Outcomes and complications after long versus short gastric pouch Roux-en-Y gastric bypass in patients with severe obesity

Roux-en-Y gastric bypass (RYGB) is the second most common metabolic and bariatric surgery (MBS) globally. The impact of pouch size on weight loss outcomes and complications remains unclear. This study aims to compare the weight loss outcomes and complications in long pouch versus short pouch RYGB in patients with severe obesity. This retrospective study, conducted in 2021 in two academic tertiary Hospitals, included patients aged 18-65 with severe obesity who underwent RYGB with two different methods. Demographic data, past medical history, and surgical details were assessed. The study outcome was postoperative metrics at 12 months including weight loss outcomes and complications like marginal ulceration, and leaks. A total of 219 patients, who were included in this study, were divided into two groups: 107 with long gastric pouches and 112 with short gastric pouches. The average age was 41.33 ± 10.26 and 42.45 ± 11.70 in long and short gastric pouches, respectively. Patients with long gastric pouches had a mean weight of 113.29 ± 16.52 kg and mean Body Mass Index (BMI) of 42.97 ± 4.15 kg/m², and patients with short gastric pouches had a mean weight of 118.39 ± 12.80 kg and mean BMI of 45.21 ± 5.10 kg/m². At 12 months after surgery, substantial weight loss was noted in all participants (37.8 ± 10.7 kg in patients with long gastric pouch; 48.1 ± 11.3 kg in patients with short gastric pouch; P = 0.033). Delta BMI (P = 0.072), and TWL% (P = 0.061), were more pronounced in patients with short pouches, however the difference was not significant. Remission of underlying diseases and endoscopic findings were comparable for short and long gastric pouch groups. Both long and short-pouch gastric bypass surgeries are effective and safe for weight loss and remission of obesity-associated medical problems in patients with severe obesity and exhibited similar rates for remission of underlying diseases and endoscopic findings. More studies are needed to individualize surgical approaches based on patient characteristics.