The impact of patient’s height-adjusted biliopancreatic limb length on short-term outcomes in one-anastomosis gastric bypass

The prevalence of obesity continues to rise globally, making metabolic bariatric surgery a crucial intervention. One Anastomosis Gastric Bypass(OAGB)¹ is an increasingly popular surgical technique, with variations in biliopancreatic limb (BPL) length potentially influencing outcomes. This study aims to assess the efficacy and safety of height-adjusted BPL compared to fixed lengths (180 cm and 200 cm) in OAGB. This retrospective cohort study included 3,617 patients who underwent OAGB from 2011 to 2022. Patients were categorized into three groups based on BPL length: 200 cm (Group 1), 180 cm (Group 2), and height-adjusted (Group 3). Propensity score matching was used to compare total weight loss (TWL), comorbidity improvement, anemia, and hypoalbuminemia rates. Group 1 (200 cm BPL) demonstrated significantly higher TWL at most time points compared to Groups 2 and 3 (p < 0.05). However, Groups 2 and 3 showed superior improvements in comorbidities, particularly in T2DM and hypertension control. Safety analysis revealed a higher incidence of hypoalbuminemia in Group 1 at 12 months, while anemia rates were similar across groups. While a longer BPL (200 cm) may enhance weight loss, height-adjusted and 180 cm BPL lengths offer a lower incidence of hypoalbuminemia.