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Standard Biliopancreatic Limb (50 cm) Roux-en-Y Gastric Bypass Versus Long Biliopancreatic Limb (100 cm) Roux-en-Y Gastric Bypass in Patients with Body Mass Index 40–50 kg/m2: a Randomized Prospective Study



Roux-en-Y gastric bypass (RYGB) is a widely performed procedure worldwide especially with the presence of associated medical conditions. Patients with body mass index (BMI) 40–50 kg/m2 are at more risk of weight regain and relapse of comorbidities. There is a controversy on the optimum alimentary (AL) and biliopancreatic (BPL) limb lengths to be used in RYGB to achieve weight loss and remission of comorbidities without causing nutritional deficiencies in those patients.

Study Design

hundred-and-fifty patients with BMI between 40 and 50 kg/m2 were divided equally into 2 groups undergoing standard RYGB (S-RYGB) with AL:150 cm and BPL: 50 cm and long biliopancreatic RYGB (L-RYGB) with AL: 100 cm and BPL: 100 cm. BMI, % of total weight loss (%TWL), effect on diabetes (DM), hypertension (HTN), dyslipidemia, and nutritional statuses were recorded at 1, 2, and 3 years.


Only 64/75 patients in S-RYGB and 57/75 patients in L-RYGB completed the study. L-RYGB had faster weight loss, higher %TWL, and less BMI than S-RYGB with the maintenance of achieved weight. L-RYGB had better control of DM and dyslipidemia than S-RYGB. There were no significant differences in nutritional status between S-RYGB and L-RYGB rather than lower levels of calcium and Hb and higher levels of PTH in L-RYGB yet they remain within the normal range.


The application of L-RYGB helps in achieving faster weight loss for a longer period with better remission of associated comorbidities as DM, HTN, and dyslipidemia in patients with BMI 40–50 kg/m2 but with effects on the nutritional status.

Graphical abstract

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Correspondence to Moheb S. Eskandaros.

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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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Key points

• Long BP RYGB had better weight loss in patients with BMI 40–50 kg/m2 than standard RYGB.

• Long BP and standard RYGB achieve remission of HTN, DM, and dyslipidemia.

• Long BP RYGB causes more nutritional deficiencies than standard RYGB.

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Eskandaros, M.S., Abbass, A. Standard Biliopancreatic Limb (50 cm) Roux-en-Y Gastric Bypass Versus Long Biliopancreatic Limb (100 cm) Roux-en-Y Gastric Bypass in Patients with Body Mass Index 40–50 kg/m2: a Randomized Prospective Study. OBES SURG 32, 577–586 (2022).

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  • Standard RYGB
  • Long BP RYGB
  • Patients with BMI 40–50
  • Long biliopancreatic limb
  • Diabetes remission