IBC Oxford Oral Abstract 61 - Adjusted biliopancreatic limb length versus fixed biliopancreatic limb length in OAGB for weight regain after sleeve gastrectomy: a controlled randomized trial

Abstract Background Adjusting the biliopancreatic limb length in one anastomosis gastric bypass is proposed as the main factor for weight loss and glycemic control. The aim of our randomized clinical trial was to ascertain whether adjusted biliopancreatic limb (PBL) length measuring 35 percent from total bowel length (TBL) results in superior outcomes after one anastomosis gastric bypass (OAGB) compared with a fixed 200 cm biliopancreatic limb length in redo surgery for weight regain after sleeve gastrectomy (SG). Methods This controlled randomized study was conducted at General Surgery Department, Kafr El Sheikh University Hospital and affiliated hospitals from June 2020 to June 2023. 60 patients were randomly divided into two groups, with 30 patients in each group. Patients were prepared for OAGB as a redo surgery for previous SG. In Group A, a fixed 200 cm PBL length was done, while in Group B, a tailored PBL based on TBL with PBL length measuring 35 percent of the TBL. The primary outcome was percentage total weight loss at 5 years. Results 60 patients were randomized into the standard biliopancreatic limb group (30 patients) or the tailored biliopancreatic limb group (30 patients). 1-year percentage total weight loss was 25.8% in the fixed group and 36.2% in the tailored group. The mean operative duration was 78.63 ± 7.42 min in group A and 105.45 ± 5.41 min in group B (P 0.05). There was statistically significant difference in %EWL, %TWL, T2DM, and hypertension resolution rates among the groups. About vitamin deficiency, Iron and ferritin deficiency, differences were not statistically significant. Conclusion Tailoring biliopancreatic limb length based on TBL is safe and feasible. Giving more total weight loss percentage than the fixed group and similar vitamin supplements needed and comparable complications rate.