The Influence of Different Alimentary and Biliopancreatic Limb Lengths in Gastric Bypass Patients
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ORIGINAL CONTRIBUTIONS
The Influence of Different Alimentary and Biliopancreatic Limb Lengths in Gastric Bypass Patients H. J. M. Smelt 1,2
&
S. Van Rijn 3 & S. Pouwels 4 & M. P. W. Aarts 1 & J. F. Smulders 1,2
Received: 25 February 2020 / Revised: 1 October 2020 / Accepted: 6 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The aim of this study was to compare the effect of two different limb lengths after RYGB on weight loss, postoperative gastro-intestinal complications, and vitamin deficiencies. Materials and Methods A retrospective analyses of 100 patients after RYGB with 2 different limb lengths were done. Group A (50 patients) had a biliopancreatic limb (BPL) of 75 cm and an alimentary limb (AL) of 150 cm. Group B (50 patients) had a BPL of 150 cm and an AL of 75 cm. The effect on weight loss, body mass index, excess weight loss (EWL), total weight loss (TWL), and postoperative complications was analyzed up to 2 years postoperatively. Results Patients with a longer BPL achieved significantly more %EWL compared to a shorter BPL 2 years postoperatively (82.8 ± 31.2 versus 93.8 ± 15.1; p = 0.038). A significant difference was also seen in %TWL after 1 year (30.3 ± 10.1 versus 37.4 ± 6.9; p < 0.01) and 2 years (31.6 ± 7.5 versus 35.6 ± 8.6; p = 0.022), both in favor of group B. However, patients with a longer BPL (group B) showed significant more diarrhea and steatorrhea compared to group A (p < 0.01). Conclusion BPL of 150 cm is associated with more %EWL and %TWL 2 years after RYGB. However, it is accompanied by an increase of diarrhea and steatorrhea to disadvantage off group B. Future studies need to focus on further tailoring BPL and AL lengths to achieve the best possible outcomes for patients with morbid obesity. Keywords Gastric bypass . Alimentary limb . Biliopancreatic limb . Weight loss . Excess weight loss . Total weight loss . Malabsorption
Introduction Morbid obesity is an increasing worldwide problem, and up to now, bariatric surgery has proven to be the only effective method for sustained weight loss. Laparoscopic Roux-en-Y gastric bypass (RYGB) is one of the most performed bariatric procedures worldwide and has long been considered the gold standard for bariatric surgery [1]. Laparoscopic RYGB is
highly effective at reducing Excess weight loss (EWL) when compared with other procedures. The average excess weight loss is 50 to 66% [1, 2]. Several studies have shown substantial improvement of obesity-related comorbidities as diabetes type 2, hypertension, hyperlipidemia, and obstructive sleep apnea syndrome [1–5]. The RYGB derives its effectiveness from combining a restrictive and a malabsorptive procedure. Amounts of food are restricted by the size of the smaller pouch
* H. J. M. Smelt [email protected]
J. F. Smulders [email protected] 1
Obesity Center, Catharina Hospital, Eindhoven, The Netherlands
2
S. Pouwels [email protected]
Department of Surgery, Catharina Hospital, Michelangelolaan 2 P.O.
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