Biliopancreatic Limb Length in One Anastomosis Gastric Bypass: Which Is the Best?
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ORIGINAL CONTRIBUTIONS
Biliopancreatic Limb Length in One Anastomosis Gastric Bypass: Which Is the Best? Francesco Pizza 1 & Francesco Saverio Lucido 2 & Dario D’Antonio 1 & Salvatore Tolone 2 & Claudio Gambardella 2 & Chiara Dell’Isola 3 & Ludovico Docimo 2 & Alberto Marvaso 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The use of one anastomosis gastric bypass (OAGB) is rapidly spreading. Concerns about biliary reflux and malabsorption with consequent nutritional deficits exist, so studies on biliopancreatic limb (BPL) adequate length in OAGB are required to balance excess weight loss in percentage (% EWL), resolution of comorbidities, and nutritional deficit. The purpose was to evaluate, at 2 years after OAGB, the effects of BPL length on weight loss, resolution of comorbidity, and nutritional deficiencies in patients. Methods From January 2015 to January 2017, 180 patients were collected into three groups based BPL length: group A, 150 cm; group B, 180 cm; and group C, 200 cm. Aims were to compare %EWL, co-morbidity resolution rates, nutritional parameters, and morbidity/mortality in the three groups. Results The total number of patients was 180: 60 for each group. One hundred seventy-two (95%) patients attended the 1-year follow-up (group A = 58; group B = 58, group C = 56). One hundred fifty-seven (87%) patients attended the 2-year follow-up (group A = 52 (87%); group B = 53 (88%); group C = 52 (87%)). There was no statistically significant difference in %EWL, %TWL, T2DM, and hypertension resolution rates among the groups. About vitamin deficiency, differences were not statistically significant. Iron and ferritin deficiency rate were statistically significant only between A and C groups. Conclusions According to our evidence, standardization of BPL length shorter than 200 cm is suggested, potentially minimizing malnutrition-related outcomes. Our study seems to show that a BPL of 150–180 cm is safe and effective in terms of EWL and comorbidity improvement with low malnutrition effects even in BMI > 50. Keywords One anastomosis gastric bypass . Obesity surgery . Malabsorption . Nutritional deficiencies
Introduction The one anastomosis gastric bypass (OAGB) has currently gained a widespread diffusion among bariatric surgeons, being the third commonest procedure worldwide performed after
* Francesco Pizza [email protected] 1
Division of Surgery, Hospital “A. Rizzoli”, Lacco Ameno, Naples, Italy
2
Division of General, Mininvasive and Bariatric Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
3
Department of Infectious Diseases, AORN “Dei Colli”, Naples, Italy
sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB) [1]. OAGB gained many supporters but also several criticisms for the possible onset of biliary reflux and malabsorption with consequent nutritional deficits. Moreover, the American Society for Metabolic and Bariatric Surgery has not yet approved OAGB, for concerns regarding long-term “nutritional deficiencies” and “carcinogen
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