Abstract Introduction Bariatric surgery has been proven to enhance durable excess weight loss (EWL), eliminate (or ameliorate) comorbidities, improve quality of life (QoL), and lengthen life span. The modification of the original Mason and Ito loop gastric bypass, as pioneered by Rutledge, consisted of a long, narrow, vertical gastric tube along the lesser curvature of the stomach that was connected to a loop of small bowel approximately 200 cm from the ligament of Treitz in an antecolic fashion. There is also no consensus on the ideal length of the afferent loop. Due to the limited data on the effect of common limb length on the outcomes of laparoscopic one anastomosis gastric bypass (OAGB), the aims of this study were to evaluate the effect of the common limb length on the outcomes of laparoscopic OAGB in morbidly obese patients, specifically regarding %EBWL, remission of comorbidities, incidence of malnutrition, and the necessity for revisional surgery. Patients and methods This comparative prospective study was conducted on 46 patients with clinically diagnosed morbid obesity at Mansoura University Hospital between May 2016 and May 2019. Patients were divided into two groups: Group I (conventional OAGB): included 25 patients who underwent conventional laparoscopic OAGB with a 200 cm limb from the duodenojejunal flexure. Group II (distal OAGB): included 21 patients who underwent distal laparoscopic OAGB with a common limb length of 300 cm measured from the ileocecal valve. Each group was then subdivided based on the initial BMI into subgroups, depending on whether their BMI was below or above 50 kg/m2. Results Group II shows a notably higher frequency of esophageal reflux symptoms and malnutrition. Nine cases from the distal group were re-admitted due to PEM with severe weight loss and chronic diarrhea accompanied by micronutrient deficiency. One patient in the conventional group was re-admitted for PEM. Six cases from the distal group underwent revisional bariatric procedures: three total restorations, two RYGBs, and one with BPL length reduced to 200 cm. In the conventional group, only one patient underwent revisional surgery, which involved total restoration through division of the gastrojejunostomy and gastrogastric anastomosis. In cases of morbid obesity across both groups (subgroups IA and IIA), there was a higher incidence of re-admission and revision surgery in Group II compared to Group I (50% versus 9.1%, respectively). At a ten-year follow-up, there is no statistically significant difference between the two groups of morbidly obese cases in terms of body mass index or percentage of excess body weight lost (EBWL), with weight regain being more evident in the conventional group. One case in the conventional group developed an anastomotic ulcer, treated conservatively, but conversion to RYGB was performed due to intractable pain, which was found due to chronic posterior penetration. Conclusion Our results showed comparable outcomes regarding %EBWL and comorbidity.
Elghadban et al. (Thu,) studied this question.