Mid-term Outcomes in Primary Roux-en-Y Gastric Bypass Procedures with Short or Long Biliopancreatic Limb

Background This study reports mid-term results on weight loss and T2D remission in patients undergoing Roux-en-Y gastric bypass (RYGB) with short versus long biliopancreatic limb (BPL). Methods All patients with obesity undergoing RYGB procedures with long BPL (150 cm) versus short BPL (60 cm) between 2016 and 2021 at a tertiary reference center for bariatric surgery were compared using propensity score matching to assess for T2D remission, HbA1c evolution, weight loss and nutritional deficiencies. Results A total of 165 patients were included, 69 patients (71% female, mean age 43.9 ± 14 years, mean baseline BMI 42.4 ± 4.3 kg/m 2 , mean HbA1c 6.75 ± 1.9%) underwent long-BPL RYGB and 96 patients (76% female, mean age 43.1 ± 12 years, mean baseline BMI 41.7 ± 3.5 kg/m 2 , mean HbA1c 5.97 ± 1.1%) had a short-BPL. In long-BPL RYGB weight loss was more accelerated after 1 year, but did not differ after 2 years compared to short-BPL RYGB (mean %TWL of 33.9 ± 9.4% versus 31.6 ± 7.7%; p = 0.09 at 1 year and mean %TWL of 33.8 ± 9.6% and 32 ± 8.8%; p = 0.24 at 2 years). Complete remission of T2D occurred in 53.3% after long-BPL RYGB and 61.3% after short-BPL RYGB ( p = 0.53). Long-BPL RYGB resulted in higher reduction of HbA1c after 2 years (1.5% vs. 0.72%, p = < 0.001). Besides a higher zinc deficiency in the long-BPL group ( p = 0.009), no significant differences in nutritional deficiencies or malnutrition were observed between the two groups. Conclusion Implementation of a long-BPL RYGB is safe and shows an accelerated weight loss and improved HbA1c reduction with low overall morbidity after 2 years.