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Background: Long-term durability after Roux-en-Y gastric bypass is challenging in the super-obese population. Although lengthening of biliopancreatic limb (BPL) is associated with higher rates of weight loss, shortening of common limb (CL) is related to higher risk of malabsorption., Objectives: In this study, we aimed at evaluating the importance of the total alimentary limb length by creating a 2-m BPL diversion with varying CL lengths., Setting: High-volume bariatric center, Norway., Methods: Three groups of patients (N = 187) with different limb lengths were included in this retrospective cohort-analysis as follows: group 1 (n = 69; Roux limb = 150 cm, BPL = 60 cm), group 2 (n = 88; BPL = 200 cm, CL = 150 cm), and group 3 (n = 30; BPL = 200 cm, CL = 200 cm). Weight loss, regain, and failure were analyzed along with malabsorption issues., Results: Preoperative body mass index (BMI) was higher in group 2 (58.5, P < .001) and 3 (57.4) versus group 1 (54.6, P = .011). No other clinically significant differences between the groups were noted. Follow-up rate was 95% at year 2, 74% at year 5, and 52% at year 10. At 10-year follow-up, excess weight loss and total weight loss was higher in group 2 (70.4%; 40.3%) and 3 (64.0%; 35.9%) compared with group 1 (55.9%; 29.2%). Excess weight loss failure was higher in group 1 versus 2 (30% versus 8.3%, P < .001). No difference in short- or long-term complications was seen except higher occurrence of internal hernia in distal Roux-en-Y gastric bypass groups (11.4%, 6.7%). Vitamin and mineral deficiencies occurred more frequently the shorter the CL was., Conclusion: Sustainable weight loss in a long-term follow-up is achieved by shortening the total alimentary limb length with a 2-m BPL diversion that should not be attached <200 cm from the ileocecal junction owing to higher rates of internal hernia and vitamin and mineral deficiencies., (Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Reversal of Roux-en-Y gastric bypass (RYGB) to normal anatomy (NA) is mandated in selected cases. However, reversal operations are associated with high complication rates and long operative times. In this study, we present the functional reversal (FR) as a novel method and an alternative to reversal to NA in treating the otherwise intractable symptoms rarely occurring after RYGB. Methods: This is a retrospective cohort study of RYGB-patients with symptoms resistant to non-surgical treatment. Placement of gastrostomy tube for surgical evaluation and optimization of patients was usually done before FR. Resolution of symptoms was assessed along with efficacy and safety of the procedure. Achieved results were compared with data from the literature pertaining to reversal to NA. Settings: High-volume bariatric center, Norway. Results: Ten patients underwent FR. Mean follow-up after reversal was 18.4 months. Symptoms leading to operation improved in all patients. Eight patients suffered from hypoglycemia; resolution was seen in six and improvement of symptoms in the remaining two. Food intolerance, early dumping, nausea, postprandial abdominal pain, and malnutrition were alleviated in all patients. One leak was seen. Mean surgical time was 35.2 min. Total weight loss (TWL) and excess weight loss (EWL) after index RYGB were reduced 4.5% and 17.8%. Conclusion: Functional reversal looks promising as an alternative to reversal to normal anatomy as it is technically simpler and safer and seems at least as effective in treating otherwise refractory symptoms. [ABSTRACT FROM AUTHOR]

Background: In super-obese patients, rates of weight loss failure and weight regain are high after RYGB. In order to improve weight loss, lengthening of the biliopancreatic limb is vital. In this study, efficacy and safety of two types of RYGB with 2-m BP-limb were assessed in improving weight loss and in the resolution of comorbidities compared with standard RYGB in a long-term follow-up. Methods: This is a retrospective cohort analysis on 671 super-obese patients operated in a 10-year period. Patients were classified into three groups: (1) 155 patients; roux limb 150 cm, BP-limb 60 cm; (2) 230 patients; roux limb 60 cm, BP-limb 200 cm; and (3) 286 patients; roux limb 150 cm, BP-limb 200 cm. EWL, TWL, BMI, failure, weight regain, comorbidity resolution, nutritional status, and complications were assessed. Results: Total alimentary limb length was shortened with 60 cm in group 1 and with 200 cm in groups 2 and 3. EWL, BMI change, and TWL were higher in the 2-m BP-limb groups vs group 1. No differences in complication rates were found, except higher frequency of marginal ulcers in patients with a shorter roux limb. EWL failure was higher in group 1 (10.3%) vs the other groups (4.3%; 5.2%). Group 3 had significantly less weight regain (26.6%). Remission of comorbidities was higher in the 2-m BP-limb groups at expense of nutritional and vitamin deficiencies (3.9%; 5.9%). No difference in hypoalbuminemia was noted. Conclusion: Lengthening of the BP-limb gives significantly higher weight loss, lower rate of EWL failure, and lesser weight regain along with better resolution of obesity-associated comorbidities. [ABSTRACT FROM AUTHOR]