Total Alimentary Limb Length Is Not Associated with Weight Loss Following Proximal Roux-en-Y Gastric Bypass.

IF 2.9 3区医学 Q1 SURGERY

Obesity Surgery Pub Date : 2025-03-27 DOI:10.1007/s11695-025-07817-5

Vance L Albaugh, Jacob L Weinberg, Danxia Yu, Matthew D Spann, D Brandon Williams, Jason M Samuels, Charles Robb Flynn, Wayne J English

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引用次数: 0

Abstract

Background: Standard Roux-en-Y gastric bypass (RYGB) typically manipulates the proximal portion of the small intestine, leaving a variable and unknown common channel and total alimentary limb length (TALL). Despite high variability in postoperative weight loss, the factors contributing to this variability remain unknown. Given the known variability in small intestinal length, this unmeasured variability in TALL may be associated with weight loss responses.

Objective: To test the hypothesis that TALL is associated with postoperative weight loss following primary laparoscopic Roux-en-Y gastric bypass (RYGB).

Setting: Vanderbilt University Medical Center; Nashville, Tennessee, USA.

Methods: A total of 329 patients were recruited for this observational study and consented to laparoscopic measurement of the entire small intestinal length at the time of primary RYGB. Of these patients, 208 had successful measurement of the small bowel length (SBL) and underwent RYGB with a fixed biliopancreatic limb length (BPL, 50 cm). Common channel length (CCL) was allowed to vary normally to test the association between TALL and postoperative weight loss.

Results: Follow-up rates were 77% at 6 months and 41% at 24 months. Average SBL was 592 cm (min = 390 cm, max = 910 cm), with a standard deviation of 107 cm that led to significant variation in CCL (shortest 190 cm, longest 730 cm). Regression was used to model weight loss and body mass index, as well as percent change from baseline, for each patient given the measured TALL and CCL. Despite significant variation in TALL, there were no clinically significant effects of TALL or CCL on weight loss up to 24 months.

Conclusions: With a fixed BPL, normal variation in TALL does not significantly contribute to weight loss variability following RYGB. Future studies are needed to better understand the importance of intestinal limb lengths in primary and revisional RYGB surgery.

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近端Roux-en-Y胃旁路术后总消化肢体长度与体重减轻无关。

背景：标准Roux-en-Y胃旁路术（RYGB）通常操作小肠近端部分，留下可变且未知的公共通道和总消化肢长度（TALL）。尽管术后体重减轻有很大的可变性，但导致这种可变性的因素仍然未知。考虑到小肠长度的已知变异性，这种未测量的TALL变异性可能与减肥反应有关。目的：验证原发性腹腔镜Roux-en-Y胃旁路术（RYGB）术后体重减轻与TALL相关的假设。地点：范德比尔特大学医学中心；纳什维尔，美国田纳西州。方法：本观察性研究共招募了329例患者，并同意在原发性RYGB时腹腔镜测量整个小肠长度。在这些患者中，208例成功测量了小肠长度（SBL），并接受了固定胆胰肢长度（BPL, 50 cm）的RYGB。允许共通道长度（CCL）正常变化，以测试TALL与术后体重减轻之间的关系。结果：6个月随访率为77%，24个月随访率为41%。平均SBL为592 cm（最小= 390 cm，最大= 910 cm），标准差为107 cm，导致CCL差异显著（最短190 cm，最长730 cm）。根据测量的TALL和CCL，对每个患者的体重减轻和体重指数以及与基线相比的百分比变化进行回归建模。尽管TALL有显著差异，但在长达24个月的时间里，TALL或CCL对体重减轻没有显著的临床影响。结论：在BPL固定的情况下，正常的TALL变化不会显著影响RYGB后体重减轻的变异性。未来的研究需要更好地了解肠肢长度在原发性和改进性RYGB手术中的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Obesity Surgery 医学-外科

CiteScore

5.80

自引率

24.10%

发文量

567

审稿时长

3-6 weeks

期刊介绍： Obesity Surgery is the official journal of the International Federation for the Surgery of Obesity and metabolic disorders (IFSO). A journal for bariatric/metabolic surgeons, Obesity Surgery provides an international, interdisciplinary forum for communicating the latest research, surgical and laparoscopic techniques, for treatment of massive obesity and metabolic disorders. Topics covered include original research, clinical reports, current status, guidelines, historical notes, invited commentaries, letters to the editor, medicolegal issues, meeting abstracts, modern surgery/technical innovations, new concepts, reviews, scholarly presentations and opinions. Obesity Surgery benefits surgeons performing obesity/metabolic surgery, general surgeons and surgical residents, endoscopists, anesthetists, support staff, nurses, dietitians, psychiatrists, psychologists, plastic surgeons, internists including endocrinologists and diabetologists, nutritional scientists, and those dealing with eating disorders.