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Randomized Controlled Trial
. 2014 Oct;24(10):1595-602.
doi: 10.1007/s11695-014-1245-7.

Gastric bypass with long alimentary limb or long pancreato-biliary limb--long-term results on weight loss, resolution of co-morbidities and metabolic parameters

Bent Johnny Nergaard  1 , Björn Geir Leifsson, Jan Hedenbro, Hjörtur Gislason
Affiliations
Randomized Controlled Trial

Gastric bypass with long alimentary limb or long pancreato-biliary limb--long-term results on weight loss, resolution of co-morbidities and metabolic parameters

Bent Johnny Nergaard et al. Obes Surg. 2014 Oct.

Abstract

Background: Several studies indicate that increasing the alimentary limb length in gastric bypass surgery produces only a minor improvement of excess BMI loss. Few studies have addressed the efficacy of increasing the length of the pancreatico-biliary limb.

Methods: Here, we present a prospective randomized study of 187 consecutive laparoscopic Roux-Y gastric bypass operations operated over 2 years (2004-2005) in Iceland. The patients were operated with a gastric bypass with either a 2-m biliopancreatic (BP)-limb and a 60-cm alimentary (A)-limb (n = 93) or with a 150-cm A-limb and a 60-cm BP-limb (n = 94).

Results: Preoperative median BMI was 44.1 (38-70), median age 35.5 (17-74) years, and 85 % of the patients were female. Follow-up rate after 5 years was 85 %. Eighteen months following surgery, the weight loss was significantly higher in the BP-limb group (p < 0.001), and this difference remained 7 years after surgery. Weight regain occurred in both groups, and 7 years after surgery, excess BMI loss (EBMIL) was 78.4 % in the BP-limb group compared to 67.1 % in the A-limb group (p < 0.001). Most patients (78 %) needed supplementation adjustment (iron, vitamin D and calcium) during the study period, significantly more often in the BP-limb group compared to the A-limb group (p < 0.001). Patients in the BP-limb group had more frequent stools than patients in the A-limb group; otherwise, gastro-intestinal symptoms rating scoring were comparable. Complication rate was similar.

Conclusions: Gastric bypass with a 2-m BP-limb gives better weight loss than gastric bypass with a 60-cm BP-limb and a 150-cm A-limb. Metabolic follow-up is of utmost importance, as most patients needed repeated adjustments of their supplementation.

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Conflict of interest statement

All authors declare that they have no conflict of interest and the study has not been supported by any grants.

Figures

Fig. 1
Fig. 1
Schematic drawing of the operation with 150-cm A-limb or 200-cm BP-limb
Fig. 2
Fig. 2
Postoperative weight loss expressed as percentage of excess BMI loss (EBMIL%) plotted against time. The lines are drawn using the locally weighted scatter plot smoothing method (Lowess). The figures demonstrate a greater weight loss using the long BP-limb procedure compared to long A-limb procedure
Fig. 3
Fig. 3
Postoperative weight loss expressed as percentage of excess BMI loss (EBMIL%) plotted against time. The figures demonstrate a greater weight loss in both obese and super obese patients using the long BP-limb procedure compared to long A-limb procedure
See this image and copyright information in PMC

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