Yoshida Miya C, Luong Diana, Tan Sally, Pan Jennifer, Luu Jonathan, Pyke Owen, Kella Venkata, Brathwaite Collin E M, Levine Jun
NYU Langone Hospital - Long Island, Mineola, NY, USA.
Harvard University, Cambridge, MA, USA.
Obes Surg. 2025 Apr;35(4):1493-1503. doi: 10.1007/s11695-025-07797-6. Epub 2025 Mar 18.
Despite widespread use of Roux-en-Y gastric bypass (RYGB), there are no standardized limb lengths in the United States.
A multi-center retrospective cohort study was conducted from 2020 to 2023. Eligible patients who had undergone RYGB were divided into subgroups based on BP limb lengths: short (50-75 cm), intermediate (80-125 cm), and long (150-175 cm). Primary outcomes were total weight loss (TWL) and % TWL at 1 and 2 years. Secondary outcomes were post-operative BMI and % BMI change at 1 and 2 years, micronutrient deficiencies, hypothyroidism, acute kidney injury (AKI) requiring treatment, and remission in associated medical problems. Subgroups were compared using multivariate analysis.
Two hundred twenty-eight patients received a long BP limb, 194 patients received an intermediate BP limb, while 152 patients received a short BP limb. Primary outcomes TWL and % TWL were significantly different between the groups at 1 year: TWL and % TWL were greater in patients with long BP limbs. The difference between the long and short BP limb groups increased at the 2-year mark. Patients who had long BP limbs had higher rates of DM remission (12.3% vs 11.9% 6.6%), HTN (8.8% vs 5.7% vs 7.9%), GERD symptoms (14.5% vs 9.8% vs 5.3%), and OSA (8.8% vs 7.7% vs 5.3%). Vitamin A deficiency rates were higher in the long BP limb group.
The results suggest that longer BP limb lengths are conducive to TWL and overall treatment of obesity-related problems without severe rates of complications. Additional longer longitudinal studies are needed to assess the impact of long BP limbs on nutrition and weight loss in the long term.
尽管Roux-en-Y胃旁路术（RYGB）已广泛应用，但在美国，其肠袢长度并无标准化。
2020年至2023年开展了一项多中心回顾性队列研究。接受RYGB手术的符合条件患者根据胆胰（BP）肠袢长度分为亚组：短肠袢（50 - 75厘米）、中肠袢（80 - 125厘米）和长肠袢（150 - 175厘米）。主要结局为1年和2年时的总体体重减轻（TWL）及TWL百分比。次要结局为1年和2年时的术后体重指数（BMI）及BMI变化百分比、微量营养素缺乏、甲状腺功能减退、需要治疗的急性肾损伤（AKI）以及相关内科问题的缓解情况。使用多变量分析对亚组进行比较。
228例患者接受了长BP肠袢手术，194例患者接受了中BP肠袢手术，152例患者接受了短BP肠袢手术。1年时，各亚组间主要结局TWL及TWL百分比存在显著差异：长BP肠袢患者的TWL及TWL百分比更高。长、短BP肠袢亚组间的差异在2年时增大。长BP肠袢患者的糖尿病缓解率（12.3%对11.9%对6.6%）、高血压缓解率（8.8%对5.7%对7.9%）、胃食管反流病（GERD）症状缓解率（14.5%对9.8%对5.3%）和阻塞性睡眠呼吸暂停（OSA）缓解率（8.8%对7.7%对5.3%）更高。长BP肠袢组的维生素A缺乏率更高。
结果表明，较长的BP肠袢长度有利于总体体重减轻及肥胖相关问题的整体治疗，且并发症发生率不高。需要更多长期纵向研究来评估长BP肠袢对营养和体重减轻情况的长期影响。
