Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 7/2021

Open Access 01-07-2021 | Obesity | Review

The Importance of Intestinal Length in Triglyceride Metabolism and in Predicting the Outcomes of Comorbidities in Laparoscopic Roux-en-Y Gastric Bypass—a Narrative Review

Authors: Pirjo Käkelä, Tuomo Rantanen, Kirsi A. Virtanen

Published in: Obesity Surgery | Issue 7/2021

Login to get access

Abstract

In this narrative review, we will appraise if modification of the length of bypassed small intestine based on measured total small intestinal length could optimize the outcomes of the laparoscopic Roux-en-Y gastric bypass (LRYGB). We provide a summary of carefully selected studies to serve as examples and to draw tentative conclusions of the effects of LRYGB on remission of comorbidities. As the heterogeneity of the included studies varied in terms of outcomes, type of study, length of the bypassed small intestine, and the follow-up, a common endpoint could not be defined for this narrative article. To achieve efficient metabolic outcomes, it is important to carefully choose the small intestine length excluded from the food passage suited best to each individual patient.

Graphical abstract

Literature
1.
Ramos A, Kow L, Brown W, et al. The International Federation for the Surgery of Obesity and Metabolic Disorders. In: Fifth IFSO Global Registry Report; 2019.
2.
NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956–61.CrossRef
3.
4.
Dixon JB, Zimmet P, Alberti KG, et al. International Diabetes Federation Taskforce on Epidemiology and Prevention. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med. 2011;28(6):628–42.PubMedPubMedCentralCrossRef
5.
6.
Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg 2014. 24(3):437–55.
7.
Miller K, Pump A, Hell E. Vertical banded gastroplasty versus adjustable gastric banding: prospective long-term follow-up study. Surg Obes Relat Dis. 2007;3(1):84–90.PubMedCrossRef
8.
Deitel M, Dixon J. Comorbidities of morbid obesity and determination of optimal weight. In: Deitel M, Dixon J, Gagner M, Madan A, Himpens J, editors. Handbook of obesity surgery 2010. 1st ed. Toronto: FD-Communications. ISBN 978–0-9684426–5-4.
9.
Hatoum IJ, Kaplan LM. Advantages of percent weight loss as a method of reporting weight loss after Roux-en-Y gastric bypass. Obesity (Silver Spring). 2013;21(8):1519–25.CrossRef
10.
11.
Madan AK, Harper JL, Tichansky DS. Techniques of laparoscopic gastric bypass: on-line survey of American Society for Bariatric Surgery practicing surgeons. Surg Obes Relat Dis. 2008;4:166–72. discussion 172-3PubMedCrossRef
12.
Rubino F, R`Bibo SL, del Genio F, et al. Metabolic surgery: the role of the gastrointestinal tract in diabetes mellitus. Nat Rev Endocrinol. 2010;6(2):102–9.PubMedPubMedCentralCrossRef
13.
Gadiot RPM, Leeman M, Biter LU, et al. Does the length of the common channel as part of the total alimentary tract matter? One year results from the multicenter Dutch Common Channel Trial (DUCATI) comparing standard versus distal Roux-en-Y gastric bypass with similar biliopancreatic bowel limb lengths. Obes Surg. 2020 December 01;30(12):4732–40.PubMedCrossRef
14.
Yousseif A, Emmanuel J, Karra E, et al. Differential effects of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on appetite, circulating acyl-ghrelin, peptide YY3-36 and active GLP-1 levels in nondiabetic humans. Obes Surg. 2014;24(2):241–52.PubMedCrossRef
15.
Mans E, Serra-Prat M, Palomera E, et al. Sleeve gastrectomy effects on hunger, satiation, and gastrointestinal hormone and motility responses after a liquid meal test. Am J Clin Nutr. 2015;102(3):540–7.PubMedCrossRef
16.
Korner J, Bessler M, Cirilo LJ, et al. Effects of Roux-en-Y gastric bypass surgery on fasting and postprandial concentrations of plasma ghrelin, peptide YY, and insulin. J Clin Endocrinol Metab. 2005;90(1):359–65.PubMedCrossRef
17.
le Roux CW, Welbourn R, Werling M, et al. Gut hormones as mediators of appetite and weight loss after Roux-en-Y gastric bypass. Ann Surg. 2007;246(5):780–5.PubMedCrossRef
18.
Abdeen G, le Roux CW. Mechanism underlying the weight loss and complications of Roux-en-Y gastric bypass. Review. Obes Surg. 2016;26(2):410–21.PubMedCrossRef
19.
Chewal JP. Anatomy of jejunum and ileum. In: Chewal JP, editor. Surgery of esophagus, stomach and small intestine. Phildelphia: Little Brown; 1995. p. 784–8.
20.
Evers B. Small intestine. In: Evers B, editor. Schwartz principles of surgery. Philadelphia.: McGraw Hill; 1999. p. 1217–57.
21.
Guzman IJ, Fitch LL, Varco RL, et al. Small bowel length in hyperlipidemia and massive obesity. Am J Clin Nutr. 1997;30(7):1006–8.CrossRef
22.
Stefanidis D, Kuwada TS, Gersin KS. The importance of the length of the limbs for gastric bypass patients--an evidence-based review. Obes Surg. 2011;21(1):119–24.PubMedCrossRef
23.
Pinheiro JS, Schiavon CA, Pereira PB, et al. Long-long limb Roux-en-Y gastric bypass is more efficacious in treatment of type 2 diabetes and lipid disorders in super-obese patients. Surg Obes Relat Dis. 2008;4(4):521–5.PubMedCrossRef
24.
Käkelä P, Männistö V, Vaittinen M, et al. Small intestinal length associates with serum triglycerides before and after LRYGB. Obes Surg. 2018;13:1–7.
25.
Gleysteen JJ. Five-year outcome with gastric bypass: Roux limb length makes a difference. Surg Obes Relat Dis. 2009;5(2):242–7.PubMedCrossRef
26.
Mahawar KK, Kumar P, Parmar C, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2016;26(3):660–71.PubMedCrossRef
27.
Kalfarentzos F, Skroubis G, Karamanakos S, et al. Biliopancreatic diversion with Roux-en-Y gastric bypass and long limbs: advances in surgical treatment for super-obesity. Obes Surg. 2011;21(12):1849–58.PubMedCrossRef
28.
Tacchino RM. Bowel length: measurement, predictors, and impact on bariatric and metabolic surgery. Surg Obes Relat Dis. 2015;11(2):328–34.PubMedCrossRef
29.
Nelson WK, Fatima J, Houghton SG, et al. The malabsorptive very, very long limb Roux-en-Y gastric bypass for super obesity: results in 257 patients. Surgery. 2006;140(4):517–22.PubMedCrossRef
30.
Teitelbaum EN, Vaziri K, Zettervall S, et al. Intraoperative small bowel length measurements and analysis of demographic predictors of increased length. Clin Anat 2013. 26(7):827–32.
31.
Nordgren S, McPheeters G, Svaninger G, et al. Small bowel length in inflammatory bowel disease. Int J Colorectal Dis. 1997;12(4):230–4.PubMedCrossRef
32.
Hosseinpour M, Behdad A. Evaluation of small bowel measurement in alive patients. Surg Radiol Anat 2008. 2008;30(8):653–5.CrossRef
33.
Lohsiriwat V, Wiangphoem N, Lohsiriwat S. The length of small bowel in Thai patients. J Med Assoc Thai. 2014;97(5):525–9.PubMed
34.
Choban PS, Flancbaum L. The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial. Obes Surg. 2002;12(4):540–5.PubMedCrossRef
35.
Navez B, Thomopoulos T, Stefanescu I, et al. Common limb length does not influence weight loss after standard laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2016;26:1705–9.PubMedCrossRef
36.
Mahawar KK, Sharples AJ. Contribution of malabsorption to weight loss after Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2017;27:2194–206.PubMedCrossRef
37.
Hamoui N, Anthone GJ, Kaufman HS, et al. Maintenance of weight loss in patients with body mass index >60 kg/m2: importance of length of small bowel bypassed. Surg Obes Relat Dis. 2008;4:404–6.PubMedCrossRef
38.
39.
Vanni E, Bugianesi E, Kotronen A, et al. From the metabolic syndrome to NAFLD or vice versa? Dig Liver Dis. 2010;42(5):320–30.PubMedCrossRef
40.
Puri P, Baillie RA, Wiest MM, et al. A lipidomic analysis of nonalcoholic fatty liver disease. Hepatology. 2007;46(4):1081–90.PubMedCrossRef
41.
Simonen P, Kotronen A, Hallikainen M, et al. Cholesterol synthesis is increased and absorption decreased in non-alcoholic fatty liver disease independent of obesity. J Hepatol. 2011;54(1):153–9.PubMedCrossRef
42.
Heffron SP, Parikh A, Volodarskiy A, et. al. Changes in lipid profile of obese patients following contemporary bariatric surgery: a meta-analysis. Am J Med. 2016;129(9):952-959.
43.
Nelson DW, Blair KS, Martin MJ. Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity. Arch Surg. 2012;147(9):847–54.PubMedCrossRef
44.
Valera-Mora ME, Simeoni B, Gagliardi L, et al. Predictors of weight loss and reversal of comorbidities in malabsorptive bariatric surgery. Am J Clin Nutr. 2005;81(6):1292–7.PubMedCrossRef
45.
Jammah AA. Endocrine and metabolic complications after bariatric surgery. Saudi J Gastroenterol 2015. 2015;21(5):269–77.CrossRef
46.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedCrossRef
47.
Søvik TT, Aasheim ET, Taha O, et al. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial. Ann Intern Med. 2011;155(5):281–91.PubMedCrossRef
48.
Savassi-Rocha AL, Diniz MT, Savassi-Rocha PR, et al. Influence of jejunoileal and common limb length on weight loss following Roux-en-Y gastric bypass. Obes Surg. 2008;18(11):1364–8.PubMedCrossRef
Metadata
Title
The Importance of Intestinal Length in Triglyceride Metabolism and in Predicting the Outcomes of Comorbidities in Laparoscopic Roux-en-Y Gastric Bypass—a Narrative Review
Authors
Pirjo Käkelä
Tuomo Rantanen
Kirsi A. Virtanen
Publication date
01-07-2021
Publisher
Springer US
Keywords
Obesity
Obesity
Published in
Obesity Surgery / Issue 7/2021
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-021-05421-x

Other articles of this Issue 7/2021

Obesity Surgery 7/2021 Go to the issue

Brief Communication

Impact of COVID-19 Lockdown on Short-term Weight Loss in a Single Italian Institution

Original Contributions

Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Lower Urinary Tract Symptoms in Males

Review

Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy Plus Procedures for Treatment of Morbid Obesity: Systematic Review and Meta-Analysis

Letter to the Editor

Long-Term Manometric Impact of the Adjustable Gastric Band on Esophageal Motility: a Prospective Case-Control Study

Review

Incremental Net Monetary Benefit of Bariatric Surgery: Systematic Review and Meta-Analysis of Cost-Effectiveness Evidences

Original Contributions

Patterns of Change in Device-Based Physical Activity and Sedentary Time Following Bariatric Surgery: a Longitudinal Observational Study