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The Ideal Length of Jejunal Limb in MGB

  • Karl Peter Rheinwalt
  • Andreas Plamper
Chapter

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.

Keywords

Mini-gastric bypass One-anastomosis gastric bypass Bypass length Biliopancreatic limb Total bowel length Measuring bowel length Common limb length Jejunal limb Malnutrition Weight loss 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obesity, Metabolic and Plastic SurgerySt. Franziskus-Hospital Cologne, Academic Teaching Hospital of the University of CologneCologneGermany

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