Abstract Background The optimal biliopancreatic limb (BPL) length in one anastomosis gastric bypass (OAGB) remains a topic of debate, particularly in revisional surgeries after failed sleeve gastrectomy (SG). In clinical practice, the entire small bowel length is not always measured. Instead, physicians commonly measure the proximal portion of the small bowel and create a BPL at a fixed distance, without assessing the entire length of the small bowel. Neglecting BPL length can lead to complications as inadequate weight loss in patients with small bowel length 650 cm, or nutritional deficiencies and excessive weight loss in patients with small bowel length 550 cm Objective This study evaluates and compare the effect of fixed versus tailored biliopancreatic limb (BPL) lengths on excess weight loss (%EWL), resolution of comorbidities, and nutritional deficiencies, after converting sleeve gastrectomy (SG) to one anastomosis gastric bypass (OAGB), within a 2-year follow-up. Patients and Methods A retrospective cohort study evaluated 80 patients undergoing elective laparoscopic one anastomosis gastric bypass (OAGB) after failed sleeve gastrectomy (SG) from July 2020 to March 2023 at Ain Shams University Hospital. Patients were divided into two groups; group A with Fixed biliopancreatic limb (BPL) length of 200 cm from the ligament of Treitz, group B with tailored BPL length to bypass approximately 35% of the small bowel, with a common limb (CL) of at least 400 cm. Results There were no statistically significant differences between the groups in terms of baseline characteristics. Preliminary findings suggest that tailored BPL length relative to the small bowel was associated with higher weight loss, fewer nutritional deficiencies, and comparable resolution of comorbidities, when compared to the fixed BPL group. Conclusion Measuring the entire length of the small bowel and creation of a reasonable BPL length relative to small bowel is crucial to prevent postoperative nutritional deficiencies or unsatisfactory weight loss results specially in revisional cases to minimize the need for new corrective surgery. Tailored BPL length relative to small bowel is superior to the fixed 200-cm BPL as it is associated with better weight loss results, fewer nutritional deficiencies, and similar resolution of comorbidities, however a common channel of 400 cm should be left. Further randomized studies with larger sample sizes and longer follow-up periods are necessary to confirm the primary results of this study.
A Sat, study studied this question.