Outcomes and Effects of 250-cm Biliopancreatic Limb One Anastomosis Gastric Bypass in Patients with BMI > 50 kg/m2 with Total Bowel Length > 6 m: a 2-Year Follow-up

Laparoscopic small bowel length measurement: nonassociative nature of total small bowel length with anthropometric and clinical characteristics in patients undergoing bariatric surgery

BACKGROUND

Small bowel length (SBL) may have an impact on the outcomes of bariatric surgeries, but it can be difficult to make a direct association between SBL and the safety and outcome of bariatric surgeries.

OBJECTIVES

To address this issue, we set out to devise a predictive model for SBL determination based on clinical and anthropometric variables.

SETTING

An academic tertiary medical center.

METHODS

Anthropometric and clinical data, including age, sex, height, weight, and past medical history, were collected upon enrollment. SBL was measured twice during the surgery using a marked grasper. In all cases, measurements were carried out by a single surgeon. To create a predictive model, a 2-step approach was employed. In the first step, linear regression was used to determine influential variables. In the second step, all variables with a P value < .2 were entered into a multivariate regression model.

RESULTS

Overall, 961 bariatric candidates were enrolled. The mean age of the participants was 40.08 years, and 77.5% (n = 745) were female. The mean SBL was 748.90 centimeters. There was a weak but statistically significant positive correlation between SBL with both weight and height. Our univariate linear model determined only anthropometric parameters as a predictor of SBL. The multivariate model also yielded that none of the entered parameters were shown to be accurate predictors of SBL. Moreover, only 4.3% of variances were explainable by this model.

CONCLUSION

Although we found a weak positive association between height and SBL, this association lacked clinical practicality.

The length of the biliopancreatic limb in one anastomosis gastric bypass

Introduction

The one-anastomosis gastric bypass (OAGB), first published by Dr Rutledge in 1997 is now a well-established procedure in the bariatric-metabolic armamentarium. This procedure based on a (single) loop gastro-jejunal anastomosis (the biliopancreatic limb or BPL) with a long narrow gastric pouch combines restriction with hypo-absorption. The biliopancreatic limb and in particular its length is held responsible for the degree of the hypo-absorptive effect but the most appropriate or "optimal" length of the BPL remains debatable.

Methods

The following text is based on a comprehensive and meticulous selection of the most recent literature in Cochrane, Pubmed and Google Scholar using the search terms "biliopancreatic limb", "biliopancreatic limb in one anastomosis gastric bypass" in an attempt to define not only the most common used biliopancreatic limb length but also to find out If there is an "ideal" limb length not only to optimize the outcomes of the OAGB in terms of weight loss and resolution of obesity-related diseases but also to reduce the potential side-effects in particular nutritional deficiencies.

Results

Until today there is no consensus about the "standard" or "ideal" length of the biliopancreatic limb in OAGB, a fixed length of 200 cm is still the most common used procedure although many reports and studies are in favour of shorter limb lengths adjusted to the BMI or the total small bowel length.

Conclusion

The "ideal" or "optimal" biliopancreatic limb length in OAGB still needs to be defined. There are different options and all of them have their credits, the question remains if a consensus can be reached regarding the best strategy to obtain the best outcome.

American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass

The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available.

Does One-Anastomosis Gastric Bypass Expose Patients to Gastroesophageal Reflux: a Systematic Review and Meta-analysis

This systematic review and meta-analysis aimed to investigate the incidence of new-onset gastroesophageal reflux, reflux change, esophagitis, Barrett's esophagus, and revision due to reflux, gastritis, and marginal ulcer after one-anastomosis gastric bypass (OAGB). We performed subgroup analyses based on primary and revisional OAGB and time of follow-up. Meta-analysis of 87 studies with 27,775 patients showed a 6% rate of new-onset reflux after OAGB. Preoperative reflux status did not change significantly after OAGB. The rate of esophagitis and Barrett's esophagus was 15% and 1%, respectively. The new-onset reflux rate after OAGB was significantly higher than gastric bypass but not different with sleeve gastrectomy. The current study showed a relatively low rate of reflux and its complications after OAGB, but it was significantly higher than Roux-en-Y gastric bypass.