Google Scholar 

  40. Sanchez-Santos R, Estevez S, Tome C, Gonzalez S, Brox A, Nicolas R, Crego R, Pinon M, Masdevall C, Torres A (2012) Training programs influence in the learning curve of laparoscopic gastric bypass for morbid obesity: a systematic review. Obes Surg 22:34–41

    Article  PubMed  Google Scholar 

  41. Dallal RM, Trang A (2012) Analysis of perioperative outcomes, length of hospital stay, and readmission rate after gastric bypass. Surg Endosc 26:754–758

    Article  PubMed  Google Scholar 

  42. Lancaster RT, Hutter MM (2008) Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc 22:2554–2563

    Article  PubMed  Google Scholar 

  43. Aghajani E, Jacobsen HJ, Nergaard BJ, Hedenbro JL, Leifson BG, Gislason H (2012) Internal hernia after gastric bypass: a new and simplified technique for laparoscopic primary closure of the mesenteric defects. J Gastrointest Surg Off J Soc Surg Alimentary Tract 16:641–645

    Article  Google Scholar 

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Acknowledgments

We would like to thank N. Ploeger (MANP) for collecting the prospective data.

Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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Authors and Affiliations

  1. Department of Surgery, Rijnstate Hospital, Postal Number 1190, PO box 9555, 6800 TA, Arnhem, The Netherlands

    Kemal Dogan, Jens Homan, Edo O. Aarts, Ignace M. C. Janssen & Frits J. Berends

  2. Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands

    Cees J. H. M. van Laarhoven

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  1. Kemal Dogan
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  2. Jens Homan
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Correspondence to Kemal Dogan.

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Disclosures

Drs. Kemal Dogan, Drs. Jens Homan, Dr. Edo Aarts, Prof. Dr. Cees van Laarhoven, Drs. Ignace Janssen, and Dr. Frits Berends have no conflicts of interest or financial ties to disclose.

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Dogan, K., Homan, J., Aarts, E.O. et al. A short or a long Roux limb in gastric bypass surgery: does it matter?. Surg Endosc 31, 1882–1890 (2017). https://doi.org/10.1007/s00464-016-5188-z

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  • DOI: https://doi.org/10.1007/s00464-016-5188-z

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