Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2026
Tailored vs fixed biliopancreatic limb length in redo one-anastomosis gastric bypass after sleeve gastrectomy: A retrospective cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Abosheisha Mohamed, Omar Islam, Ismaiel Mohamed, Aosmali Ahmed, Terra Mohamed, Abdelglil Momen, Mohamed Mohamed, Fawzy Reda, Ismaiel Abdulrahman, Wilson Jeremy, Magee Conor, Elemawy Mohamed
Аннотация
BACKGROUND: Revisional one-anastomosis gastric bypass (OAGB) is an available intervention after failed sleeve gastrectomy (SG), but the optimal biliopancreatic limb (BPL) length remains uncertain. This study compares tailored vs fixed BPL length in revisional OAGB after SG, with an emphasis on weight loss, nutritional outcomes, and gastrointestinal symptoms.
METHODS: This retrospective cohort study included 200 patients who underwent revisional OAGB after SG for inadequate weight loss or weight regain. Patients were assigned according to operative strategy into a tailored BPL group (n = 100) and a fixed BPL group (n = 100). In the fixed group, the BPL length was 200 cm. In the tailored group, BPL length was set at 30% of the total measured small bowel length, with a mean length of 276.66 ± 34.12 cm. Patients were followed up at 6, 12, and 24 months. Outcomes included percentage excess weight loss (%EWL), percentage total weight loss (%TWL), body mass index, micronutrient deficiency, 1-year biochemical markers, gastrointestinal symptoms, complications, and quality of life.
RESULTS: Weight-loss outcomes significantly favored the tailored group at all follow-up points. Mean %EWL at 6, 12, and 24 months was 38% ± 10%, 71% ± 23%, and 92% ± 30% in the tailored group vs 31% ± 10%, 55% ± 20%, and 66% ± 22% in the fixed group (all P <.001). Mean %TWL was also greater in the tailored group: 18% ± 5% vs 14% ± 3% at 6 months, 33% ± 5% vs 25% ± 6% at 12 months, and 45% ± 5% vs 33% ± 7% at 24 months (all P <.001). Micronutrient deficiency was less frequent in the tailored group (4% vs 26%; P <.001), with significantly better hemoglobin, serum iron, vitamin D, calcium, and albumin levels at 1 year. Quality-of-life outcomes also favored the tailored approach, although mild bile reflux was reported more often in this group.
CONCLUSION: Our findings suggest that in revisional OAGB after SG, tailoring the BPL to 30% of the total small bowel length is associated with greater weight loss, better nutritional preservation, and improved quality of life compared with a fixed 200-cm limb.
METHODS: This retrospective cohort study included 200 patients who underwent revisional OAGB after SG for inadequate weight loss or weight regain. Patients were assigned according to operative strategy into a tailored BPL group (n = 100) and a fixed BPL group (n = 100). In the fixed group, the BPL length was 200 cm. In the tailored group, BPL length was set at 30% of the total measured small bowel length, with a mean length of 276.66 ± 34.12 cm. Patients were followed up at 6, 12, and 24 months. Outcomes included percentage excess weight loss (%EWL), percentage total weight loss (%TWL), body mass index, micronutrient deficiency, 1-year biochemical markers, gastrointestinal symptoms, complications, and quality of life.
RESULTS: Weight-loss outcomes significantly favored the tailored group at all follow-up points. Mean %EWL at 6, 12, and 24 months was 38% ± 10%, 71% ± 23%, and 92% ± 30% in the tailored group vs 31% ± 10%, 55% ± 20%, and 66% ± 22% in the fixed group (all P <.001). Mean %TWL was also greater in the tailored group: 18% ± 5% vs 14% ± 3% at 6 months, 33% ± 5% vs 25% ± 6% at 12 months, and 45% ± 5% vs 33% ± 7% at 24 months (all P <.001). Micronutrient deficiency was less frequent in the tailored group (4% vs 26%; P <.001), with significantly better hemoglobin, serum iron, vitamin D, calcium, and albumin levels at 1 year. Quality-of-life outcomes also favored the tailored approach, although mild bile reflux was reported more often in this group.
CONCLUSION: Our findings suggest that in revisional OAGB after SG, tailoring the BPL to 30% of the total small bowel length is associated with greater weight loss, better nutritional preservation, and improved quality of life compared with a fixed 200-cm limb.