IBC-Oxford University2023_BJSOral_10Selection of the Length of the Biliopancreatic Loop in OAGB-MGB

Abstract

Abstract Introduction One anastomosis gastric bypass (Omega loop gastric bypass/minigastric bypass/single bypass) has gained supporters worldwide, especially in recent years in Europe and Asia. Several studies have shown that this is a simple, safe and effective bariatric surgery. However, there are many controversial and ambiguously accepted technical aspects of this procedure. The purpose of this study is to report on the clinical results of choosing the length of the biliopancreatic loop in laparoscopic mini-gastric bypass. Methods From April 2018 to April 2023, we performed OAGB-MGB in 678 obese patients, 586 of them had type 2 diabetes. Median age: 46.2 years (29 to 63 years). The average weight was 122 ± 11.5 kgs (98-244); BMI on average 44.8±8.7 kg/m2 (37-72); The average operation time was 74±9.6 minutes (52-140). All examined patients were divided into 2 groups, the control group and main group of patients. The control group had 302 patients (2018-2020) and the length of the biliopancreatic loop (BPL) ranged from 180 to 250 cms. The main group had 376 (2021-2023) patients and the length of the BPL ranged from 150 to 200 cms, depending on BMI. At BMI < 40 kg/m2, the length of the BPL was 150 cms; at BMI > 40 kg/m2, it was 180 cms; at BMI > 50 kg/m2, the length of the BPL was 200 cms. Results Analysis of the results of treatment of patients in the control group showed that the number of complications were high, especially protein and vitamin-mineral deficiencies were observed. Therefore, we have developed a computer programme for selecting the length of the biliopancreatic loop depending on BMI. This program was taken as the basis for performing OAGB-MGB in patients of the main group. Analysis of the results of treatment of patients in the main group showed the effectiveness of this technique, which resulted in a decrease in the number of early and late postoperative complications in the main group compared with the control group. Conclusions OAGB/MGB is a feasible, safe and effective bariatric surgery. When performing OAGB/MGB, depending on the patient's BMI, it is necessary to individually select the length of the biliopancreatic loop. The length of the biliopancreatic loop of more than 250 cms increases the risk of developing protein, vitamin and mineral deficiencies.