Abstract
BACKGROUND: This study reports mid-term results on weight loss and T2D remission in patients undergoing Roux-en-Y gastric bypass (RYGB) with short versus long biliopancreatic limb (BPL). METHODS: All patients with obesity undergoing RYGB procedures with long BPL (150 cm) versus short BPL (60 cm) between 2016 and 2021 at a tertiary reference center for bariatric surgery were compared using propensity score matching to assess for T2D remission, HbA1c evolution, weight loss and nutritional deficiencies. RESULTS: A total of 165 patients were included, 69 patients (71% female, mean age 43.9 ± 14 years, mean baseline BMI 42.4 ± 4.3 kg/m(2), mean HbA1c 6.75 ± 1.9%) underwent long-BPL RYGB and 96 patients (76% female, mean age 43.1 ± 12 years, mean baseline BMI 41.7 ± 3.5 kg/m(2), mean HbA1c 5.97 ± 1.1%) had a short-BPL. In long-BPL RYGB weight loss was more accelerated after 1 year, but did not differ after 2 years compared to short-BPL RYGB (mean %TWL of 33.9 ± 9.4% versus 31.6 ± 7.7%; p = 0.09 at 1 year and mean %TWL of 33.8 ± 9.6% and 32 ± 8.8%; p = 0.24 at 2 years). Complete remission of T2D occurred in 53.3% after long-BPL RYGB and 61.3% after short-BPL RYGB (p = 0.53). Long-BPL RYGB resulted in higher reduction of HbA1c after 2 years (1.5% vs. 0.72%, p = < 0.001). Besides a higher zinc deficiency in the long-BPL group (p = 0.009), no significant differences in nutritional deficiencies or malnutrition were observed between the two groups. CONCLUSION: Implementation of a long-BPL RYGB is safe and shows an accelerated weight loss and improved HbA1c reduction with low overall morbidity after 2 years.