Abstract
Background
While some studies have shown that long-limb gastric bypass with Roux limb length of 150 to 200 cm can attain better weight loss outcomes in super-obese patients (BMI >50 kg/m2) than the standard limb gastric bypass with Roux limb length of 100 to 150 cm, other studies have not shown similar findings. Additionally, no study has demonstrated the optimal length of the Roux limb that will result in ideal weight loss. The purpose of this study is to compare the long-term weight loss and weight regain of standard limb length (SLL) and long limb length (LLL) gastric bypass in patients with BMI >50 kg/m2.
Methods
A total of 120 patients with BMI >50 kg/m2 underwent either SLL (total bypass length = 200, biliopancreatic limb = 50–80 cm, Roux limb = 120–150 cm) or LLL (total bypass length = 250 biliopancreatic limb = 50–80 cm, Roux limb = 170–200 cm) RYGB. The excess weight loss (EWL), the weight regain, and the rate of complications were measured at 1-, 2-, and 3-year follow-up. Statistical comparisons were performed using t-test.
Results
There was no difference in patient demographics, pre-operative BMI, or comorbidities between the two groups: SLL (n = 55) and LLL (n = 65). In comparing standard- to long-limb cohorts, preoperative BMI was 56.1 ±5.34 vs. 57.5 ± 6.05 kg/m2, respectively. There was no statistical difference in percent EWL at 1, 2, and 3 years between the two groups [55.2 vs. 55 (P = 0.933), 61.5 vs. 60.8 (P = 0.831), and 61.1 vs.60 (P = 0.932)]. There was no difference in percent weight regain between the two groups, 11.2 (SLL) and 5.2 (LLL) (P = 0.13). The rates of complications were similar in the two groups.
Conclusion
There is no difference in weight loss or weight regain between the SLL and LLL RYGB. Longer-limb gastric bypass is not required in patients with BMI >50 kg/m2 for them to obtain long-term, sustained weight loss.
Similar content being viewed by others
References
Buchwald H, Avidor Y, Braunwald E. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
NIH. Gastrointestinal surgery for severe obesity. NIH Consensus Development Conference. Nutrition 1996, 12:397–404.
Mason EE, Ito C. Gastric bypass. Ann Surg. 1969;170:329–39.
Eisenberg D, Duffy AJ, Bell RL. Update on obesity surgery. World J Gastroenterol. 2006;12:3196–203.
Ciovica R, Takata M, Vittinghoff E, et al. The impact of Roux limb length on weight loss after gastric bypass. Obes Surg. 2008;18:5–10.
Pinheiro JS, Schiavon CA, Pereira PB, et al. Long-long limb Roux-en-Y gastric bypass is more efficacious in treatment of type 2 diabetes and lipid disorders in super-obese patients. Surg Obes Relat Dis. 2008;4:521–5.
Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222:339–50.
Pareja JC, Pilla VF, Callejas-Neto F, et al. Gastric bypass Roux-en-Y gastrojejunostomy—conversion to distal gastrojejunoileostomy for weight loss failure—experience in 41 patients. Arq Gastroenterol. 2005;42:196–200.
Brolin RE, Kenler HA, Gorman JH, et al. Long-limb gastric bypass in the superobese. A prospective randomized study. Ann Surg. 1992;215:387–95.
Gleysteen JJ. Five-year outcome with gastric bypass: Roux limb length makes a difference. Surg Obes Relat Dis. 2009;5:242–7.
Inabnet WB, Quinn T, Gagner M, et al. Laparoscopic Roux-en-Y gastric bypass in patients with BMI <50: a prospective randomized trial comparing short and long limb lengths. Obes Surg. 2005;15:51–7.
Christou NV, Look D, Maclean LD. Weight gain after short- and long-limb gastric bypass in patients followed for longer than 10 years. Ann Surg. 2006;244:734–40.
Choban PS, Flancbaum L. The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial. Obes Surg. 2002;12:540–5.
Feng et al. Effect of standard vs extended Roux limb length on weight loss outcomes after laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2003;17:1055–60.
Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States. JAMA. 2004;291:1238–45.
MacLean LD, Rhode BM, Nohr CW. Long- or short-limb gastric bypass? J Gastrointest Surg. 2001;5:525–30.
Lee S, Sahagian KG, Schriver JP. Relationship between varying Roux limb lengths and weight loss in gastric bypass. Curr Surg. 2006;63:259–63.
Bruder SJ, Freeman JB, Brazeau-Gravelle P. Lengthening the Roux-Y Limb Increases Weight Loss after Gastric Bypass: a preliminary report. Obes Surg. 1991;1:73–7.
Campos GM, Rabl C, Mulligan K, et al. Factors associated with weight loss after gastric bypass. Arch Surg. 2008;143:877–83.
Nelson et al. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery. 2006;140:517–22.
Guajardo-Salinas GE, Hilmy A, Martinez-Ugarte ML. Predictors of weight loss and effectiveness of Roux-en-Y gastric bypass in the morbidly obese Hispano-American population. Obes Surg. 2008;18:1369–75.
Harvin G, DeLegge M, Garrow DA. The impact of race on weight loss after Roux-en Y gastric bypass surgery. Obes Surg. 2008;18:39–42.
Capella RF, Capella JF. Ethnicity, type of obesity surgery and weight loss. Obes Surg. 1993;3:375–80.
Conflicts of interest
None of the authors has any conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sarhan, M., Choi, J.J., Al Sawwaf, M. et al. Is Weight Loss Better Sustained with Long-Limb Gastric Bypass in the Super-Obese?. OBES SURG 21, 1337–1343 (2011). https://doi.org/10.1007/s11695-011-0402-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-011-0402-5