Ideal Biliopancreatic Limb Length for One Anastomosis Gastric Bypass

Objectives: To determine the ideal biliopancreatic limb (BPL) length and common limb (CL) length compared to total bowel length (TBL) to obtain optimal weight loss and remission of comorbidities with minimal nutritional deficiencies in morbid obese patients. Background: Ideal BPL and CL lengths in OAGB to achieve optimal excess weight loss and resolution of comorbidities with minimal nutritional deficiencies still remain unclear. Methods: A prospective study conducted at General Surgery Department, Menoufia University hospital, from August 2021 till January 2023 with one year follow up over 60 morbidly obese patients were divided into 2 groups, group A included patients with BPL 50% and CL 50%, while in group B BPL 40% and CL 60%. The results were compared regarding operative outcomes, weight loss, improvement in comorbidities, nutritional deficiency and complications. Results: The mean baseline BMI for group A 48.4±5.6 kg/m2 and group B 48.8±5.8 kg/m2. Post-operative excess weight loss percentage (EWL%) after one year follow up was 102.3±3.2 % and 95.5±5.7 % for group A and B respectively. Remission of diabetes mellitus was 86.36% in group A and 80.95% in group B. Conclusion: To achieve optimal EWL with minimal nutritional deficiency we choose BPL length ratio 50% and CL length ratio 50% if TBL ≥ 5m while in TBL < 5 m we BPL length ratio 40% and choose CL length ratio 60%.