IBC-Oxford University2023_BJSPoster_4Biliopancreatic Limb Length and Patient Satisfaction One Anastomosis Gastric Bypass (Mini-Gastric Bypass-Original Technique)

Abstract

Abstract Introduction Daily Food Choices (DFCs) in obesity and Bariatric Surgery (BS) are critical components of patient’s health. The Biliopancreatic Limb (BPL) length in the Mini-Gastric Bypass-Original Technique (MGB-OT) version of the One Anastomosis Gastric Bypass (OAGB) includes a “Tailored" BPLL designed to change the outcome of the operation related to patient needs. The purpose of this study was to investigate the relationship between the impact of the MGB-OT and the "Tailored" BPL length, on weight loss and patient-reported DFCs. The primary hypothesis was that the MGB-OT would be associated with major changes in both DFCs and weight loss and that the “Tailored" BPL length would be associated with both DFCs and weight loss. Methods Data from an online patient survey of MGB-OT patients were collected including basic demographics, BPL length, pre and post-operative DFCs and weight loss. Linear regression modelling was used to quantitate the relative association between MGB-OT and the "Tailored" BPL length with DFCs and weight loss. Results 377 patients had complete responses for evaluation; 72% of patients were female, mean age 48+/-15 range 24-80 years; mean BPL length was 2.0+/-0.3m range 0.9-2.7m, mean preop weight was 131.0+/-24.2 range 86.3-222.5kg, mean post weight was 82.6+/-20.0 range 47.2-193.0, mean weight loss 48.4+/-19.2 range 6.4-119.4 and Percent Total Weight Loss (%TWL) was 36.9%+/-8.0% range 6.4%-53.7%. 90.8% of patients reported %TWL greater than 20%. As reported elsewhere, various measures of weight loss varied linearly related to BPL length. The mean DFCs of Meat, Sugar-Sweetened Beverages and Fatty Foods (Meat, SSBs and FFs respectively) were all higher before MGB-OT and declined post-op. The mean “Bad” Food Choices (Bad DFCs = DFCs Meat+SSBs+FFs) declined from mean of 8.6+/-0.9 to 5.0+/0.7 a Delta “Bad” DFCs of 3.6+/-0.9. Daily DFCs of Fresh Fruit and Vegetables (FFVs) increased, Delta FFVs 1.2+/-0.1. The Delta All DFCs, (Delta Bad+FFVs) was 4.8+/-1.0/day with an estimated Delta of 1,757 “Yearly” Food Choices (YFCs.) The estimated Yearly “Bad” food choices declined from 2,070 YFCs to an estimated 745. Finally, there was a strong linear relation between BPL length and the decline in mean “Bad” daily food choices. Conclusions The present study demonstrates that patients report major weight loss following a “Tailored" BPL length in the MGB-OT. Patients also reported declines in “Bad” DFCs (meat, FFs & SSBs) and improvements in FFVs. Yearly projections of these changes suggest both an improvement in quality and a decrease in caloric intake of hundreds of thousands of calories per year. Both these were linearly related to Biliopancreatic limb length. A longer Biliopancreatic Limb Length was associated with greater weight loss and a greater improvement in patient-reported Daily Food Choices.