Skip to main content

Long-Term Outcome of Proximal Versus Very-Very Long Limb Roux-en-Y Gastric Bypass: the Roux-Limb to Common Channel Ratio Determines the Long-Term Weight Loss

Abstract

Background

The influence of the Roux limb (RL) length on weight loss in Roux-en-Y (RYGB)-type gastric bypass procedures is still unclear. This study analyzes the true impact of RL length by comparing the long-term outcomes of proximal RYGB (PRYGB) and very-very long limb RYGB (VVLL-RYGB).

Methods

RL length in PRYGB was 150 cm. In VVLL-RYGB, common channel length was 100 cm. In both groups, biliopancreatic limbs measured 50–60 cm, resulting in equal total alimentary limb lengths. To adjust for pre-operative differences between groups, and to predict the long-term outcome, a mixed model analysis was performed.

Results

Two hundred thirty-two patients with VVLL-RYGB (73.7% female, mean age 41.1 ± 10 years, initial BMI 45.8 ± 6.3 kg/m2) and 223 with PRYGB (83.9% female, mean age 38.5 ± 11 years, initial BMI 42.9 ± 4.9 kg/m2) were included. Mean follow-up was 9.4 ± 4 years in VVLL-RYGB and 5.3 ± 1.9 years in PRYGB. After 5 years, mean BMI reduction was 15.7 ± 5.9 kg/m2 in VVLL-RYGB and 11.9 ± 4.1 kg/m2 in PRYGB (p < 0.001), and mean %EWL was 78.3 ± 23.1% and 70.2 ± 23.7% (p = 0.002) with a follow-up rate of 78% and 75.9%, respectively. The mixed model analysis showed a significantly higher weight rebound after PRYGB.

Frequency of revisional surgery (i.e., limb length alteration, pouch banding) was similar between VVLL-RYGB and PRYGB (25 vs. 29 revisions, p = 0.463).

Conclusion

The VVLL-RYGB has a significantly higher long-term BMI reduction and a significantly lower weight rebound. The length of the Roux limb significantly influences long-term outcome.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. 1.

    Welbourn R, Hollyman M, Kinsman R, et al. Bariatric surgery worldwide : baseline demographic description and one-year outcomes from the fourth IFSO global registry report. Obes Surg. 2018;2019:782–95.

    Google Scholar 

  2. 2.

    Obeid NR, Malick W, Concors SJ, et al. Long-term outcomes after Roux-en-Y gastric bypass : 10- to 13-year data. Surg Obes Relat Dis. Elsevier. 2016;12:11–22.

    Article  Google Scholar 

  3. 3.

    Edholm D, Svensson F, Näslund I, et al. Long-term results 11 years after primary gastric bypass in 384 patients. Surg Obes Relat Dis. 2013;9(5):708–13.

    Article  Google Scholar 

  4. 4.

    Higa K, Ho T, Tercero F, et al. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25.

    Article  Google Scholar 

  5. 5.

    Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244(5):734–40.

    Article  Google Scholar 

  6. 6.

    Shantavasinkul PC, Omotosho P, Corsino L, et al. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2016;12(9):1640–5.

    Article  Google Scholar 

  7. 7.

    Shah K, Nergård BJ, Fagerland MW, et al. Limb length in gastric bypass in super-obese patients—importance of length of total alimentary small bowel tract. Obes Surg. 2019;2019:2012–21.

    Article  Google Scholar 

  8. 8.

    Homan J, Boerboom A, Aarts E, et al. 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. Obes Surg. 2018;28:3744–55.

    Article  Google Scholar 

  9. 9.

    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery - a systematic review and meta-analysis. JAMA Surg. 2004;292(14):1724–38.

    CAS  Article  Google Scholar 

  10. 10.

    Kellum JM, Chikunguwo SM, Maher JW, et al. Long-term results of malabsorptive distal Roux-en-Y gastric bypass in superobese patients. Surg Obes Relat Dis. 2011;7(2):189–93.

    Article  Google Scholar 

  11. 11.

    Kraljević M, Köstler T, Süsstrunk J, et al. Revisional surgery for insufficient loss or regain of weight after Roux-en-Y gastric bypass: biliopancreatic limb length matters. Obes Surg. 2020;30(3):804–11.

    Article  Google Scholar 

  12. 12.

    Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis. 2008;4(2):166–72.

    Article  Google Scholar 

  13. 13.

    Bhandari M, Fobi MAL, Buchwald JN, et al. Standardization of bariatric metabolic procedures: world consensus meeting statement. Obes Surg. 2019;29:309–45.

    Article  Google Scholar 

  14. 14.

    Brolin RE, Kenler HA, Gorman JH, et al. Long-limb gastric bypass in the superobese: a prospective randomized study. Ann Surg. 1992;215(4):387–95.

    CAS  Article  Google Scholar 

  15. 15.

    Brolin RE, LaMarca LB, Kenler HA, et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg. 2002;6(2):195–205.

    Article  Google Scholar 

  16. 16.

    Nelson WK, Fatima J, Houghton SG, et al. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery. 2006;140(4):517–23.

    Article  Google Scholar 

  17. 17.

    Thurnheer M, Bisang P, Ernst B, et al. A novel distal very long Roux-en Y gastric bypass (DVLRYGB) as a primary bariatric procedure—complication rates, weight loss, and nutritional/metabolic changes in the first 355 patients. Obes Surg. 2012;22(9):1427–36.

    Article  Google Scholar 

  18. 18.

    Gan J, Wang Y, Zhou X. Whether a short or long alimentary limb influences weight loss in gastric bypass: a systematic review and meta-analysis. Obes Surg. 2018;28(11):3701–10.

    Article  Google Scholar 

  19. 19.

    Ahmed B, King WC, Gourash W, et al. Proximal Roux-en-Y gastric bypass : addressing the myth of limb length. Surgery. 2019;166:445–55.

    Article  Google Scholar 

  20. 20.

    Savassi-Rocha AL, Diniz MTC, Savassi-Rocha PR, et al. Rodrigues De Almeida Sanches S, Diniz MDFHS, et al. Influence of jejunoileal and common limb length on weight loss following Roux-en-Y gastric bypass. Obes Surg. 2008;18(11):1364–8.

    Article  Google Scholar 

  21. 21.

    Reinhold R. Critical analysis of long term weight loss following gastric bypass. Surg Gynecol Obstet. 1982;3(155):385–94.

    Google Scholar 

  22. 22.

    Mehaffey JH, Lapar DJ, Clement KC, et al. 10-year outcomes after Roux-en-Y gastric bypass. Ann Surg. 2016;264(1):121–6.

    Article  Google Scholar 

  23. 23.

    O’Brien PE, Hindle A, Brennan L, et al. Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. 2019;29(1):3–14.

    Article  Google Scholar 

  24. 24.

    Yang P, Chen B, Xiang S, et al. Long-term outcomes of laparoscopic sleeve gastrectomy versus Roux-en-Y gastric bypass for morbid obesity: results from a meta-analysis of randomized controlled trials. Surg Obes Relat Dis. 2019;15(4):546–55.

  25. 25.

    Toolabi K, Sarkardeh M, Vasigh M, et al. Comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss, weight regain, and remission of comorbidities: a 5 years of follow-up study. Obes Surg. 2020;30(2):440–5.

    Article  Google Scholar 

  26. 26.

    Thomas DD, Anderson WA, Apovian CM, et al. Weight recidivism after Roux-en-Y gastric bypass surgery: an 11-year experience in a multiethnic medical center. Obesity. 2019;27(2):217–25.

    Article  Google Scholar 

  27. 27.

    Maciejewski ML, Arterburn DE, Van Scoyoc L, et al. Bariatric surgery and long-term durability of weight loss. JAMA Surg. 2017;151(11):1046–55.

    Article  Google Scholar 

  28. 28.

    Torres JC, Why I. Prefer gastric bypass distal Roux-en-Y gastroileostomy. Obes Surg. 1991;1:189–94.

    CAS  Article  Google Scholar 

  29. 29.

    Ghiassi S, Higa K, Chang S, et al. Conversion of standard Roux-en-Y gastric bypass to distal bypass for weight loss failure and metabolic syndrome : 3-year follow-up and evolution of technique to reduce nutritional complications. Surg Obes Relat Dis. 2018;14(5):554–61.

    Article  Google Scholar 

  30. 30.

    Nergaard BJ, Leifsson BG, Hedenbro J, et al. Gastric bypass with long alimentary limb or long pancreato-biliary limb—long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg. 2014;24(10):1595–602.

    Article  Google Scholar 

  31. 31.

    Leeman M, Gadiot RPM, Wijnand JMA, et al. Effects of standard v. very long roux limb Roux-en-Y gastric bypass on nutrient status: a 1-year follow-up report from the Dutch Common Channel trial (DUCATI) study. Br J Nutr. 2020;123(12):1434–40.

    CAS  Article  Google Scholar 

  32. 32.

    Rawlins ML, Teel D, Hedgcorth K, et al. Revision of Roux-en- Y gastric bypass to distal bypass for failed weight loss. Surg Obes Relat Dis. Elsevier Inc. 2011;7(1):45–9.

    Article  Google Scholar 

  33. 33.

    van der Burgh Y, Boerboom A, de Boer H, et al. Weight loss and malnutrition after conversion of the primary Roux-en-Y gastric bypass to distal gastric bypass in patients with morbid obesity. Surg Obes Relat Dis. Elsevier Inc. 2020;16(3):381–8.

    Article  Google Scholar 

  34. 34.

    Pinheiro JS, Schiavon CA, Pereira PB, et al. 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. 2008;4(4):521–5.

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank Miss Nicole Graf, Biostatistician, for her help with the statistical analyses and Miss Patricia Heeb, Scientific Assistant, for her help with the database.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Julian Süsstrunk.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval Statement

All procedures performed were in accordance with the ethical standards of the local research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent Statement

Informed consent does not apply as this is a database analysis.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Süsstrunk, J., Lazaridis, I.I., Köstler, T. et al. Long-Term Outcome of Proximal Versus Very-Very Long Limb Roux-en-Y Gastric Bypass: the Roux-Limb to Common Channel Ratio Determines the Long-Term Weight Loss. OBES SURG 31, 994–1003 (2021). https://doi.org/10.1007/s11695-020-05109-8

Download citation

Keywords

  • Bariatric surgery
  • Gastric bypass
  • Very-very long limb
  • Roux limb length
  • Distal gastric bypass