Revisions of One Anastomosis Gastric Bypass with Biliopancreatic Limb of 250 cm Multicentre Retrospective Study with a Mean Follow-up of 11 years

Background One-anastomosis gastric bypass (OAGB) is a widely performed bariatric procedure. The length of the biliopancreatic limb (BPL) is a key determinant of weight loss and metabolic effect, but excessively long limbs may predispose to malabsorptive complications. Long-term outcome data for fixed long BPLs remain limited. Objective To evaluate long-term severe complications requiring revisional surgery following OAGB with a fixed biliopancreatic limb length of 250 cm. Methods This multicentre retrospective cohort study included all consecutive patients who underwent primary OAGB with a 250-cm BPL between 2010 and 2020. Data were extracted from hospital electronic and paper records. Patients were invited for a structured clinical and biochemical assessment. Severe complications were predefined and reviewed by a multidisciplinary team. Outcomes of interest were severe complications requiring revisional surgery. Follow-up ranged from 7 to 15 years. Results Of 892 OAGB procedures performed during the study period, 97 patients (10.9%) underwent OAGB with a 250-cm BPL. Complete follow-up data were available for 78 patients (80.4%). Mean age was 47 years, mean preoperative BMI was 46.6 kg/m 2 , and 75.3% were female. Nineteen patients (24.3%) developed severe complications requiring revisional surgery. Indications included severe protein malnutrition (5.1%), refractory bile or acid reflux (6.4%), severe diarrhoea (6.4%), liver failure (2.5%), twisted gastrojejunostomy (2.5%), and excessive weight loss (1.3%). Revisions included conversion to sleeve gastrectomy, Roux-en-Y gastric bypass, or reversal to normal anatomy. Conclusion OAGB with a fixed biliopancreatic limb length of 250 cm was associated with a high rate of severe long-term complications requiring revisional surgery. These findings support cautious tailoring of BPL length and avoidance of routinely long limbs in OAGB.