Skip to main content
Erschienen in: Obesity Surgery 12/2018

02.08.2018 | Original Contributions

A Longer Biliopancreatic Limb in Roux-en-Y Gastric Bypass Improves Weight Loss in the First Years After Surgery: Results of a Randomized Controlled Trial

verfasst von: Jens Homan, Abel Boerboom, Edo Aarts, Kemal Dogan, Cees van Laarhoven, Ignace Janssen, Frits Berends

Erschienen in: Obesity Surgery | Ausgabe 12/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

Despite the fact that the RYGB is performed on a broad scale worldwide as a reliable treatment for morbid obesity, there is no uniform technique for this operation. A number of studies have tried to demonstrate an additional weight loss effect by lengthening the alimentary limb, but to no avail. At this moment in time, the role of the biliopancreatic limb on weight loss is for the greater part unknown. The aim of this randomized controlled trial was to compare the effect on weight loss of a long biliopancreatic limb Roux-en-Y gastric bypass (LBP-GB) with a standard RYGB (S-GB).

Methods

A LBP-GB (BPL 150 cm, alimentary limb 75 cm) was compared with a S-GB (BPL 75 cm, alimentary limb 150 cm). One hundred forty-six patients were randomized in two groups. Weight loss, morbidity, reduction of comorbidities, nutritional status, and quality of life were measured during a period of 4 years.

Results

Patient characteristics were comparable in both groups. Mean EWL in the LBP-GB group after 12, 24, 36, and 48 months was 81, 85, 78, and 72% respectively versus 71, 73, 68, and 64% in the S-GB group. The %EWL difference between groups was significant as soon as 9 months postoperatively and continued throughout the follow-up period.

Conclusions

While LBP-GB achieved a significant increase in %EWL in the first years after surgery, no difference in long-term %TWL was observed after 4 years. In this study, the advantage of LBP-GB with respect to weight loss is modest, but shows promising gripping points for future improvements in RYGB design.
Literatur
1.
Zurück zum Zitat Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236(5):554–9.CrossRef Rubino F, Gagner M. Potential of surgery for curing type 2 diabetes mellitus. Ann Surg. 2002;236(5):554–9.CrossRef
2.
Zurück zum Zitat Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50.CrossRef Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50.CrossRef
3.
Zurück zum Zitat Vasas P, Al-Khyatt W, Idris I, et al. Mid-term remission of type 2 diabetes mellitus after laparoscopic Roux en-Y gastric bypass. World J Surg. 2016;40(11):2719–25.CrossRef Vasas P, Al-Khyatt W, Idris I, et al. Mid-term remission of type 2 diabetes mellitus after laparoscopic Roux en-Y gastric bypass. World J Surg. 2016;40(11):2719–25.CrossRef
4.
Zurück zum Zitat Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59(5):945–53.CrossRef Cummings DE, Arterburn DE, Westbrook EO, et al. Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial. Diabetologia. 2016;59(5):945–53.CrossRef
5.
Zurück zum Zitat Courcoulas AP, Belle SH, Neiberg RH, et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg. 2015;150(10):931–40.CrossRef Courcoulas AP, Belle SH, Neiberg RH, et al. Three-year outcomes of bariatric surgery vs lifestyle intervention for type 2 diabetes mellitus treatment: a randomized clinical trial. JAMA Surg. 2015;150(10):931–40.CrossRef
6.
Zurück zum Zitat Boza C, Munoz R, Salinas J, et al. Safety and efficacy of Roux-en-Y gastric bypass to treat type 2 diabetes mellitus in non-severely obese patients. Obes Surg. 2011;21(9):1330–6.CrossRef Boza C, Munoz R, Salinas J, et al. Safety and efficacy of Roux-en-Y gastric bypass to treat type 2 diabetes mellitus in non-severely obese patients. Obes Surg. 2011;21(9):1330–6.CrossRef
7.
8.
Zurück zum Zitat Powell MS, Fernandez AZJ. Surgical treatment for morbid obesity: the laparoscopic Roux-en-Y gastric bypass. Surg Clin North Am. 2011;91(6):1203–24.CrossRef Powell MS, Fernandez AZJ. Surgical treatment for morbid obesity: the laparoscopic Roux-en-Y gastric bypass. Surg Clin North Am. 2011;91(6):1203–24.CrossRef
9.
Zurück zum Zitat Griffen Jr WO, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid. Ann Surg. 1977;1977(4):500–9.CrossRef Griffen Jr WO, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid. Ann Surg. 1977;1977(4):500–9.CrossRef
10.
Zurück zum Zitat Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis. 2008;4(2):166–72.CrossRef Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis. 2008;4(2):166–72.CrossRef
11.
Zurück zum Zitat Choban PS, Flancbaum L. The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial. Obes Surg. 2002;12(4):540–5.CrossRef Choban PS, Flancbaum L. The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial. Obes Surg. 2002;12(4):540–5.CrossRef
12.
Zurück zum Zitat MacLean LD, Rhode BM, Nohr CW. Long- or short-limb gastric bypass? J Gastrointest Surg. 2001;5(5):525–30.CrossRef MacLean LD, Rhode BM, Nohr CW. Long- or short-limb gastric bypass? J Gastrointest Surg. 2001;5(5):525–30.CrossRef
13.
Zurück zum Zitat Leifsson BG, Gislason HG. Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients. Obes Surg. 2005;15(1):35–42.CrossRef Leifsson BG, Gislason HG. Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients. Obes Surg. 2005;15(1):35–42.CrossRef
14.
Zurück zum Zitat Nergaard BJ, Leifsson BG, Hedenbro J, et al. Gastric bypass with long alimentary limb or long pancreato-biliary limb--long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg. 2014;24(10):1595–602.CrossRef Nergaard BJ, Leifsson BG, Hedenbro J, et al. Gastric bypass with long alimentary limb or long pancreato-biliary limb--long-term results on weight loss, resolution of co-morbidities and metabolic parameters. Obes Surg. 2014;24(10):1595–602.CrossRef
15.
Zurück zum Zitat Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg. 2007;17(2):260–70.CrossRef Fried M, Hainer V, Basdevant A, et al. Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg. 2007;17(2):260–70.CrossRef
16.
Zurück zum Zitat Oria HE, Moorehead MK. Bariatric analysis and reporting outcome system (BAROS). Obes Surg. 1998;8(5):487–99.CrossRef Oria HE, Moorehead MK. Bariatric analysis and reporting outcome system (BAROS). Obes Surg. 1998;8(5):487–99.CrossRef
17.
Zurück zum Zitat Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. Br Med J. 2010;340:c869.CrossRef Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. Br Med J. 2010;340:c869.CrossRef
18.
Zurück zum Zitat American Diabetes Association. Standards of medical care in diabetes - 2017. Diabetes Care. 2017;40(suppl. 1):S11–24.CrossRef American Diabetes Association. Standards of medical care in diabetes - 2017. Diabetes Care. 2017;40(suppl. 1):S11–24.CrossRef
19.
Zurück zum Zitat Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med. 2014;370(21):2002–13.CrossRef Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med. 2014;370(21):2002–13.CrossRef
20.
Zurück zum Zitat Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.CrossRef Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.CrossRef
21.
Zurück zum Zitat Mahawar KK, Kumar P, Parmar C, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2016;26(1):196–204.CrossRef Mahawar KK, Kumar P, Parmar C, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2016;26(1):196–204.CrossRef
22.
Zurück zum Zitat Rutledge R. The mini-gastric bypass: experience with the first 1274 cases. Obes Surg. 2001;11(3):276–80.CrossRef Rutledge R. The mini-gastric bypass: experience with the first 1274 cases. Obes Surg. 2001;11(3):276–80.CrossRef
23.
Zurück zum Zitat Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI>35 and <35 kg/m2. J Gastrointest Surg. 2008;12(5):945–52.CrossRef Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI>35 and <35 kg/m2. J Gastrointest Surg. 2008;12(5):945–52.CrossRef
24.
Zurück zum Zitat Topart P, Becouarn G. The single anastomosis duodenal switch modifications: a review of the current literature on outcomes. Surg Obes Relat Dis. 2017;13(8):1306–12.CrossRef Topart P, Becouarn G. The single anastomosis duodenal switch modifications: a review of the current literature on outcomes. Surg Obes Relat Dis. 2017;13(8):1306–12.CrossRef
25.
Zurück zum Zitat Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.CrossRef Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.CrossRef
26.
Zurück zum Zitat Yu J, Zhou X, Li L, et al. The long-term effects of bariatric surgery for type 2 diabetes: systematic review and meta-analysis of randomized and non-randomized evidence. Obes Surg. 2015;25(1):143–58.CrossRef Yu J, Zhou X, Li L, et al. The long-term effects of bariatric surgery for type 2 diabetes: systematic review and meta-analysis of randomized and non-randomized evidence. Obes Surg. 2015;25(1):143–58.CrossRef
27.
Zurück zum Zitat Risstad H, Kristinsson JA, Fagerland MW, et al. Bile acid profiles over 5 years after gastric bypass and duodenal switch: results from a randomized clinical trial. Surg Obes Relat Dis. 2017;13(9):1544–53.CrossRef Risstad H, Kristinsson JA, Fagerland MW, et al. Bile acid profiles over 5 years after gastric bypass and duodenal switch: results from a randomized clinical trial. Surg Obes Relat Dis. 2017;13(9):1544–53.CrossRef
28.
Zurück zum Zitat Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes. 2017;7(5):273–89.CrossRef Kolotkin RL, Andersen JR. A systematic review of reviews: exploring the relationship between obesity, weight loss and health-related quality of life. Clin Obes. 2017;7(5):273–89.CrossRef
Metadaten
Titel
A Longer Biliopancreatic Limb in Roux-en-Y Gastric Bypass Improves Weight Loss in the First Years After Surgery: Results of a Randomized Controlled Trial
verfasst von
Jens Homan
Abel Boerboom
Edo Aarts
Kemal Dogan
Cees van Laarhoven
Ignace Janssen
Frits Berends
Publikationsdatum
02.08.2018
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 12/2018
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-018-3421-7

Weitere Artikel der Ausgabe 12/2018

Obesity Surgery 12/2018 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.