Original article
Five-year outcome with gastric bypass: Roux limb length makes a difference

https://doi.org/10.1016/j.soard.2008.08.005Get rights and content

Abstract

Background

Surgical reports have indicated that longer Roux limbs (150 cm) have greater or no effect on long-term weight loss in super-obese patients (body mass index [BMI] ≥50 kg/m2) and little effect in less obese patients.

Methods

The weight loss outcomes through 5 years were compared in 3 sequential groups of patients, who underwent gastric bypass by 1 surgeon, and in whom the Roux limb lengths were different. Comparisons were made between 2 cohorts: those with a BMI of <50 (morbid obesity [MO]) and those with a BMI ≥50 kg/m2 (super obesity [SO]). Three groups of patients stratified by Roux limb lengths were compared: group 1, 41–61-cm Roux limb; group 2, 130–160-cm Roux limb; and group 3, 115–250-cm Roux limb (one third of small bowel). All comparisons were made using 2-way analysis of variance, and the interaction terms were not significant.

Results

A comparable number of patients were in each group, and the average preoperative weights were similar; however, more than twice as many patients in groups 2 and 3 were SO than MO. The BMI loss and weight loss were similar in each group. The greater BMI cohort (SO) lost more weight than did the MO cohort (P <.001). The BMI change and weight change in the shorter Roux limb group were less than those in groups 2 or 3 (longer Roux limbs; P <.01–.05). This difference was established with the BMI by 18 months. The BMI change and weight loss were not different between groups 2 and 3, presumably because their mean Roux limb lengths were not different. A limited amount of weight gain or recidivism occurred in patients with 5 years of follow-up, and it was not different among the 3 groups.

Conclusion

The results of this study have shown that longer Roux limbs improve weight loss outcomes both early and late in SO patients but not in MO patients. Clinically used long lengths of Roux limbs are close enough to one third of the total small bowel length such that the weight outcomes were not different, and total length should not need to be measured operatively. The eventual changes attributed to recidivism were not affected by the Roux limb length.

Section snippets

Methods

The weight loss outcomes of 344 MO/SO patients in 3 clinical and sequential groups were retrospectively collated for this report. All procedures had been done under the direct supervision of 1 surgeon, and all patients had undergone open Roux-en-Y gastric bypass. Those patients who had undergone revisional surgery or laparoscopic surgery were excluded. All patients had undergone gastric bypass >5 years previously and thus were potentially evaluable through 5 years. The patients who had died

Results

A total of 344 patients were followed up through 5 years by clinic visits or telephone interviews with the patient, the patient's relatives, or the patient's primary care physician. The overall follow-up through 4 years was 71%; however, it had decreased to 49% by 5 years. Follow-up for the earliest group 1 patients (81% and 51% at 4 and 5 years, respectively) was better than for the latest group 3 patients (57% and 42% at 4 and 5 years, respectively). Follow-up for the patients with a BMI <50

Discussion

The patients included in this retrospective and sequential analysis underwent gastric bypass from 1980 onward as the surgical concepts of the Roux length issues evolved. The patients in the early group (1980–1992) had a Roux limb length of 45 cm (range 41–61), with occasional minor variations. The technical discussions generated in the published reports (and at bariatric surgery meetings) in that early era addressed the effectiveness of the gastric operations for weight loss as issues of

Conclusion

The results of this study have shown that longer Roux limbs improved weight loss or BMI reduction early and through 5 years in SO patients and started later in MO patients. The reason for this in MO patients appeared to be the desirable reduced BMI achieved even with a short Roux limb, such that an additional reduction had no clinical appeal. The long Roux limbs used in group 2 patients, 25-cm longer in SO than in MO patients, were close enough to one third of the total small bowel length used

Disclosures

The author claims no commercial associations that might be a conflict of interest in relation to this article.

Acknowledgments

The author acknowledges the instructive and exacting assistance in all statistical analyses of these data by Naomi S. Fineberg, Ph.D., Research Professor, Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama.

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