title: Laparoscopic Roux-en-Y gastric bypass in patients with BMI <50: a prospective randomized trial comparing short and long limb lengths.
abstract: BACKGROUND
  It has been shown that long limb gastric bypass in the super-obese (BMI >50) results in increased weight loss in comparison with conventional gastric bypass. The purpose of this study was to compare the effect of short and long limb lengths in patients with BMI<50.
  
  
  METHODS
  48 patients with BMI <50 (46 females / 2 males, mean age 35+/-9.6 years) were prospectively randomized to either a short limb (biliopancreatic limb = 50 cm, alimentary limb = 100 cm) or long limb (biliopancreatic limb = 100 cm, alimentary limb = 150 cm) laparoscopic Roux-en-Y gastric bypass (LRYGBP). In all patients, a 25-mm EEA was used to fashion the gastrojejunostomy and the Roux limb was positioned in an antecolic, antegastric location. Limb lengths were precisely measured in all cases.
  
  
  RESULTS
  There was no difference in demographic data, preoperative BMI, presence of co-morbidities, or duration of surgery. The overall complication rate was not different between the 2 groups; however, the incidence of internal hernias was significantly higher in the long limb group (0 vs 4, P=0.029). The length of hospital stay was longer for the short limb group compared to the long limb group (3.1 vs 2.2 respectively, P=0.004). When comparing the short limb to the long limb patients, the BMI decreased equally in both groups at the following time intervals: preoperative (44.6 vs 44.9), 3 weeks (40.3 vs 40.9), 3 months (35.5 vs 35.2), 6 months (31.2 vs 31.8), and 12 months (27.7 vs 28.3). There were no significant nutritional deficiencies in either group.
  
  
  CONCLUSIONS
  In patients with BMI <50 undergoing LRYGBP, increasing the length of the Roux limb does not improve weight loss and may lead to a higher incidence of internal hernias.
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, College of Physicians and Surgeons of Columbia University, Columbia University Medical Center, New York, NY, USA. wbi2102@columbia.edu
authors.forename: William B
authors.initials: WB
authors.lastname: Inabnet
authors.forename: Theresa
authors.initials: T
authors.lastname: Quinn
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.forename: Meredith
authors.initials: M
authors.lastname: Urban
authors.forename: Alfons
authors.initials: A
authors.lastname: Pomp
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D015992:Body Mass Index; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis* / Q000601:surgery*; D011183:Postoperative Complications; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015431:Weight Loss