A Longer Biliopancreatic Limb in Roux-en-Y Gastric Bypass Improves Weight Loss in the First Years After Surgery: Results of a Randomized Controlled Trial.

Abstract

Despite the fact that the RYGB is performed on a broad scale worldwide as a reliable treatment for morbid obesity, there is no uniform technique for this operation. A number of studies have tried to demonstrate an additional weight loss effect by lengthening the alimentary limb, but to no avail. At this moment in time, the role of the biliopancreatic limb on weight loss is for the greater part unknown. The aim of this randomized controlled trial was to compare the effect on weight loss of a long biliopancreatic limb Roux-en-Y gastric bypass (LBP-GB) with a standard RYGB (S-GB). A LBP-GB (BPL 150cm, alimentary limb 75cm) was compared with a S-GB (BPL 75cm, alimentary limb 150cm). One hundred forty-six patients were randomized in two groups. Weight loss, morbidity, reduction of comorbidities, nutritional status, and quality of life were measured during a period of 4years. Patient characteristics were comparable in both groups. Mean EWL in the LBP-GB group after 12, 24, 36, and 48months was 81, 85, 78, and 72% respectively versus 71, 73, 68, and 64% in the S-GB group. The %EWL difference between groups was significant as soon as 9months postoperatively and continued throughout the follow-up period. While LBP-GB achieved a significant increase in %EWL in the first years after surgery, no difference in long-term %TWL was observed after 4years. In this study, the advantage of LBP-GB with respect to weight loss is modest, but shows promising gripping points for future improvements in RYGB design.