Obesity Surgery

, Volume 28, Issue 12, pp 3744–3755 | Cite as

A Longer Biliopancreatic Limb in Roux-en-Y Gastric Bypass Improves Weight Loss in the First Years After Surgery: Results of a Randomized Controlled Trial

  • Jens Homan
  • Abel Boerboom
  • Edo Aarts
  • Kemal Dogan
  • Cees van Laarhoven
  • Ignace Janssen
  • Frits Berends
Original Contributions



Despite the fact that the RYGB is performed on a broad scale worldwide as a reliable treatment for morbid obesity, there is no uniform technique for this operation. A number of studies have tried to demonstrate an additional weight loss effect by lengthening the alimentary limb, but to no avail. At this moment in time, the role of the biliopancreatic limb on weight loss is for the greater part unknown. The aim of this randomized controlled trial was to compare the effect on weight loss of a long biliopancreatic limb Roux-en-Y gastric bypass (LBP-GB) with a standard RYGB (S-GB).


A LBP-GB (BPL 150 cm, alimentary limb 75 cm) was compared with a S-GB (BPL 75 cm, alimentary limb 150 cm). One hundred forty-six patients were randomized in two groups. Weight loss, morbidity, reduction of comorbidities, nutritional status, and quality of life were measured during a period of 4 years.


Patient characteristics were comparable in both groups. Mean EWL in the LBP-GB group after 12, 24, 36, and 48 months was 81, 85, 78, and 72% respectively versus 71, 73, 68, and 64% in the S-GB group. The %EWL difference between groups was significant as soon as 9 months postoperatively and continued throughout the follow-up period.


While LBP-GB achieved a significant increase in %EWL in the first years after surgery, no difference in long-term %TWL was observed after 4 years. In this study, the advantage of LBP-GB with respect to weight loss is modest, but shows promising gripping points for future improvements in RYGB design.


Morbid obesity Bariatric surgery Roux-en-Y gastric bypass Long biliopancreatic limb Weight loss 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

The study protocol was reviewed and approved by the Central Medical Committee for Research in humans in Nijmegen, the Netherlands (CMO). The study was registered at the clinical trials registry of (NCT 01686997). This study was in accordance with the Declaration of Helsinki (originally adopted in 1964, with the last amendment before this trial in October 2008).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jens Homan
    • 1
  • Abel Boerboom
    • 1
  • Edo Aarts
    • 1
  • Kemal Dogan
    • 1
  • Cees van Laarhoven
    • 2
  • Ignace Janssen
    • 1
  • Frits Berends
    • 1
  1. 1.Department of SurgeryRijnstate HospitalArnhemThe Netherlands
  2. 2.Department of SurgeryRadboud University Medical CentreNijmegenThe Netherlands

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