Distal gastric bypass: 2-m biliopancreatic limb construction with varying lengths of common channel.

Abstract

BACKGROUND:

Long-term durability after Roux-en-Y gastric bypass is challenging in the super-obese population. Although lengthening of biliopancreatic limb (BPL) is associated with higher rates of weight loss, shortening of common limb (CL) is related to higher risk of malabsorption.

OBJECTIVES:

In this study, we aimed at evaluating the importance of the total alimentary limb length by creating a 2-m BPL diversion with varying CL lengths.

SETTING:

High-volume bariatric center, Norway.

METHODS:

Three groups of patients (N = 187) with different limb lengths were included in this retrospective cohort-analysis as follows: group 1 (n = 69; Roux limb = 150 cm, BPL = 60 cm), group 2 (n = 88; BPL = 200 cm, CL = 150 cm), and group 3 (n = 30; BPL = 200 cm, CL = 200 cm). Weight loss, regain, and failure were analyzed along with malabsorption issues.

RESULTS:

Preoperative body mass index (BMI) was higher in group 2 (58.5, P < .001) and 3 (57.4) versus group 1 (54.6, P = .011). No other clinically significant differences between the groups were noted. Follow-up rate was 95% at year 2, 74% at year 5, and 52% at year 10. At 10-year follow-up, excess weight loss and total weight loss was higher in group 2 (70.4%; 40.3%) and 3 (64.0%; 35.9%) compared with group 1 (55.9%; 29.2%). Excess weight loss failure was higher in group 1 versus 2 (30% versus 8.3%, P < .001). No difference in short- or long-term complications was seen except higher occurrence of internal hernia in distal Roux-en-Y gastric bypass groups (11.4%, 6.7%). Vitamin and mineral deficiencies occurred more frequently the shorter the CL was.

CONCLUSION:

Sustainable weight loss in a long-term follow-up is achieved by shortening the total alimentary limb length with a 2-m BPL diversion that should not be attached <200 cm from the ileocecal junction owing to higher rates of internal hernia and vitamin and mineral deficiencies.

• Authors: Kamran Shah, Bent Johnny Nergård, Morten Wang Fagerland, Hjörtur Gislason
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) Vol. 15 Issue 9 Pg. 1520-1526 (09 2019) ISSN: 1878-7533 [Electronic] United States
• PMID: 31548006 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Biliopancreatic Diversion (adverse effects, methods)
• Body Mass Index
• Female
• Gastric Bypass (adverse effects, methods)
• Humans
• Male
• Middle Aged
• Norway
• Obesity, Morbid (surgery)
• Postoperative Complications (epidemiology)
• Retrospective Studies
• Treatment Outcome
• Weight Loss
• Young Adult