Dig Surg. The length of alimentary and biliopancreatic limbs and their relationship with weight loss determined by RYGBP is controversial, with doubts about the ideal length of these limbs 16 The importance of the length of the limbs for gastric bypass patients--an evidence-based review. The aim of this study is to investigate the relationship between the length of these limbs and the weight loss, comparing different length limbs and the total weight loss one year after surgery.
The Instrument of Consent was presented and signed by all subjects of study. The authors declare no conflict of interest present in this research. This research was designed according to a randomized and prospective study. The criteria for inclusion and exclusion of patients in the surgical treatment of obesity program, obeyed the principles of the Brazilian Society for Bariatric and Metabolic Surgery.
For the research, four groups were constituted by draw, immediately before the surgical procedure: group A: biliopancreatic limb length of 50 cm and alimentary limb length of cm; group B: biliopancreatic limb length of 50 cm and alimentary limb length of cm; group C: biliopancreatic limb length of cm and alimentary limb length of cm; group D: biliopancreatic limb length of cm and alimentary limb length of cm.
The variables were age, gender, body mass index BMI and percentage of total weight loss. The following sample was carried out for one year. The groups were compared as to their constitution. The percentage of weight loss was measured at one year postoperatively and compared between groups during this period. The collected data were stored in Excel and analyzed later through software Statistical Package for the Social Sciences Were calculated the mean and standard deviation for quantitative variables and comparison between groups was made by analysis of variance ANOVA.
Categorical variables were compared using the Levene test. Composition of each group was homogeneous according to age, gender and BMI. There was no statistic significance between them Table 1. Group A showed total weight loss of When comparing the total weight loss between groups at one year postoperatively, there was no statistical significance Table 2. Thumbnail Table 2 Percentage of total weight loss for the groups.
RYGBP was used for this research because it is the most frequent surgery performed in the department for obese people. Sandoval D. Bariatric surgeries: beyond restriction and malabsorption. Int J Obes. Its effects results from neuroendocrine changes that occur because of anatomical changes caused by technical modifications 1 1. Alterations in gastrointestinal, endocrine, and metabolic processes after bariatric Roux-en-Y gastric bypass surgery. Diabetes Care.
Relationship of bypassed limb length and remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass.
Gastrointest Endosc. Contribution of endogenous glucagon-like peptide 1 to glucose metabolism after Roux-en-Y gastric bypass. It is not clear whether the length of the limbs affects the result of weight loss 11 Mechanisms underlying weight loss after bariatric surgery.
Nat Rev Gastroenterol Hepatol. It seems rational that the more distal the Roux-en-Y the greater the weight loss. It must make the distinction between long Roux-en-Y and distal Roux-en-Y. In general, these perceptions resembled those that previously have been reported to occur upon jejunal distensions in healthy volunteers [ 15 , 16 ].
In a study by Accrino et al. In the present study with Roux limb distension, it was not possible to establish a distinct difference between induction of non-pain and pain sensations, respectively.
The reason to this is unclear and although a statistical type 2 error cannot be excluded, it may be that the mechanosensitivity of the Roux limb had adapted to the changed luminal conditions following surgical construction. Intestinal mechanosensitivity and related perceptions may also differ between obese persons and those with normal weight.
Opposite to what was expected, the perception thresholds i. Low perception thresholds i. It may be speculated that food-induced distension, in addition to perceptions, also elicits an enhanced propulsive motility in the Roux limb that clears the lumen and makes it ready to receive more food. Future studies on Roux limb clearance are needed to further elucidate this possibility. The present investigation also explored the biomechanical properties of the Roux limb in relation to preferred meal size 6 weeks and 1 year after RYGBP surgery.
The major finding was that the size of a meal voluntarily chosen by the subject had a negative correlation to the intraluminal pressure that developed during balloon-induced distension of the Roux limb. In other words, subjects with high luminal pressure in response to balloon inflation preferred small meals. It is, therefore, reasonable to assume that the Roux limb exerts flow resistance that reduces the ingestive ability of the subject. To what extent this influenced BMI was not possible to conclude from the present study because of the small size of the investigated population.
Although still hypothetical, a restrictive property due to the state of the Roux limb wall musculature is of great interest because it may be influenced by luminal nutrients like exposure to fat [ 15 ]. The present study has an explorative character and several study limitations need to be commented. For example, the study enrolled only ten subjects and the risk for statistical type 2 error has already been mentioned. Hence, confirmative studies in larger populations are needed also taking into account to what extent the biomechanical properties of the Roux limb are sustained over longer periods of time.
A close look at the individual meal sizes in Fig. This turned out to be due to socio-cultural reasons. That particular subject had been fostered to eat what was served by others, but probably chose less at home when cooking and serving himself. Despite certain study limitations, the present results strongly indicate that the Roux limb is of great importance for determining food intake following RYGBP.
Involved mechanisms of actions await to be elucidated in future studies. One field of considerable interest is the potential role of mechanically liberated gastrointestinal hormones like PYY and GLP-1 that in turn may influence, e.
Unfortunately, such analyses could not be performed in the present study because blood samplings were not done in direct association to the Roux limb distensions. In summary, the present study shows that the preferred meal size decreased radically in patients after RYGBP.
Distension of the Roux limb by gradual balloon inflation was used to assess thresholds for perceptions as well as volume—pressure relationships. Roux limb distension elicited sensations of discomfort and even pain. Interestingly, subjects with a low perception threshold in the Roux limb sensations were induced at low balloon volumes preferred a large meal and vice versa.
Furthermore, balloon-induced intra-Roux limb pressure correlated negatively to preferred meal size suggesting that the Roux limb exerts a flow resistance to luminal flow. Taken together, the results suggest that the Roux limb is an important determinant for the regulation of food intake after Roux-Y bypass bariatric surgery. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author s and source are credited.
National Center for Biotechnology Information , U. Obesity Surgery. Obes Surg. Published online Jun 2. Author information Copyright and License information Disclaimer.
Corresponding author. This article has been cited by other articles in PMC. Introduction The exceptional effectiveness of bariatric surgery to treat morbid obesity has highlighted the central role of the gastrointestinal tract in the regulation of body weight and metabolism [ 1 , 2 ].
Investigational Procedures All subjects underwent a preoperative study day where baseline characteristics were recorded including the results of a test meal see Study Day A below. Study Day A—Meal Ingestion The subjects arrived at the laboratory in the morning after a standardized light breakfast consisting of one small sandwich and one glass of milk or fruit juice.
Open in a separate window. Protocol After that the balloon had been correctly positioned in the Roux limb, the subjects were left for 30 min to allow baseline motility conditions to be established as assessed by the esophago-gastro-Roux manometric recording. Statistics All included individuals acted as their own controls. Balloon Distension Volume—Pressure Relationships Inflation of air into the Roux limb-located balloon resulted in a corresponding increased intraluminal pressure.
Thresholds for Distension-Induced Sensations Perceived sensations in association with the distension-protocol varied considerably between individuals. Table 1 Threshold luminal pressure for induction of sensation. Discussion Roux-en-Y gastric bypass is a bariatric construction where a small gastric pouch is connected to the mid-jejunum leaving most of the stomach, the duodenum, as well as proximal jejunum unloaded from the passage of food.
Conflicts of Interest The authors declare that they have no conflict of interest. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author s and source are credited.
References 1. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. Effects of bariatric surgery on mortality in Swedish obese subjects. Body composition, dietary intake, and energy expenditure after laparoscopic Roux-en-Y gastric bypass and laparoscopic vertical banded gastroplasty: a randomized clinical trial.
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Download references. Feng, M. Gagner, A. Pomp, N. Korgaonkar, B. Jacob, C. Chu, D. Voellinger, T. Quinn, D. You can also search for this author in PubMed Google Scholar. Correspondence to M. Reprints and Permissions. Feng, J. Effect of standard vs extended Roux limb length on weight loss outcomes after laparoscopic Roux-en-Y gastric bypass.
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