title: Perioperative Outcomes of Proximal and Distal Gastric Bypass in Patients with BMI Ranged 50-60 kg/m(2)--A Double-Blind, Randomized Controlled Trial.
abstract: BACKGROUND
  Proximal Roux-en-Y gastric bypass may not ensure adequate weight loss in superobese patients. Bypassing a longer segment of the small bowel may increase weight loss. The objective of the study was to compare the perioperative outcomes of laparoscopic proximal and distal gastric bypass in a double-blind randomized controlled trial of superobese patients. The study was conducted at two public tertiary care obesity centers in Norway.
  
  
  METHODS
  Patients with body mass index (BMI) 50-60 kg/m(2) were randomly assigned to a proximal (150 cm alimentary limb) or a distal (150 cm common channel) gastric bypass. The biliopancreatic limb was 50 cm in both operations. Patients and follow-up personnel were blinded to the type of procedure. Thirty-day outcomes including complications are reported.
  
  
  RESULTS
  We operated on 115 patients, of whom two were excluded at surgery, leaving 56 and 57 patients in the proximal group and distal group, respectively. The median (range) operating time was 72 (36-151) and 101 (59-227) min, respectively (p < 0.001). Two distal procedures were converted to laparotomy during the primary procedure. Median length of hospital stay was 2 (1-4) days in the proximal group and 2 (1-24) days in the distal group. The number of patients with complications and complications categorized according to the Contracted Accordion classification did not differ significantly. However, all six reoperations were performed in the distal group, of which three were completed by laparoscopy (p = 0.01 between groups). There were no deaths.
  
  
  CONCLUSIONS
  In superobese patients with BMI between 50 and 60 kg/m(2), distal gastric bypass was associated with longer operating time and more severe complications resulting in reoperation than proximal gastric bypass.
authors.affiliation: Morbid Obesity Center, Vestfold Hospital Trust, Halfdan Wilhelmsens alle 17, 3103, Tønsberg, Norway, drsvanevik@hotmail.com.
authors.forename: Marius
authors.initials: M
authors.lastname: Svanevik
authors.forename: Hilde
authors.initials: H
authors.lastname: Risstad
authors.forename: Dag
authors.initials: D
authors.lastname: Hofsø
authors.forename: Carl Fredrik
authors.initials: CF
authors.lastname: Schou
authors.forename: Brita
authors.initials: B
authors.lastname: Solheim
authors.forename: Torgeir T
authors.initials: TT
authors.lastname: Søvik
authors.forename: Jon
authors.initials: J
authors.lastname: Kristinsson
authors.forename: Jøran
authors.initials: J
authors.lastname: Hjelmesæth
authors.forename: Tom
authors.initials: T
authors.lastname: Mala
authors.forename: Rune
authors.initials: R
authors.lastname: Sandbu
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004311:Double-Blind Method; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D009767:Obesity, Morbid / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D059035:Perioperative Period; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology