Perioperative Outcomes of Proximal and Distal Gastric Bypass in Patients with BMI Ranged 50–60 kg/m2—A Double-Blind, Randomized Controlled Trial

Abstract

BackgroundProximal Roux-en-Y gastric bypass may not ensure adequate weight loss in superobese patients. Bypassing a longer segment of the small bowel may increase weight loss. The objective of the study was to compare the perioperative outcomes of laparoscopic proximal and distal gastric bypass in a double-blind randomized controlled trial of superobese patients. The study was conducted at two public tertiary care obesity centers in Norway.MethodsPatients with body mass index (BMI) 50–60 kg/m2 were randomly assigned to a proximal (150 cm alimentary limb) or a distal (150 cm common channel) gastric bypass. The biliopancreatic limb was 50 cm in both operations. Patients and follow-up personnel were blinded to the type of procedure. Thirty-day outcomes including complications are reported.ResultsWe operated on 115 patients, of whom two were excluded at surgery, leaving 56 and 57 patients in the proximal group and distal group, respectively. The median (range) operating time was 72 (36–151) and 101 (59–227) min, respectively (p < 0.001). Two distal procedures were converted to laparotomy during the primary procedure. Median length of hospital stay was 2 (1–4) days in the proximal group and 2 (1–24) days in the distal group. The number of patients with complications and complications categorized according to the Contracted Accordion classification did not differ significantly. However, all six reoperations were performed in the distal group, of which three were completed by laparoscopy (p = 0.01 between groups). There were no deaths.ConclusionsIn superobese patients with BMI between 50 and 60 kg/m2, distal gastric bypass was associated with longer operating time and more severe complications resulting in reoperation than proximal gastric bypass.

Rapid Evidence Review of Bariatric Surgery in Super Obesity (BMI ≥ 50 kg/m2)

“…For the comparison of bariatric surgery to non-surgical treatment, we identified one subgroup analysis from a VA observational study. 27 For the comparison of different bariatric surgery types, data were available from one systematic review, 28 two RCTs, 29,30 and 18 retrospective cohorts. [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] The majority of studies involved mostly women aged 35 to 45 years.…”

Should Roux-en-Y gastric bypass biliopancreatic limb length be tailored to achieve improved diabetes outcomes?

“…The implementation of these experimental techniques has led to a series of reports using a wide range of AL and BPL lengths. [ 22 – 25 ] Data available is characterized by a high variability of procedures performed for the same BMI range, small patient cohorts, short-term follow-up, and use of different criteria for diabetes remission, which rend comparisons difficult to perform. [ 26 , 27 ] In the absence of head–head comparison studies, the ideal RYGB limb length to optimize the metabolic outcomes remains uncertain.…”

The metabolic benefits of different bariatric operations: what procedure to choose?

“…In addition to the highly anticipated reporting of these studies, there is a growing body of evidence to support the notion that regardless of the surgical procedure, these are operations that are all considered safe and effective treatments for obesity and related complications ( Table 1). Beyond direct comparisons between procedures, further research is required to determine if variations of specific operations may improve outcomes as has been investigated in various bypass procedures, both RYGB and OAGB, to determine if changes of the length of proximal bowel bypassed can improve outcomes or reduce postoperative complications (42,43,44). Assessment of the value of each individual procedure is complex, requiring evaluation on the basis of factors beyond weight loss alone, namely the metabolic effects as these are most likely to contribute to improvements in long-term outcomes.…”