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

Abstract

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Long versus short biliopancreatic limb in Roux-en-Y gastric bypass: short-term results of a randomized clinical trial

“…Changes employed recently by some authors to lengthen the BPL theoretically would add a more potent effect via malabsorption, microbiota, and biliary salts [6]. Our results agree with other series that also support the trend to give more importance to the biliary limb for its benefits of greater glycemic control and T2D remission in those with persistent disease [12]. The experience in our trial shows that lengthening the BPL achieves highest benefits on weight loss at 12 months; however, its midand long-term impact is still in question.…”

“…The experience in our trial shows that lengthening the BPL achieves highest benefits on weight loss at 12 months; however, its midand long-term impact is still in question. LBPL-GB's advantage related to co-morbidities seems to be modest, as described by other authors, but follow-up will continue to be a determining factor [12][13][14]. Physiologic changes exist that could support limb elongation in gastric bypass, exceeding "simple" malabsorption.…”

Differential GIP/GLP‐1 intestinal cell distribution in diabetics’ yields distinctive rearrangements depending on Roux‐en‐Y biliopancreatic limb length

“…More recently, T2D remission rates after RYGB with 100 cm longer biliopancreatic limbs were shown to be greater as compared to classic procedures with shorter 50 cm biliopancreatic limbs . In our own series the metabolic outcomes of T2D submitted to RYGB with a longer biliopancreatic limb, were found to be better than predicted from the previously reported for classic procedures . A possible explanation for the enhanced anti‐diabetic effects could be a different arrangement of the intestinal anatomy leading to distinctive gut hormone variations .…”

“…16 In our own series the metabolic outcomes of T2D submitted to RYGB with a longer biliopancreatic limb, were found to be better than predicted from the previously reported for classic procedures. 25,26 A possible explanation for the enhanced anti-diabetic effects could be a different arrangement of the intestinal anatomy leading to distinctive gut hormone variations. 13 Guedes et al 17 documented in 30 cadavers that GIP staining cell density were predominant in the first 80 cm after the duodenal angle, while GLP-1 staining cell density was higher from 200 cm onwards.…”

Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases

“…Ideally, the bowel length must always be measured. There is now enough evidence showing that a long BP limb provides more weight loss and better metabolic effect [31][32][33][34][35][36]. In LPRYGB, the common channel is usually 200 cm and the alimentary limb 100 cm.…”