Obesity Surgery

, Volume 29, Issue 7, pp 2012–2021 | Cite as

Limb Length in Gastric Bypass in Super-Obese Patients—Importance of Length of Total Alimentary Small Bowel Tract

  • Kamran ShahEmail author
  • Bent Johnny Nergård
  • Morten Wang Fagerland
  • Hjörtur Gislason
Original Contributions



In super-obese patients, rates of weight loss failure and weight regain are high after RYGB. In order to improve weight loss, lengthening of the biliopancreatic limb is vital. In this study, efficacy and safety of two types of RYGB with 2-m BP-limb were assessed in improving weight loss and in the resolution of comorbidities compared with standard RYGB in a long-term follow-up.


This is a retrospective cohort analysis on 671 super-obese patients operated in a 10-year period. Patients were classified into three groups: (1) 155 patients; roux limb 150 cm, BP-limb 60 cm; (2) 230 patients; roux limb 60 cm, BP-limb 200 cm; and (3) 286 patients; roux limb 150 cm, BP-limb 200 cm. EWL, TWL, BMI, failure, weight regain, comorbidity resolution, nutritional status, and complications were assessed.


Total alimentary limb length was shortened with 60 cm in group 1 and with 200 cm in groups 2 and 3. EWL, BMI change, and TWL were higher in the 2-m BP-limb groups vs group 1. No differences in complication rates were found, except higher frequency of marginal ulcers in patients with a shorter roux limb. EWL failure was higher in group 1 (10.3%) vs the other groups (4.3%; 5.2%). Group 3 had significantly less weight regain (26.6%). Remission of comorbidities was higher in the 2-m BP-limb groups at expense of nutritional and vitamin deficiencies (3.9%; 5.9%). No difference in hypoalbuminemia was noted.


Lengthening of the BP-limb gives significantly higher weight loss, lower rate of EWL failure, and lesser weight regain along with better resolution of obesity-associated comorbidities.


Gastric bypass RYGB Limb length Super-obese Biliopancreatic Total alimentary small bowel tract 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


The authors have no commercial or financial associations that might be of conflict of interest in relation to this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Aleris Obesity Clinic and Department of SurgeryAleris HospitalOsloNorway
  2. 2.Oslo Centre for Biostatistics and Epidemiology, Research Support ServicesOslo University HospitalOsloNorway

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