A short or a long Roux limb in gastric bypass surgery: does it matter?
- 566 Downloads
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.
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.
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.
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.
KeywordsMorbid obesity Roux-en-Y gastric bypass Laparoscopy Weight loss Complication Alimentary limb
We would like to thank N. Ploeger (MANP) for collecting the prospective data.
This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.
Compliance with ethical standards
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.
- 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 CrossRefGoogle 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):56–58Google 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 9:37–46Google 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 244:741–749CrossRefPubMedPubMedCentralGoogle 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 22:740–748CrossRefPubMedPubMedCentralGoogle Scholar