Limb Length Studies
Duodenal Switch related limb length studies.
Maintenance of weight loss in patients with body mass
index >60 kg/m2: importance of length of small bowel
Anthone et al. May 2008
BACKGROUND: It is commonly believed that weight loss after
biliopancreatic diversion/duodenal switch is inversely related
to the length of the alimentary limb and the common channel.
However, the effect of the biliopancreatic limb length (BPL)
on weight loss has received little attention.
METHODS: A total of 1001 patients after biliopancreatic
diversion/duodenal switch (209 men and 792 women, mean age
42 +/- 10 yr, mean body mass index [BMI] 52 +/- 9 kg/m(2))
were divided into 2 groups according to the ratio of the
BPL to the total small bowel length (SBL): a BPL < or =45% of the SBL versus a BPL >45% of the SBL. The nutritional
parameters and percentage of excess weight loss were compared
between the 2 groups.
RESULTS: In patients with a BMI of < or =60 kg/m(2), the
percentage of excess weight loss at 1 year postoperatively
was 66.8% for those with a BPL < or =45% of the SBL and
69.3% for those with a BPL >45% of the SBL (P = NS). At 2
years, the corresponding percentages were 73.7% and 79.5%
(P = NS) and, at 3 years, were 73.4% and 75.2% (P = NS).
In patients with a BMI >60 kg/m(2), the corresponding percentages
of excess weight loss was 56.8% versus 61.4% (P = .07) at 1
year, 62.2% versus 77.5% (P = .04) at 2 years, and 59.8%
versus 77.5% at 3 years (P = .05).
CONCLUSION: The results of our study have shown that amount
of weight lost after biliopancreatic diversion/duodenal switch
is directly related to the proportion of small bowel bypassed
in patients with a BMI >60 kg/m(2). Also, the effect increased
with the duration of follow-up. In less heavy patients, the
BPL/SBL ratio had a minimal effect on long-term weight loss
and a more pronounced effect on nutritional parameters.