LONG-TERM WEIGHT LOSS, DIABETES, AND DUMPING SYNDROME OUTCOMES AFTER SHORT VERSUS LONG ALIMENTARY LIMB ROUX-EN-Y GASTRIC BYPASS
Catherine Tsai*1, Joerg Zehetner1, Lia Bally2, Rudolf Steffen1
1Visceral Surgery, Clinik Beau-Site Hirslanden Bern, Bern, Switzerland; 2Endocrinology, Inselspital University Hospital of Bern, Bern, Switzerland
Introduction: Roux-en-Y gastric bypass (RYGB) is the most commonly performed surgery for morbidly obese patients worldwide. Consensus is still lacking on whether a short or long alimentary limb is superior regarding weight loss, comorbidity resolution, and complications. The aim of this study was to compare the long-term outcomes after short alimentary limb (SAL) and long alimentary limb (LAL) RYGB.
Methods: Morbidly obese patients were randomized to receive either a short alimentary limb (80cm) or long alimentary limb (250cm) RYGB at a single institution in Bern, Switzerland in 2003. Patients were followed up annually in an outpatient bariatric center, and those who completed a minimum of 10 years' follow-up were included in this study. Patients' medical records were reviewed and analyzed for complications, weight loss outcomes, comorbidity resolution, and development of dumping syndrome.
Results: A total of 41 patients were randomized to the SAL group and 46 patients to the LAL group. There were no differences in baseline body mass index (BMI), age, gender, nor rate of comorbidities (diabetes, hypertension, hyperlipidemia) between the two groups. Sufficient follow-up was available for 70.7% of the SAL group and 84.8% of the LAL group. Mean follow-up time for the SAL group was 14.2 years (R12-15) and 13.8 years (R10-15) for the LAL group. There were no differences in rates of leak, infection, nor bleeding between the two groups. At most recent follow-up, mean excess weight loss (EWL) was 66.8% (R37.4-96.9) for the SAL group and 64.4% (R33.5-93.3) in the LAL group (p=0.84). The rate of comorbidity resolution was similar between the two groups. Specifically, 38.5% of diabetes cases resolved in the SAL group and 50% resolved in the LAL group (p=0.71). There were no differences in development of dumping syndrome between the two groups (19.2% vs 10%, SAL vs LAL, respectively, p=0.45). One patient from the SAL group died from cancer. Otherwise, no deaths were recorded.
Conclusions: Alimentary limb length does not influence long-term outcomes after RYGB. Weight loss outcomes and comorbidity control between SAL RYGB and LAL RYGB are similar. Limb length does not affect the rate of developing dumping syndrome.
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