Effect of Roux-en-Y Gastric Bypass with Different Lengths of Biliopancreatic and Alimentary Limbs for Patients with Type 2 Diabetes Mellitus and a BMI\u2009<\u200935 kg/m2: 5-Year Outcomes in Chinese Patients

Abstract

There have been no definite conclusions about the biliopancreatic limb (BPL) and alimentary limb (AL) lengths in Roux-en-Y gastric bypass (RYGB) operations for different populations and BMIs. Western scholars have performed many studies on the lengths of the BPL and AL in patients with a BMI\u2009≥\u200935 kg/m2. However, for diabetic Chinese patients with BMI\u2009<\u200935 kg/m2, few people have compared the effects of different BPL and AL lengths on patient prognosis. Clinical data were collected prospectively and analyzed retrospectively for 87 patients with type 2 diabetes (T2DM) who underwent RYGB with a BPL of 50 cm and an AL of 50 cm (BPL50/AL50) or with a BPL of 100 cm and an AL of 100 cm (BPL100/AL100) and who were followed up for 5 years. The cohort included 42 patients in the BPL50/AL50 group and 45 patients in the BPL100/AL100 group. At 5 years, there were significant differences in BMI, total weight loss (TWL%), glycosylated hemoglobin, and homeostasis model assessment insulin resistance between BPL50/AL50 and BPL100/AL100 (P\u2009<\u20090.05). Diabetes remission rate of the BPL100/AL100 group was significantly higher than that of the BPL50/AL50 group. Diabetes remission at 1 year after surgery correlated with the length limb (BPL\u2009+\u2009AL), duration of diabetes and TWL%. There was no difference in complications between BPL50/AL50 and BPL100/AL100. RYGB with BPL100/AL100 is a safe and effective treatment for diabetic patients with a BMI\u2009<\u200935 kg/m2 and offers significant improvement in weight loss and glycemic control.