Impact of Biliopancreatic Limb Length (70 cm vs 120 cm), with Constant 150 cm Alimentary Limb, on Long-Term Weight Loss, Remission of Comorbidities and Supplementation Needs After Roux-En-Y Gastric Bypass: a Prospective Randomized Clinical Trial

2019 ◽  
Vol 29 (8) ◽  
pp. 2367-2372 ◽  
Author(s):  
Jaime Ruiz-Tovar ◽  
Peter Vorwald ◽  
Gilberto Gonzalez-Ramirez ◽  
María Posada ◽  
Gabriel Salcedo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Weight Loss ◽  
Gastric Bypass ◽  
Randomized Clinical Trial ◽  
Prospective Randomized Clinical Trial ◽  
Alimentary Limb ◽  
Biliopancreatic Limb ◽  
Biliopancreatic Limb Length ◽  
Remission Of Comorbidities

scholarly journals P-B02 Does the length of  alimentary limb  make a significant difference  in the weight loss in  Roux en y gastric bypass patients?

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Mayank Bhandari ◽  
Sabyasachi Chowdhary ◽  
Milind Rao ◽  
Gopinath Bussa ◽  
Julie Holm
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Statistical Significance ◽  
Limb Length ◽  
Alimentary Limb ◽  
Significant Difference ◽  
Alimentary Limb Length ◽  
Biliopancreatic Limb ◽  
Group A ◽  
Group B

Abstract Background Roux en Y gastric bypass (RYGB) surgery for morbid obesity is considered as gold standard, but there can be a difference in the length of alimentary and biliopancreatic limb to achieve optimum weight loss. Till now there is no agreed consensus on the ideal limb lengths and their effect on the weight loss. We would like to evaluate the change in the alimentary limb length on the weight loss after the gastric bypass surgery,  as a short to medium term single center study. Methods A retrospective analysis from prospectively maintained   database of 523 patients who underwent RYGB from  2012 till 2018 was done. Patient who had at least a follow up of 2 years(n = 388) were included.  At our center we use alimentary limb of 120 +/- 10 cm for Body Mass Index (BMI) < 40 kg/m2 (group A)  and 150+/-10 cm for the BMI >40 kg/m2  (Group B). The biliopancreatic limb length varies from 50 to 70 cm and this does not change with BMI.  The percentage excess weight(EWL) loss was measured and analyzed  at 1st  and 2nd year post operatively. We used paired t test to check for statistical significance. Results There were 172 patients in Group A and 216 in Group B. The number of females were 330 and  males were 58.   The average age was 44 years .  The mean  preoperative  BMI for the 120 cm limb group was  37.1 kg/m2 and  that for  150 cm limb was 45.3kg/m2. The EWL for the group A at 1 year and 2 year post op was a  Mean and standard deviation  of 79.3% +/- 39.4% and 78.3% +/- 35.2% respectively and for group B was 58.8% +/- 26.6% and 58.6% +/- 23.2% respectively. The difference was statistically significant (p < 0.001) . The analysis and interpretation for metabolic syndrome is yet to be determined.   Conclusions In our study, Increasing the alimentary limb length for higher BMI reduced  EWL. This is consistent with few other publications regarding the same. This has resulted in a  change in our practice namely keeping the length of alimentary limb constant and varying the BP limb length. We will be analyzing  and presenting this data in future.

scholarly journals Roux-en-Y gastric bypass with a long compared to a short biliopancreatic limb leads to better weight loss and glycemic control in obese mice

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
R Schneider ◽  
M Kraljević ◽  
C J Peterson ◽  
I Lazaridis ◽  
T V Rohm ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Glucose Tolerance ◽  
Negative Effects ◽  
Alimentary Limb ◽  
Bowel Length ◽  
Biliopancreatic Limb ◽  
Glucose Tolerance Tests ◽  
And Control ◽  
The Impact

Abstract Objective Roux-en-Y gastric bypass (RYGB) shows durable long-term weight loss and control of comorbidities in randomized controlled trials. However, the impact of the proportions of the biliopancreatic limb (BPL) and the total alimentary limb (TALL) on weight loss or glucose metabolism is still unclear. Methods Six weeks old C57BL/6J mice were fed high fat diet (HFD) to induce obesity and glucose intolerance. Mice underwent RYGB surgery with a very-long BPL (35% of total bowel length [TBL]), long BPL (25% of TBL), short BPL (15 % of TBL), or sham surgery. The alimentary limb (AL) was adjusted in dependency on the BPL to achieve a fixed CC length. Glycemia was assessment by intraperitoneal glucose tolerance tests. Results Mice undergoing RYGB with a very-long BPL showed excessive weight loss and mortality and were therefore excluded for further analyses. Total weight loss (TWL%) was significantly higher in the long BPL- compared to short BPL-group. Mice with a long BPL showed significantly improved glucose tolerance 14 days postoperatively, while 35 days postoperatively, the improvement in glucose tolerance with a long BPL was much less distinctive. Conclusion RYGB with a longer BPL leads to improved results including weight loss and glucose tolerance. However, the metabolic improvements seem to decrease over time. These findings could potentially be translated to humans by adjusting the BPL according to body weight and comorbidities. To avoid possible negative effects of a longer BPL total bowel length measurement is mandatory.

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