One Anastomosis Gastric Bypass-Mini Gastric Bypass with Tailored Biliopancreatic Limb Length Formula Relative to Small Bowel Length: Preliminary Results

Obes Surg. 2019 Sep;29(9):3062-3070. doi: 10.1007/s11695-019-04019-8.

Abstract

Background: One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB) is rapidly gaining popularity and is currently being performed by an increasing number of bariatric surgeons worldwide. However, excessive postoperative weight loss and malnutrition still remain a major concern regarding this procedure. The aim of this observational retrospective study was to investigate whether a tailored biliopancreatic limb (BPL) length relative to small bowel length (SBL) is superior to a fixed BPL length of 200 cm in terms of weight loss results and nutritional deficiencies in morbidly obese patients 1 year following OAGB-MGB.

Materials and methods: Sixty-four patients who underwent OAGB-MGB were divided into two consecutive groups depending on the BPL length used: fixed 200-cm BPL and tailored BPL groups. Anthropometric measurements (%EWL, TWL, %TWL) and nutritional parameters (vitamin A, vitamin D3, vitamin B12, serum iron, serum albumin, total protein) were compared between the two groups at 1-year follow-up.

Results: No statistically significant differences were observed between the patients in two groups in terms of %EWL, TWL, %TWL. The number of patients with deficiencies of vitamin A (p = 0.030), vitamin D3 (p = 0.020), and albumin (p = 0.030) was significantly higher in fixed 200-cm BPL group as compared with tailored BPL group, 1 year following OAGB-MGB. No statistically significant differences were seen between the patients in two groups in terms of vitamin B12, iron, and total protein deficiencies.

Conclusion: Tailoring BPL length by bypassing about 40% of the SBL seems to be safe and effective. According to preliminary results of this study, a tailored BPL length relative to SBL is even likely to be superior to the fixed 200-cm BPL as it is associated with less nutritional deficiencies while providing similar weight loss results. Further randomized studies with larger sample sizes and longer follow-up periods are necessary to confirm the primary results of this study.

Keywords: Bariatric surgery; Biliopancreatic limb (BPL); Common limb (CL); One anastomosis gastric bypass–mini gastric bypass (OAGB-MGB); Severe malnutrition; Small bowel length (SBL); Small bowel measurement; Weight loss.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical / methods
  • Biliopancreatic Diversion* / adverse effects
  • Biliopancreatic Diversion* / methods
  • Female
  • Gastric Bypass / adverse effects*
  • Gastric Bypass / methods*
  • Gastric Stump / pathology
  • Humans
  • Intestine, Small / pathology*
  • Intestine, Small / surgery
  • Malabsorption Syndromes / etiology
  • Malabsorption Syndromes / pathology
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery*
  • Organ Size
  • Postoperative Complications / etiology*
  • Postoperative Complications / pathology
  • Postoperative Period
  • Preliminary Data
  • Retrospective Studies
  • Weight Loss / physiology
  • Young Adult