Biliopancreatic Limb Length in One Anastomosis Gastric Bypass: Which Is the Best?

Abstract

Background

The use of one anastomosis gastric bypass (OAGB) is rapidly spreading. Concerns about biliary reflux and malabsorption with consequent nutritional deficits exist, so studies on biliopancreatic limb (BPL) adequate length in OAGB are required to balance excess weight loss in percentage (% EWL), resolution of comorbidities, and nutritional deficit. The purpose was to evaluate, at 2 years after OAGB, the effects of BPL length on weight loss, resolution of comorbidity, and nutritional deficiencies in patients.

Methods

From January 2015 to January 2017, 180 patients were collected into three groups based BPL length: group A, 150 cm; group B, 180 cm; and group C, 200 cm. Aims were to compare %EWL, co-morbidity resolution rates, nutritional parameters, and morbidity/mortality in the three groups.

Results

The total number of patients was 180: 60 for each group. One hundred seventy-two (95%) patients attended the 1-year follow-up (group A = 58; group B = 58, group C = 56). One hundred fifty-seven (87%) patients attended the 2-year follow-up (group A = 52 (87%); group B = 53 (88%); group C = 52 (87%)). There was no statistically significant difference in %EWL, %TWL, T2DM, and hypertension resolution rates among the groups. About vitamin deficiency, differences were not statistically significant. Iron and ferritin deficiency rate were statistically significant only between A and C groups.

Conclusions

According to our evidence, standardization of BPL length shorter than 200 cm is suggested, potentially minimizing malnutrition-related outcomes. Our study seems to show that a BPL of 150–180 cm is safe and effective in terms of EWL and comorbidity improvement with low malnutrition effects even in BMI > 50.

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References

  1. 1.

    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg. 2017;27(9):2279–89.

    Article  CAS  Google Scholar 

  2. 2.

    Mahawar KK, Carr WRJ, Balupuri S, et al. Controversy surrounding ‘mini’ gastric bypass. Obs Surg. 2014;24(2):324–33.

    Article  Google Scholar 

  3. 3.

    Ahuja A, Tantia O, Goyal G, et al. MGB-OAGB: effect of biliopancreatic limb length on nutritional deficiency, Weight Loss, and Comorbidity Resolution. Obes Surg. 2018;28(11):3439–45.

    Article  Google Scholar 

  4. 4.

    Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.

    Article  Google Scholar 

  5. 5.

    Tacchino RM. Bowel length: measurement, predictors, and impact on bariatric and metabolic surgery. Surg Obes Relat Dis. 2015;11(2):328–34.

    Article  Google Scholar 

  6. 6.

    Sugerman HJ, Kellum JM, DeMaria EJ. Conversion of proximal to distal bypass for failed gastric bypass for superobesity. J Gastrointest Surg. 1997;1:517–26.

    Article  CAS  Google Scholar 

  7. 7.

    Rutledge R. The mini-gastric bypass: experience with the first 1, 274 cases. Obes Surg. 2001;11:276–80.

    Article  CAS  Google Scholar 

  8. 8.

    Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-y gastric bypass for obesity (YOMEGA): a multicenter, randomized, open-label, non-inferiority trial. Lancet. 2019;393(10178):1299–309.

    Article  Google Scholar 

  9. 9.

    Gero D, Raptis DA, Vleeschouwers W, et al. Defining global benchmarks in bariatric surgery: a retrospective multicenter analysis of minimally invasive Roux-en-Y gastric bypass and sleeve gastrectomy. Ann Surg. 2019;270(5):859–67.

    Article  Google Scholar 

  10. 10.

    Stefater MA, Wilson-Perez HE, Chambers AP, et al. All bariatric surgeries are not created equal: insights from mechanistic comparisons. Endocr Rev. 2012;33:595–622.

    Article  CAS  Google Scholar 

  11. 11.

    Bueter M, Ashrafian H, le Roux CW. Mechanisms of weight loss after gastric bypass and gastric banding. Obes Facts. 2009;2:325–31.

    Article  Google Scholar 

  12. 12.

    Saeidi N, Nestoridi E, Kucharczyk J, et al. Sleeve gastrectomy and Roux-en-Y gastric bypass exhibit differential effects on food preferences, nutrient absorption and energy expenditure in obese rats. Int J Obes. 2012;36:1396–402.

    Article  CAS  Google Scholar 

  13. 13.

    Karagul S, Kayaalp C, Kirmizi S, et al. Influence of repeated measurements on small bowel length. SpringerPlus [internet]. 2016; [cited 2018 Oct 10];5. Available from: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC5074942/

  14. 14.

    Mahawar KK, Parmar C, Carr WRJ, et al. Impact of biliopancreatic limb length on severe protein–calorie malnutrition requiring revisional surgery after one anastomosis (mini) gastric bypass. JMAS. 2018;14(1):37–43.

    PubMed  Google Scholar 

  15. 15.

    Genser L, Soprani A, Tabbara M, et al. Laparoscopic reversal of mini-gastric bypass to original anatomy for severe postoperative malnutrition. Langenbeck's Arch Surg. 2017;402:1263–70.

    Article  Google Scholar 

  16. 16.

    Kular KS, Manchanda N, Rutledge R, et al. A 6-year experience with 1,054 mini-gastric bypasses first study from Indian subcontinent. Obes Surg. 2014;24(9):1430–5.

    Article  CAS  Google Scholar 

  17. 17.

    Lee WJ, Lee YC, Ser KH, et al. Revisional surgery for laparoscopic minigastric bypass. Surg Obes Relat Dis Off J Am Soc Bariatric Surg. 2011;7(4):486–91.

    Article  Google Scholar 

  18. 18.

    Lee WJ, Lin YH. Single-anastomosis gastric bypass (SAGB): appraisal of clinical evidence. Obes Surg. 2014;24(10):1749–56.

    Article  Google Scholar 

  19. 19.

    McConnell DB, O’Rourke RW, Deveney CW. Common channel length predicts outcomes of biliopancreatic diversion alone and with the duodenal switch surgery. Am J Surg. 2005;189:536–40.

    Article  Google Scholar 

  20. 20.

    Magouliotis DE, Tasiopoulou VS, Tzovaras G. One anastomosis gastric bypass versus Roux-en-Y gastric bypass for morbid obesity: an updated meta-analysis. Obes Surg. 2019;29(9):2721–30.

    Article  Google Scholar 

  21. 21.

    Kessler Y, Adelson D, Mardy-Tilbor L, et al. Nutritional status following one anastomosis gastric bypass. Clin Nutr. 2019;

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Correspondence to Francesco Pizza.

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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.

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

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This observational monocentric study was conducted in a single hospital from January 2015 to January 2017 after obtaining approval from the institutional review boards and ethical committees. After explaining the study procedure, the techniques, the possible side effects, and outcome which may be favorable, an informed consent was obtained from each participant before surgery.

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Pizza, F., Lucido, F.S., D’Antonio, D. et al. Biliopancreatic Limb Length in One Anastomosis Gastric Bypass: Which Is the Best?. OBES SURG 30, 3685–3694 (2020). https://doi.org/10.1007/s11695-020-04687-x

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Keywords

  • One anastomosis gastric bypass
  • Obesity surgery
  • Malabsorption
  • Nutritional deficiencies