Long-Term Outcome of Proximal Versus Very-Very Long Limb Roux-en-Y Gastric Bypass: the Roux-Limb to Common Channel Ratio
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ORIGINAL CONTRIBUTIONS
Long-Term Outcome of Proximal Versus Very-Very Long Limb Roux-en-Y Gastric Bypass: the Roux-Limb to Common Channel Ratio Determines the Long-Term Weight Loss Julian Süsstrunk 1
&
Ioannis I. Lazaridis 2 & Thomas Köstler 1 & Marko Kraljević 2 & Tarik Delko 2 & Urs Zingg 1
Received: 7 July 2020 / Revised: 29 October 2020 / Accepted: 10 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The influence of the Roux limb (RL) length on weight loss in Roux-en-Y (RYGB)-type gastric bypass procedures is still unclear. This study analyzes the true impact of RL length by comparing the long-term outcomes of proximal RYGB (PRYGB) and very-very long limb RYGB (VVLL-RYGB). Methods RL length in PRYGB was 150 cm. In VVLL-RYGB, common channel length was 100 cm. In both groups, biliopancreatic limbs measured 50–60 cm, resulting in equal total alimentary limb lengths. To adjust for pre-operative differences between groups, and to predict the long-term outcome, a mixed model analysis was performed. Results Two hundred thirty-two patients with VVLL-RYGB (73.7% female, mean age 41.1 ± 10 years, initial BMI 45.8 ± 6.3 kg/m2) and 223 with PRYGB (83.9% female, mean age 38.5 ± 11 years, initial BMI 42.9 ± 4.9 kg/m2) were included. Mean follow-up was 9.4 ± 4 years in VVLL-RYGB and 5.3 ± 1.9 years in PRYGB. After 5 years, mean BMI reduction was 15.7 ± 5.9 kg/m2 in VVLLRYGB and 11.9 ± 4.1 kg/m2 in PRYGB (p < 0.001), and mean %EWL was 78.3 ± 23.1% and 70.2 ± 23.7% (p = 0.002) with a follow-up rate of 78% and 75.9%, respectively. The mixed model analysis showed a significantly higher weight rebound after PRYGB. Frequency of revisional surgery (i.e., limb length alteration, pouch banding) was similar between VVLL-RYGB and PRYGB (25 vs. 29 revisions, p = 0.463). Conclusion The VVLL-RYGB has a significantly higher long-term BMI reduction and a significantly lower weight rebound. The length of the Roux limb significantly influences long-term outcome.
Julian Süsstrunk and Ioannis I. Lazaridis contributed equally to this work. * Julian Süsstrunk [email protected] Ioannis I. Lazaridis [email protected] Thomas Köstler [email protected] Marko Kraljević [email protected] Tarik Delko [email protected] Urs Zingg [email protected] 1
Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland
2
Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002 Basel, Switzerland
Keywords Bariatric surgery . Gastric bypass . Very-very long limb . Roux limb length . Distal gastric bypass
Introduction Laparoscopic proximal Roux-en-Y gastric bypass (PRYGB) is the second most commonly performed bariatric operation worldwide [1]. Several studies have shown a sustainable weight loss after PRYGB with frequent remission of comorbidities, such as hypertension, hyperlipidemia, and diabetes mellitus [2–4]. However, the PRYGB has also been associated with a significant mid- and long-term weight regain, e
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