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Optimal Small Bowel Limb Lengths of Roux-en-Y Gastric Bypass

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Abstract

Purpose of Review

Gastric bypass and biliopancreatic diversion (BPD) have come full circle, from a loop configuration to a Roux-en-Y and finally back to a loop configuration as one anastomosis gastric bypass and single-anastomosis duodenal switch. Most surgeons performing Roux-en-Y gastric bypass (RYGB) do not measure the common channel (CC) length and most surgeons performing BPD do not measure the biliopancreatic limb length (BPL).

Recent Findings

The small bowel length in humans is variable from as short as < 400 cm to as long as > 1000 cm. The combination of these two facts means that even if surgeons keep the limb lengths constant, surgeons will get variable limb length due to the variability of small bowel length in patients. Hence, outcomes of weight loss, resolution of medical problems, or developing nutritional deficiencies which are related to limb length are variable.

Summary

In this article, we evaluate the published literature related to the effect of varying the Roux limb, BPL, CC, and total alimentary limb lengths on the outcomes of RYGB. We have focused on historical and current randomized controlled trials as well as systematic reviews and meta-analysis to outline the current literature and our interpretation of this literature.

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Abbreviations

RYGB:

Roux-en-Y gastric bypass

SG:

Sleeve gastrectomy

GBP:

Gastric bypass

BPD:

Biliopancreatic diversion

BPD-DS:

Biliopancreatic diversion-duodenal switch

OAGB:

One anastomosis gastric bypass

SADI-S:

Single-anastomosis duodenal switch (sleeve gastrectomy with single-anastomosis duodeno-ileostomy also known as SADI-S)

BMI:

Body mass index kg/m2

RL:

Roux limb

BPL:

Biliopancreatic limb

CC:

Common channel

TALL:

Total alimentary limb length

PCM:

Protein-calorie malnutrition

GLP-1:

Glucagon-like peptide-1

GIP:

Glucose-dependent insulinotropic polypeptide

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Bariatric Surgery, Department of Surgery, Atrium Health, Charlotte, USA

    Justin Eagleston

  2. Wake Forest School of Medicine, Bariatric Surgery, Atrium Health, Charlotte, NC, USA

    Abdelrahman Nimeri

  3. Director, of Bariatric Surgery, Brigham and Womens Hospital, Harvard Medical School, 75 Francis, MA, 02115, Boston, USA

    Abdelrahman Nimeri

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Correspondence to Abdelrahman Nimeri.

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Eagleston, J., Nimeri, A. Optimal Small Bowel Limb Lengths of Roux-en-Y Gastric Bypass. Curr Obes Rep 12, 345–354 (2023). https://doi.org/10.1007/s13679-023-00513-4

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