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150-cm Versus 200-cm Biliopancreatic Limb One-Anastomosis Gastric Bypass: Propensity Score–Matched Analysis

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Abstract

Background

It has been suggested that shortening the length of the biliopancreatic limb (BPL) to 150 cm in one anastomosis gastric bypass (OAGB) would reduce nutritional complication rates without impairing weight loss outcomes. The aim of this study is to compare patients who underwent OAGB with a 200-cm BPL (OAGB-200) to patients with OAGB with a 150-cm BPL (OAGB-150) in terms of weight loss and late morbidity.

Methods

This is a monocentric retrospective matched cohort study including patients with a body mass index between 35 and 50 kg/m2 who underwent an OAGB-150 or an OAGB-200. Patients were matched 1:1 based on age, sex, and body mass index, prior to bariatric surgery.

Results

In total, 784 patients who underwent OAGB were included (OAGB-150 n = 392 and OAGB-200 (n = 392). There was no significant difference in terms of early morbidity. Regarding late morbidity in patients with an OAGB-150, significantly lower rates for marginal ulcer (OR = 0.4, CI 95% [0.2; 0.8], p = 0.006), incisional hernia (OR = 0.5, CI 95% [0.3; 1], p = 0.041), and bowel obstruction (OR = 0.3, CI 95% [0.1; 0.9], p = 0.039) were reported. Likewise, regarding late nutritional deficiencies, post-OAGB-150, a significantly lower number of patients with hypoalbuminemia (OR = 0.3, CI 95% [0.2; 0.7], p = 0.006), low vitamin B9 (OR = 0.5, CI 95% [0.2; 1], p = 0.044), and low ferritin (OR = 0.5, CI 95% [0.3; 0.8], p = 0.005) were observed. There was no significant difference in the percentage of excess BMI loss at 1, 2, 3, 4, and 5 years.

Conclusion

Compared to OAGB-200 in patients with BMI ≤ 50 kg/m2, OAGB-150 results in fewer nutritional deficiency rates long term, without impairing weight loss.

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Authors and Affiliations

  1. Université de Paris Cité, F-75015, Paris, France

    Thibaud Bertrand, Claire Rives-Lange, Anne-Sophie Jannot, Clement Baratte, Flore de Castelbajac, Maud Le Gall, Claire Carette, Sebastien Czernichow, Jean-Marc Chevallier & Tigran Poghosyan

  2. Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Chirurgie Digestive, Oncologique Et Bariatrique, Hôpital Européen Georges Pompidou, Paris, France

    Thibaud Bertrand, Clement Baratte, Jean-Marc Chevallier & Tigran Poghosyan

  3. Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France

    Claire Rives-Lange, Flore de Castelbajac, Claire Carette & Sebastien Czernichow

  4. Assistance Publique-Hôpitaux de Paris (AP-HP), Service d’informatique Médicale, Biostatistiques Et Santé Publique, Hôpital Européen Georges Pompidou, Paris, France

    Anne-Sophie Jannot & Estelle Lu

  5. CRC: Inserm, Centre de Recherche Des Cordeliers, Sorbonne Université, Université de Paris Cité, F-75006, Paris, France

    Anne-Sophie Jannot

  6. INRIA: HeKA, Inria Paris, F-75015, Paris, France

    Anne-Sophie Jannot

  7. 2Nd Department of General Surgery, Upper Digestive Tract Surgery Center, IASO Group (General Clinic), Athens, Greece

    Sylvia Krivan

  8. Inserm UMRS 1149, Paris, France

    Maud Le Gall & Tigran Poghosyan

  9. INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS team, Paris, France

    Sebastien Czernichow

Authors
  1. Thibaud Bertrand
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  2. Claire Rives-Lange
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  11. Jean-Marc Chevallier
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  12. Tigran Poghosyan
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Corresponding author

Correspondence to Tigran Poghosyan.

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Key points

• Biliopancreatic limb length in OAGB is still debatable.

• OAGB-150 cm results in fewer late nutritional deficiencies than a 200-cm BPL.

• At long term, there is no significant difference in weight loss between OAGB-150 and OAGB-200.

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Bertrand, T., Rives-Lange, C., Jannot, AS. et al. 150-cm Versus 200-cm Biliopancreatic Limb One-Anastomosis Gastric Bypass: Propensity Score–Matched Analysis. OBES SURG 32, 2839–2845 (2022). https://doi.org/10.1007/s11695-022-06203-9

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  • DOI: https://doi.org/10.1007/s11695-022-06203-9

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