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Whether a Short or Long Alimentary Limb Influences Weight Loss in Gastric Bypass: a Systematic Review and Meta-Analysis

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Abstract

Roux-en-Y gastric bypass, the most commonly performed procedure in bariatric surgery, still lacks a consensus on whether alimentary limb length (ALL) influences weight loss. Studies were identified by searching multiple electronic databases. Studies with enough data including body mass index (BMI) loss and percent excess weight loss (% EWL) were eligible. The statistical analysis was performed with Stata 14.0. In total, eight studies with 1714 patients were included. The meta-analysis suggested that short ALLs weakened the efficacy of Roux-en-Y gastric bypass in terms of BMI loss (standard mean deviation (SMD), − 0.33 [95% confidence intervals (CI), − 0.60, − 0.05], p = 0.021) with 3 years of follow-up and % EWL (SMD, − 0.17 [95% CI, − 0.31, − 0.04], p = 0.013) with 2 years of follow-up. The subgroup analysis demonstrated that the group with a BMI ≥ 50 kg/m2 had a significant SMD between the use of short and the standard ALLs (− 0.71 [95% CI, − 1.07, − 0.35], p = 0.000), while the subgroup with a BMI < 50 kg/m2 (SMD, − 0.29 [95% CI, − 0.78, 0.20], p = 0.247) did not. Compared with a standard ALL (130–150 cm), a short ALL (40–100 cm) may reduce the efficacy of the Roux-en-Y gastric bypass surgery, while a long ALL (170–250 cm) did not significantly improve the effects in terms of BMI loss and % EWL. In addition, a potential view of the meta-analysis indicated patients with a BMI < 50 kg/m2 might get more benefits with a short ALL, while those patients with a BMI ≥ 50 kg/m2 might benefit more from a standard ALL.

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Funding

This work was supported by the Natural Science Foundation of China (No. 81160307 and No. 81560395), the Jiangxi Science & Technology Pillar Programme and the Science Foundation for Young Scholars of Jiangxi Province (No. 2007GQY1167), and Voyage Project of the Jiangxi Province Science and Technology Association.

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Author notes

  1. Yingjin Wang and Jiadi Gan contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizheng Road, Donghu District, Nanchang, 330006, Jiangxi Province, China

    Jiadi Gan, Yingjin Wang & Xiaodong Zhou

  2. First and Second Clinical Medical College, Nanchang University, Nanchang, 330006, China

    Jiadi Gan & Yingjin Wang

Authors
  1. Jiadi Gan
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  2. Yingjin Wang
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  3. Xiaodong Zhou
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Contributions

All authors have contributed significantly. Jiadi Gan performed the meta-analysis, Yingjin Wang was responsible for the statistical analysis, and Xiaodong Zhou prepared the manuscript. All authors agree with the content of the manuscript.

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Correspondence to Xiaodong Zhou.

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Supplement 1

. Forest plots for the performance of long versus short ALL in terms of BMI loss. ALL, alimentary limb length; SMD, standardized mean deviation. (PNG 76 kb)

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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 28, 3701–3710 (2018). https://doi.org/10.1007/s11695-018-3475-6

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