Impact of Variations in Biliopancreatic Limb Length on Surgical Outcomes in Laparoscopic Roux-en-Y Gastric Bypass: A Single Centre Pilot Study

Background: Obesity has emerged as a global health challenge, with a significant rise in its prevalence over recent decades. Bariatric surgery, particularly Roux-en-Y Gastric Bypass (RYGB), is recognized as an effective treatment for severe obesity and related comorbidities, offering sustained weight loss and improvement in metabolic health. However, the impact of biliopancreatic limb (BPL) length on outcomes, including body mass index (BMI) reduction, total weight loss (TWL), and nutritional balance, remains a subject of debate. This study aims to evaluate the impact of varying BPL lengths on weight loss, metabolic outcomes, and postoperative complications, providing insights into optimal limb reduction strategies for achieving balanced surgical outcomes. Methods: A pilot study involving 75 patients with randomized classification into three groups: 7.5%, 15% and 22.5% limb reduction was carried out. The data were collected pre- and postoperation, where BMI, excess weight loss (EWL), and TWL were statistically analyzed. Related data, such as age, sex, height, co-morbid conditions, and adverse events, were also recorded. Results: The 22.5% BPL reduction group demonstrated the most significant weight loss outcomes, achieving the highest reductions in BMI, EWL, and TWL. However, this group also carried a risk of nutritional deficiencies. The 15% BPL reduction group exhibited optimized outcomes, with substantial BMI reduction and weight loss, fewer outliers in EWL and TWL, and maintained nutritional balance. The 7.5% BPL reduction group showed the least weight loss and BMI reduction, with one case of postsurgery weight gain attributed to lifestyle factors. Across all groups, the changes in BMI were statistically significant, with postoperative complications being minimal and specific to longer limb reductions. Conclusion: The 22.5% limb reduction group achieved the greatest weight and BMI reductions, while the 15% group provided more balanced results with fewer complications and better nutritional outcomes. Larger studies are needed to confirm these findings and evaluate long-term impacts.