Rui Ribeiro1, Sjaak Pouwels2, Chetan Parmar3, João Pereira4, Leonor Manaças4, Anabela Guerra4, Nuno Borges4, João Ribeiro1, Octávio Viveiros4. 1. Clínica de Santo António, Metabolic Patient Multidisciplinary Centre, Reboleira, Lisbon, Portugal. 2. Department of Surgery, Haaglanden Medical Center, Lijnbaan 32, P.O. Box 432, 2501 CK, The Hague, The Netherlands. Sjaakpwls@gmail.com. 3. Whittington Hospital, London, UK. 4. Obesity and Endocrine Diseases Unit, Department of Surgery, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.
Abstract
BACKGROUND: One of the most important complications of the one anastomosis gastric bypass (OAGB) is enterobilio acid reflux (EBAR). We report the concept of the long pouch Roux-en-Y gastric bypass (LPRYGB) meaning a Roux-en-Y with a long pouch and a 100-cm alimentary limb to avoid EBAR, with a long biliopancreatic limb to increase metabolic effects. METHODS: A total of 300 LPRYGB cases in a 4-year period, with a 90% follow-up rate, were analysed. Anthropometric, technical feasibility, morbidity, weight loss and comorbidity outcomes were analysed. RESULTS: The percentage total weight loss (%TWL) was 30.5% at 4 years of follow-up (32.3% in primary and 28.3% in revisions). Six intra-operative (2%) and 28 postoperative complications (9.3%) were seen. Out of this 28 complications, 11 (3.6%) were late complications. Reoperations were performed in 15 patients (5.0%). Clinically relevant EBAR was present in 3 cases only (1%) 4 years after the operation. CONCLUSIONS: The LPRYGB combines the main advantages of the OAGB (light restriction and moderate malabsorption) with the anti-reflux effect from the Roux-en-Y diversion.
BACKGROUND: One of the most important complications of the one anastomosis gastric bypass (OAGB) is enterobilio acid reflux (EBAR). We report the concept of the long pouch Roux-en-Y gastric bypass (LPRYGB) meaning a Roux-en-Y with a long pouch and a 100-cm alimentary limb to avoid EBAR, with a long biliopancreatic limb to increase metabolic effects. METHODS: A total of 300 LPRYGB cases in a 4-year period, with a 90% follow-up rate, were analysed. Anthropometric, technical feasibility, morbidity, weight loss and comorbidity outcomes were analysed. RESULTS: The percentage total weight loss (%TWL) was 30.5% at 4 years of follow-up (32.3% in primary and 28.3% in revisions). Six intra-operative (2%) and 28 postoperative complications (9.3%) were seen. Out of this 28 complications, 11 (3.6%) were late complications. Reoperations were performed in 15 patients (5.0%). Clinically relevant EBAR was present in 3 cases only (1%) 4 years after the operation. CONCLUSIONS: The LPRYGB combines the main advantages of the OAGB (light restriction and moderate malabsorption) with the anti-reflux effect from the Roux-en-Y diversion.
Authors: Ted D Adams; Lance E Davidson; Sheldon E Litwin; Jaewhan Kim; Ronette L Kolotkin; M Nazeem Nanjee; Jonathan M Gutierrez; Sara J Frogley; Anna R Ibele; Eliot A Brinton; Paul N Hopkins; Rodrick McKinlay; Steven C Simper; Steven C Hunt Journal: N Engl J Med Date: 2017-09-21 Impact factor: 91.245