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Small Bowel Limb Lengths and Roux-en-Y Gastric Bypass: a Systematic Review

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Abstract

There is currently no consensus on the combined length of small bowel that should be bypassed as biliopancreatic or alimentary limb for optimum results with Roux-en-Y gastric bypass. A number of different limb lengths exist, and there is significant variation in practice amongst surgeons. Inevitably, this means that some patients have too much small bowel bypassed and end up with malnutrition and others end up with a less effective operation. Lack of standardisation poses further problems with interpretation and comparison of scientific literature. This systematic review concludes that a range of 100–200 cm for combined length of biliopancreatic or alimentary limb gives optimum results with Roux-en-Y gastric bypass in most patients.

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Abbreviations

TSBL:

Total small bowel length

RYGB:

Roux-en-Y gastric bypass

BPL:

Biliopancreatic

AL:

Alimentary limb

CL:

Common limb

NBSR:

National Bariatric Surgery Registry

UK:

United Kingdom

BMI:

Body mass index

SBL:

Small bowel length

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

EWL:

Excess weight loss

DGB:

Distal gastric bypass

PGB:

Proximal gastric bypass

BPLDGB:

Biliopancreatic limb-based distal gastric bypass

ALDGB:

Alimentary limb-based distal gastric bypass

ELPGB:

Extended limb proximal gastric bypass

STPGB:

Standard proximal gastric bypass

SLPGB:

Short limb proximal gastric bypass

TPN:

Total parenteral nutrition

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Author Contributions

KM conceived the idea for the topic. KM and PK independently collected information and analysed it. All authors participated in departmental discussion on the topic and manuscript writing. All authors have seen the final version and approve of it.

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Authors and Affiliations

  1. Bariatric Unit, Sunderland Royal Hospital, Sunderland, SR4 7TP, UK

    Kamal K. Mahawar, Chetan Parmar, Yitka Graham, William R. J. Carr, Neil Jennings, Norbert Schroeder, Shlok Balupuri & Peter K. Small

  2. Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia

    Parveen Kumar

  3. Department of Pharmacy, Health and Well-Being, University of Sunderland, Sunderland, SR1 3SD, UK

    Yitka Graham

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  1. Kamal K. Mahawar
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  2. Parveen Kumar
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  3. Chetan Parmar
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Correspondence to Kamal K. Mahawar.

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Mahawar, K.K., Kumar, P., Parmar, C. et al. Small Bowel Limb Lengths and Roux-en-Y Gastric Bypass: a Systematic Review. OBES SURG 26, 660–671 (2016). https://doi.org/10.1007/s11695-016-2050-2

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