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Review
. 2021 Feb 10;10(4):674.
doi: 10.3390/jcm10040674.

Bariatric Surgery-How Much Malabsorption Do We Need?-A Review of Various Limb Lengths in Different Gastric Bypass Procedures

Daniel Moritz Felsenreich  1 , Felix Benedikt Langer  1 , Jakob Eichelter  1 , Julia Jedamzik  1 , Lisa Gensthaler  1 , Larissa Nixdorf  1 , Mahir Gachabayov  1 , Aram Rojas  1 , Natalie Vock  1 , Marie Louise Zach  1 , Gerhard Prager  1
Affiliations
Review

Bariatric Surgery-How Much Malabsorption Do We Need?-A Review of Various Limb Lengths in Different Gastric Bypass Procedures

Daniel Moritz Felsenreich et al. J Clin Med. .

Abstract

The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different bypass procedures exist alongside each other today and each type of bypass is performed using a distinct technique. Furthermore, the length of the bypassed intestine may differ as well. One might add that the operations are performed differently in different parts of the world and have been changing and evolving over time. This review evaluates the most frequently performed bariatric bypass procedures (and their variations) worldwide: Roux-en-Y Gastric Bypass, One-Anastomosis Gastric Bypass, Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy, Biliopancreatic Diversion + Duodenal Switch and operations due to weight regain. The evaluation of the procedures and different limb lengths focusses on weight loss, remission of comorbidities and the risk of malnutrition and deficiencies. This narrative review does not aim at synthesizing quantitative data. Rather, it provides a summary of carefully selected, high-quality studies to serve as examples and to draw tentative conclusions on the effects of the bypass procedures mentioned above. In conclusion, it is important to carefully choose the procedure and small bowel length excluded from the food passage suited best to each individual patient. A balance has to be achieved between sufficient weight loss and remission of comorbidities, as well as a low risk of deficiencies and malnutrition. In any case, at least 300 cm of small bowel should always remain in the food stream to prevent the development of deficiencies and malnutrition.

Keywords: Roux-en-Y gastric bypass; SADI-S; biliopancreatic diversion; malabsorption; one-anastomosis gastric bypass; weight regain.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Roux-en-Y-Gastric Bypass (RYGB)/Diverted One-Anastomosis Gastric bypass (D-OAGB).
Figure 2
Figure 2
One-Anastomosis Gastric Bypass (OAGB).
Figure 3
Figure 3
Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy (SADI-S).
Figure 4
Figure 4
Biliopancreatic Diversion with Duodenal Switch (BPD-DS).
See this image and copyright information in PMC

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