Short-term outcomes after long inverted versus short standard biliopancreatic limb in Roux-en-Y gastric bypass

Authors

  • Cuauhtemoc Morfin Vela Department of Endoscopic Surgery, American British Cowdray Medical Center, Mexico City, Mexico
  • Antonio G. Spaventa Ibarrola Department of Endoscopic Surgery, American British Cowdray Medical Center, Mexico City, Mexico
  • Carlos Zerrweck Lopez Department of Endoscopic Surgery, American British Cowdray Medical Center, Mexico City, Mexico
  • Arturo A. Rodriguez Gonzalez Department of Endoscopic Surgery, American British Cowdray Medical Center, Mexico City, Mexico
  • Cesar M. Vargas Sahagun Department of Endoscopic Surgery, American British Cowdray Medical Center, Mexico City, Mexico
  • Tomas E. Benavides Zavala Department of Endoscopic Surgery, American British Cowdray Medical Center, Mexico City, Mexico

DOI:

https://doi.org/10.18203/2320-6012.ijrms20222516

Keywords:

Bariatric surgery, Gastric bypass, Long biliopancreatic limb bypass, Morbid obesity, Obesity, Standard bypass

Abstract

Background: Obesity is a public health issue that affects the entire world and it is rising. Roux-en-Y gastric bypass is one of the most common bariatric procedures and it can reach a significant and sustained excess weight loss and efficient comorbidity control. The main objective was to compare short-term outcomes between standard versus long biliopancreatic limb gastric bypass patients.

Methods: it was a retrospective, comparative, descriptive, single-center study. We evaluated obese patients that underwent a laparoscopic Roux-en-Y gastric bypass with standard or long biliopancreatic limb in Centro Medico ABC, Mexico City, and compared general demographics, weight loss, excess weight loss, comorbidities and quality of life.

Results: Of 50 patients analyzed, 24 were in the standard gastric bypass (S-GB) and 26 in the long biliopancreatic limb (LBPL-GB). Mean weight loss in the S-GB group was 33.1±12.1 kg and in the LBPL-GB was 40.2±12.6 kg with a difference of 7.1 kg. The percentage of excess weight loss (%EWL) was 72.5±14% in S-GB and 72.9±19% in LBPL-GB, with a difference of 0.4% in the 12 months of follow-up. There was a complete reduction of hypoglycemic drugs in 80% in the S-GB group and 100% in the LBPL-GB group.

Conclusions: With this modification of the technique, we achieved important outcomes in regard of comorbidities, without affecting drastically weight loss or the EWL. This procedure is safe and feasible.

Author Biography

Cuauhtemoc Morfin Vela, Department of Endoscopic Surgery, American British Cowdray Medical Center, Mexico City, Mexico

General Surgeon, currently in a bariatric surgery specialization

References

Faria GR. A brief history of bariatric surgery. Porto Med J. 2017;2(3):90-2.

Zhang Y, Liu J, Yao J, Ji G, Qian L, Wang J, et al. Obesity: pathophysiology and intervention. Nutrients. 2014;6:5153-83.

Lee WJ, Wang W, Lee YC, Huang MT, Ser KH, Chen JC. Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg. 2008;18:294-9.

Rubino F, Gagner M, Gentileschi P, Kini S, Fukuyama S, Feng J, et al. The early effect of the roux-en-y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240:236-42.

Berbiglia L, Zografakis JG, Dan AG. Laparoscopic Roux-en-Y gastric bypass: surgical technique and perioperative care. Surg Clin. 2016;96(4):773-94.

Ruiz J, Vorwald P, Gonzalez G, Posada M, Salcedo G, Llavero C, et al. Impact of biliopancreatic limb length (70 cm versus 120 cm), with constant 150 cm alimentary limb, on long-term weight loss, remission of comorbidities and supplementation needs after Roux-En-Y gastric bypass: a prospective randomized clinical trial. Obes Surg. 2019;29:2367-72

Murad AJ, Cohen RV, de Godoy EP, Scheibe CL, Campelo GP, Ramos AC, et al. A prospective single-arm trial of modified long biliopancreatic and short alimentary limbs Roux-en-Y gastric bypass in type 2 diabetes patients with mild obesity. Obes Surg. 2018;28(3):599-605.

Coulman K, Blazeby J. Health-related quality of life in bariatric and metabolic surgery. Curr Obes Rep. 2020;9:307-14.

McCarty T, Arnold D, Lamont J, Fisher T, Kuhn J. Optimizing outcomes in bariatric surgery. outpatient laparoscopic gastric bypass. Ann Surg. 2005;242(4).

Guilbert L, Ortiz C, Espinosa O, Sepulveda E, Piña T, Joo P, et al. Metabolic syndrome 2 years after laparoscopic gastric bypass. Int J Surg. 2018;52:264-8.

Zerrweck C, Herrera A, Sepúlveda EM, Rodríguez FM, Guilbert L. Long versus short biliopancreatic limb in Roux-en-Y gastric bypass: short-term results of a randomized clinical trial. Surg Obes Rel Dis. 2021;17(8):1425-30.

Nergaard BJ, Leifsson BG, Hedenbro J, Gislason H. Gastric bypass with long alimentary limb or long pancreato-biliary limb- long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg. 2014;24(10):1595-602.

Zorrilla-Nunez LF, Campbell A, Giambartolomei G, Menzo EL, Szomstein S, Rosenthal RJ. The importance of the biliopancreatic limb length in gastric bypass: a systematic review. Surg Obes Rel Dis. 2019;15(1):43-9.

Christou N, Look D, MacLean L. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244(5).

Schauer P, Kashyap S, Wolski K, Brethauer S, Kirwan J, Pothier C, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567-76.

Balla A, Batista G, Corradetti S, Belagué C, Fernandez S, Targarona E. Outcomes after bariatric surgery according to large databases: a systematic review. Langenbecks Arch Surg. 2017;402:885-99.

McTigue K, Wellman R, Nauman E, Anau J, Yates R, Odor A, et al. Comparing the 5-year diabetes outcomes of sleeve gastrectomy and gastric bypass the national patient-centered clinical research network (PCORNet) bariatric study. JAMA Surg. 2020;155(5):e200087.

Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Capristo E, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial. Lancet. 2021;397:293-304.

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Published

2022-09-27

How to Cite

Morfin Vela, C., Spaventa Ibarrola, A. G., Lopez, C. Z., Rodriguez Gonzalez, A. A., Vargas Sahagun, C. M., & Benavides Zavala, T. E. (2022). Short-term outcomes after long inverted versus short standard biliopancreatic limb in Roux-en-Y gastric bypass. International Journal of Research in Medical Sciences, 10(10), 2122–2125. https://doi.org/10.18203/2320-6012.ijrms20222516

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Original Research Articles