Standard Biliopancreatic Limb (50cm) Roux-en-Y Gastric Bypass Versus Long Biliopancreatic Limb (100cm) Roux-en-Y Gastric Bypass in Patients with Body Mass Index 40-50kg/m2: a Randomized Prospective Study.

Abstract

Roux-en-Y gastric bypass (RYGB) is a widely performed procedure worldwide especially with the presence of associated medical conditions. Patients with body mass index (BMI) 40-50kg/m2 are at more risk of weight regain and relapse of comorbidities. There is a controversy on the optimum alimentary (AL) and biliopancreatic (BPL) limb lengths to be used in RYGB to achieve weight loss and remission of comorbidities without causing nutritional deficiencies in those patients. hundred-and-fifty patients with BMI between 40 and 50kg/m2 were divided equally into 2 groups undergoing standard RYGB (S-RYGB) with AL:150cm and BPL: 50cm and long biliopancreatic RYGB (L-RYGB) with AL: 100cm and BPL: 100cm. BMI, % of total weight loss (%TWL), effect on diabetes (DM), hypertension (HTN), dyslipidemia, and nutritional statuses were recorded at 1, 2, and 3years. Only 64/75 patients in S-RYGB and 57/75 patients in L-RYGB completed the study. L-RYGB had faster weight loss, higher %TWL, and less BMI than S-RYGB with the maintenance of achieved weight. L-RYGB had better control of DM and dyslipidemia than S-RYGB. There were no significant differences in nutritional status between S-RYGB and L-RYGB rather than lower levels of calcium and Hb and higher levels of PTH in L-RYGB yet they remain within the normal range. The application of L-RYGB helps in achieving faster weight loss for a longer period with better remission of associated comorbidities as DM, HTN, and dyslipidemia in patients with BMI 40-50kg/m2 but with effects on the nutritional status.