Skip to main content
SpringerLink
Log in
Book cover

Essentials of Mini ‒ One Anastomosis Gastric Bypass pp 51–60Cite as

The Ideal Length of Jejunal Limb in MGB

  • Chapter
  • First Online:

  • 748 Accesses

Abstract

Whereas 200 cm has been the original length of the bypassed jejunal limb in Mini-Gastric Bypass (MGB) as proposed by R. Rutledge in 1997, there have been variations of the limb length over the past 20 years. The longer the biliopancreatic limb, the more malabsorption will be present and the higher will be the expected weight loss, but unfortunately as well the risk of malnutrition concerning protein metabolism and micronutrients. On the other hand, there are some indications that a shorter biliopancreatic limb—which seems to be a recent tendency among MGB/OAGB-surgeons—might carry less risks for deficiencies without leading to frequent failure of weight loss and inadequate remission of comorbidities.

Ideally, systematic measuring of total bowel length (TBL) allows tailoring the bypass in a way to avoid possible malnutrition with an efferent (common) limb (CL) length of minimum 250–300 cm. However, this allows excluding an individualized biliopancreatic limb length providing the possibility of best weight loss and remission of co-morbidities. This measuring should be considered mandatory at least when bypassing >250 cm (e.g., in super-obesity or for tailored approach in revisional procedures). When systematic measurement of TBL is avoided for reasons of shortening the operative time or possibly elevated risk of bowel injury, a jejunal limb length of 150 to a maximum of 250 cm (in super-obesity) can be considered reasonably adequate and safe. Within this range, the decision about concrete length might be influenced not only by the patients’ weight and BMI, but also by other important factors such as expected compliance concerning supplementation, eating behaviors, quality of follow-up examinations and experience of the surgeon as well as the patient’s sociocultural set-up. In lower BMI-classes (purely metabolic procedures), even 100–150 cm should be sufficient.

These statements are mainly the result of studying publications from single-center experiences. Little to no evidence of a high degree exists regarding the ideal absolute or relative length of excluded jejunum in the MGB or OAGB, as only few studies contribute to give answers to this delicate question.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Cavin JB, Voitellier E, Cluzeaud F, Kapel N, Marmuse JP, Chevallier JM, Msika S, Bado A, Le Gall M. Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats. Am J Physiol Gastrointest Liver Physiol. 2016;311(3):G492–500.

    Article  PubMed  Google Scholar 

  2. Miyachi T, Nagao M, Shibata C, Kitahara Y, Tanaka N, Watanabe K, Tsuchiya T, Motoi F, Naitoh T, Unno M. Biliopancreatic limb plays an important role in metabolic improvement after duodenal-jejunal bypass in a rat model of diabetes. Surgery. 2016;159:1360–71.

    Article  PubMed  Google Scholar 

  3. Isreb S, Hildreth AJ, Mahawar K, Balupuri S, Small P. Laparoscopic instruments marking improve length measurement precision. World J Laparosc Surg. 2009;2:57–60.

    Article  Google Scholar 

  4. Bodenstedt S, Wagner M, Mayer B, Stemmer K, Kenngott H, Müller-Stich B, Dillmann R, Speidel S. Image-based laparoscopic bowel measurement. Int J Comput Assist Radiol Surg. 2016;11:407–19.

    Article  PubMed  Google Scholar 

  5. Scopinaro N, Adami GF, Marinari GM, Gianetta E, Traverso E, Friedman D, Camerini G, Baschieri G, Simonelli A. Biliopancreatic diversion. World J Surg. 1998;22:936–46.

    Article  CAS  PubMed  Google Scholar 

  6. Marceau P, Hould FS, Simard S, Lebel S, Bourque RA, Potvin M, Biron S. Biliopancreatic diversion with duodenal switch. World J Surg. 1998;22:947–54.

    Article  CAS  PubMed  Google Scholar 

  7. Gleysteen JJ. Five-year outcome with gastric bypass: Roux limb length makes a difference. Surg Obes Relat Dis. 2009;5:242–7.

    Article  PubMed  Google Scholar 

  8. Hess DS. Limb measurements in duodenal switch. Obes Surg. 2003;13:966.

    Article  PubMed  Google Scholar 

  9. Sánchez-Pernaute A, Herrera MA, Pérez-Aguirre ME, Talavera P, Cabrerizo L, Matía P, Díez-Valladares L, Barabash A, Martín-Antona E, García-Botella A, Garcia-Almenta EM, Torres A. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). One to three-year follow-up. Obes Surg. 2010;20:1720–6.

    Article  PubMed  Google Scholar 

  10. Carbajo MA, Luque-de-León E, Jiménez JM, Ortiz-de-Solórzano J, Pérez-Miranda M, Castro-Alija MJ. Laparoscopic one-anastomosis gastric bypass: technique, results and long-term follow-up in 1200 patients. Obes Surg. 2017;27:1153–67.

    Article  PubMed  Google Scholar 

  11. Rutledge R, Walsh TR. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005;15:1304–8.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  13. Chevallier JM, Arman GA, Guenzi M, Rau C, Bruzzi M, Beaupel N, Zinzindohoué F, Berger A. One tousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy. Obes Surg. 2015;25:951–8.

    Article  PubMed  Google Scholar 

  14. Lee WJ, Lee YC, Ser KH, Chen SC, Chen JC, Su YH. Revisional surgery for laparoscopic mini-gastric bypass. Surg Obes Relat Dis. 2011;7:486–91.

    Article  PubMed  Google Scholar 

  15. Lee WJ, Ser KH, Lee YC, Tsou JJ, Chen SC, Chen JC. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22:1827–34.

    Article  PubMed  Google Scholar 

  16. Lee WJ, Wang W, Lee YC, Huang MT, Ser KH, Chen JC. Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg. 2008;18:294–9.

    Article  PubMed  Google Scholar 

  17. Noun R, Skaff J, Riachi E, Daher R, Antoun NA, Nasr M. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22:697–703.

    Article  PubMed  Google Scholar 

  18. Musella M, Susa A, Greco F, De Luca M, Manno E, Di Stefano C, Milone M, Bonfanti R, Segato G, Antonino A, Piazza L. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc. 2014;28:156–63.

    Article  CAS  PubMed  Google Scholar 

  19. Taha O, Abdelaal M, Abozeid M, Askalany A, Alaa M. Outcomes of omega loop gastric bypass, 6-years experience of 1520 cases. Obes Surg. 2017;27:1952–60. https://doi.org/10.1007/s11695-017-2623-8.

    Article  PubMed  Google Scholar 

  20. Jammu GS, Sharma R. A 7-year clinical audit of 1107 cases comparing sleeve gastrectomy, Roux-en-Y gastric bypass, and mini-gastric bypass to determine an effective and safe bariatric and metabolic procedure. Obes Surg. 2016;26:926–32.

    Article  PubMed  Google Scholar 

  21. Motamedi MAK, Barzin M, Ebrahimi M, Ebrahimi R, Khalaj A. Severe fatal protein malnutrition and liver failure in a morbidly obese patient after mini-gastric bypass surgery: Case report. Int J Surg Case Rep. 2017;33:71–4.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Skroubis G, Sakellaropoulos G, Pouggouras K, Mead N, Nikiforidis G, Kalfarentzos F. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg. 2002;12:551–8.

    Article  PubMed  Google Scholar 

  23. Kalfarentzos F, Skroubis G, Karamanakos S, Argentou M, Mead N, Kehagias I, Alexandrides TK. Biliopancreatic diversion with Roux-en-Y gastric bypass and long limbs: advances in surgical treatment for super-obesity. Obes Surg. 2011;21:1849–58.

    Article  PubMed  Google Scholar 

  24. Stefanidis D, Kuwada TS, Gersin KS. The importance of the length of the limbs for gastric bypass patients—an evidence-based review. Obes Surg. 2011;21:119–24.

    Article  PubMed  Google Scholar 

  25. Pinheiro JS, Schiavon CA, Pereira PB, Correa JL, Noujaim P, Cohen R. 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;4:521–5.

    Article  PubMed  Google Scholar 

  26. Hernández-Martínez J, Calvo-Ros MÁ. Gastric bypass with fixed 230-cm-long common limb and variable alimentary and biliopancreatic limbs in morbid obesity. Obes Surg. 2011;21:1879–86.

    Article  PubMed  Google Scholar 

  27. Gupta RV, Chamany T, Makam R. Does length of common limb influence remission of diabetes? Short-term results. J Minim Access Surg. 2016;12:54–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kaska L, Kobiela J, Proczko M, Stefaniak T, Sledziński Z. Does the length of the biliary limb influence medium-term laboratory remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass in morbidly obese patients? Wideochir Inne Tech Maloinwazyjne. 2014;9:31–9.

    PubMed  PubMed Central  Google Scholar 

  29. Thurnheer M, Bisang P, Ernst B, Schultes B. 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;22:1427–36.

    Article  PubMed  Google Scholar 

  30. Caruana JA, Monte SV, Jacobs DM, Voytovich C, Ghanim H, Dandona P. Distal small bowel bypass for weight regain after gastric bypass: safety and efficacy threshold occurs at <70% bypass. Surg Obes Relat Dis. 2015;11:1248–55.

    Article  PubMed  Google Scholar 

  31. Sugerman HJ, Kellum JM, DeMaria EJ. Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity. J Gastrointest Surg. 1997;1:517–24.

    Article  CAS  PubMed  Google Scholar 

  32. Nelson WK, Fatima J, Houghton SG, Thompson GB, Kendrick ML, Mai JL, Kennel KA, Sarr MG. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery. 2006;140:517–22.

    Article  PubMed  Google Scholar 

  33. Rawlins ML, Teel D 2nd, Hedgcorth K, Maguire JP. Revision of Roux-en-Y gastric bypass to distal bypass for failed weight loss. Surg Obes Relat Dis. 2011;7:45–9.

    Article  PubMed  Google Scholar 

  34. Dogan K, Homan J, Aarts EO, van Laarhoven CJ, Janssen IM, Berends FJ. A short or a long Roux limb in gastric bypass surgery: does it matter? Surg Endosc. 2017;31:1882–90.

    Article  PubMed  Google Scholar 

  35. Orci L, Chilcott M, Huber O. Short versus long Roux-limb length in Roux-en-Y gastric bypass surgery for the treatment of morbid and super obesity: a systematic review of the literature. Obes Surg. 2011;21:797–804.

    Article  PubMed  Google Scholar 

  36. Ramos RJ, Mottin CC, Alves LB, Benzano D, Padoin AV. Effect of size of intestinal diversions in obese patients with metabolic syndrome submitted to gastric bypass. Arq Bras Cir Dig. 2016;29(Suppl 1):15–9.

    Article  PubMed Central  Google Scholar 

  37. Navez B, Thomopoulos T, Stefanescu I, Coubeau L. Common limb length does not influence weight loss after standard laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2016;26:1705–9.

    Article  PubMed  Google Scholar 

  38. Ralki M, Cassiman D, Van Dongen J, Ferrante M, Van Overbeke L. Liver failure after long-limb gastric bypass. Clin Res Hepatol Gastroenterol. 2017;41:e32–7.

    Article  PubMed  Google Scholar 

  39. Nergaard BJ, Leifsson BG, Hedenbro J, Gislason H. 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;24:1595–602.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obesity, Metabolic and Plastic Surgery, St. Franziskus-Hospital Cologne, Academic Teaching Hospital of the University of Cologne, Cologne, Germany

    Karl Peter Rheinwalt MD & Andreas Plamper MD

Authors
  1. Karl Peter Rheinwalt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andreas Plamper MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karl Peter Rheinwalt MD .

Editor information

Editors and Affiliations

  1. Obesity Surgery, Toronto, Ontario, Canada

    Mervyn Deitel

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rheinwalt, K.P., Plamper, A. (2018). The Ideal Length of Jejunal Limb in MGB. In: Deitel, M. (eds) Essentials of Mini ‒ One Anastomosis Gastric Bypass. Springer, Cham. https://doi.org/10.1007/978-3-319-76177-0_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-76177-0_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-76176-3

  • Online ISBN: 978-3-319-76177-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation