Obesity Surgery

, Volume 26, Issue 3, pp 660–671 | Cite as

Small Bowel Limb Lengths and Roux-en-Y Gastric Bypass: a Systematic Review

  • Kamal K. MahawarEmail author
  • Parveen Kumar
  • Chetan Parmar
  • Yitka Graham
  • William R. J. Carr
  • Neil Jennings
  • Norbert Schroeder
  • Shlok Balupuri
  • Peter K. Small
Review Article


There is currently no consensus on the combined length of small bowel that should be bypassed as biliopancreatic or alimentary limb for optimum results with Roux-en-Y gastric bypass. A number of different limb lengths exist, and there is significant variation in practice amongst surgeons. Inevitably, this means that some patients have too much small bowel bypassed and end up with malnutrition and others end up with a less effective operation. Lack of standardisation poses further problems with interpretation and comparison of scientific literature. This systematic review concludes that a range of 100–200 cm for combined length of biliopancreatic or alimentary limb gives optimum results with Roux-en-Y gastric bypass in most patients.


Bariatric surgery Gastric bypass Small bowel limb length Biliopancreatic limb Alimentary limb Roux limb Roux-en-Y gastric bypass Small bowel length Obesity 



Total small bowel length


Roux-en-Y gastric bypass




Alimentary limb


Common limb


National Bariatric Surgery Registry


United Kingdom


Body mass index


Small bowel length


Preferred Reporting Items for Systematic Reviews and Meta-Analyses


Excess weight loss


Distal gastric bypass


Proximal gastric bypass


Biliopancreatic limb-based distal gastric bypass


Alimentary limb-based distal gastric bypass


Extended limb proximal gastric bypass


Standard proximal gastric bypass


Short limb proximal gastric bypass


Total parenteral nutrition


Author Contributions

KM conceived the idea for the topic. KM and PK independently collected information and analysed it. All authors participated in departmental discussion on the topic and manuscript writing. All authors have seen the final version and approve of it.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Human and Animal Rights

Not applicable.

Statement of Informed Consent

Not applicable.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Kamal K. Mahawar
    • 1
    Email author
  • Parveen Kumar
    • 2
  • Chetan Parmar
    • 1
  • Yitka Graham
    • 1
    • 3
  • William R. J. Carr
    • 1
  • Neil Jennings
    • 1
  • Norbert Schroeder
    • 1
  • Shlok Balupuri
    • 1
  • Peter K. Small
    • 1
  1. 1.Bariatric UnitSunderland Royal HospitalSunderlandUK
  2. 2.Department of General SurgerySir Charles Gairdner HospitalNedlandsAustralia
  3. 3.Department of Pharmacy, Health and Well-BeingUniversity of SunderlandSunderlandUK

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