Analysis of medium-length biliopancreatic limb on weight loss efficacy in Roux-en-Y gastric bypass: A propensity score-matched retrospective cohort study.

Abstract

Roux-en-Y gastric bypass has emerged as an effective treatment for obesity. The biliopancreatic limb is a critical determinant of surgical efficacy. Existing research predominantly focuses on extreme lengths, whereas the impact of a medium-length biliopancreatic limb (75-125 cm) remains unclear. This study explored the effect of a medium-length biliopancreatic limb on weight loss efficacy at 1-year post-Roux-en-Y gastric bypass. We collected 587 patients undergoing Roux-en-Y gastric bypass at our center between September 2015 and September 2023. Patients were stratified into a medium-length biliopancreatic limb group (biliopancreatic limb between ≥75 cm and ≤125 cm) and a short-length biliopancreatic limb group (biliopancreatic limb ≤50 cm). Propensity score matching was performed at a 1:1 ratio. The primary end points were percentage of total weight loss and percentage of excess weight loss at 1 year postoperatively. Multivariable logistic regression analysis identified independent predictors of weight loss efficacy. In the propensity score matching cohort, the medium-length biliopancreatic limb group exhibited significantly superior weight loss outcomes compared with the short-length biliopancreatic limb group at 1 year: percentage of total weight loss (31.76% vs 27.71%, P < .001) and percentage of excess weight loss (76.28% vs 67.61%, P = .006). Multivariable analysis identified higher preoperative body mass index (odds ratio = 1.10, 95% confidence interval 1.02-1.19, P = .017), longer biliopancreatic limb (odds ratio = 2.27, 95% confidence interval 1.42-3.66, P < .001), and absence of hyperlipidemia (odds ratio = 0.20, 95% confidence interval 0.09-0.39, P < .001) as independent predictors of effective postoperative weight loss. Use of a medium-length biliopancreatic limb in Roux-en-Y gastric bypass is associated with significantly enhanced weight loss at 1 year postoperatively. Biliopancreatic limb length, preoperative body mass index, and hyperlipidemia status are significant predictors for Roux-en-Y gastric bypass surgical efficacy.