Background

Despite being one of the most performed bariatric procedures, there is no consensus regarding optimal limb lengths of Roux-en-Y gastric Bypass (RYGB). We hypothesize that a ratio-adjusted small bowel to Roux and BP limb lengths in RYGB results in superior outcomes.

Methods

As the initial phase of a multi-part prospective study, we describe total intestinal limb length and length ratios of RYGB patients with BMI> 40. Roux and biliopancreatic limb lengths were not altered due to this study. Patient outcomes, including TWL, nutritional status, and 30-day complications were captured by chart review. As secondary outcome, we explored technical feasibility of counting small bowel length.

Results

A total of 25 patients were included with a mean age of 44 ±10.35 years. The mean BMI was 47.5 ±8.01 kg/m2. Mean operative time was 142 minutes ± 28.6 with mean time counting TIL of 11.52 minutes ±4.19. Ease of bowel measurement was measured using a 4-point Likert scale: very easy (4.3%), easy (30.4%), moderately difficult (43.5%), difficult (17.4%). One case was excluded as the small bowel was not measurable due to intraoperative factors. TIL mean was 592 ±93.34 (450-820). BP limb length mean absolute number was 109± 29 with ratio mean of 18.86% ±5.84. The Roux Length (RL) mean absolute number was 103± 15 representing 17.71% ±3.06.

Conclusions

Intestinal lengths in patients are highly variable. Measuring intestinal lengths in each patient is a safe and time efficient approach. Further studies are needed to evaluate different limb length ratios influencing outcomes of RYGB.