The importance of the biliopancreatic limb length in gastric bypass: A systematic review.

BACKGROUND: Bariatric surgery has proven to be the most durable treatment for obesity, and it also provides improvement of obesity's associated co-morbidities. Although several mechanisms for its metabolic effects have been studied, the implications of the surgically constructed anatomy on its functioning physiology have not been elucidated. This leaves some uncertainty regarding the recommended limb lengths in Roux-en-Y gastric bypass. The alimentary limb length and function has been studied extensively, but few have studied the influences of the biliopancreatic limb length.

OBJECTIVE: To present a systematic review of the literature comparing variations in length of BP limb and results in order to determine BP limb length influence.

SETTING: Academic Hospital, United States.

METHODS: We present a systematic review of all the articles comparing variations of the biliopancreatic limb length and their results.

RESULTS: Thirteen articles were identified and analyzed. Most of the articles are prospective studies. Weight loss was superior in longer limbs.

CONCLUSION: Based on our review of the subject, we can conclude that the release of enterohormones in response to a food load in the distal small bowel seems to play an important role in the remission of co-morbidities. Hence, the length of the biliopancreatic limb might affect this process.