Long Biliopancreatic Limb (BPL) RYGB Versus Short BPL RYGB Post-Suboptimal Initial Clinical Response of SG or Recurrent Weight Gain: A Randomized Controlled Study

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has long been one of the main metabolic and bariatric choices. It has been the most frequently used conversional procedure for a sleeve gastrectomy (SG) with suboptimal initial clinical response (SoCR) or recurrent weight gain (RWG). RYGB provides its effect through both dietary restriction and malabsorption, with efficient weight and metabolic control relating to the excluded gut. This study was designed to investigate the effect of long biliopancreatic limb (BPL) RYGB versus short BPL RYGB post-SoCR or RWG of SG on weight loss and metabolic profile. PATIENTS AND METHODS: This is a randomized controlled trial that included patients who had undergone SG with SoCR or RWG and were equally enrolled in the long BPL (LRYGB-LBPL) group and the short BPL group (LRYGB-SBPL). The patients were followed for 1 year, and weight loss, metabolic profile, and postoperative complications were analyzed. The LRYGB-LBPL group showed statistically significant improvements in EBMIL%, HbA1c reduction, and HDL levels, while other outcomes showed no significant differences. This study's findings suggest that extending the BPL length in conversional RYGB may enhance the procedure's effectiveness in certain aspects of weight reduction and metabolic profile, although many outcomes were similar between groups.