Elamin Doua, Wills Mélissa V, Aulestia Juan, Mocanu Valentin, Strong Andrew, Dang Jerry, Feng Xiaoxi, Kroh Matthew, Corcelles Ricard, Navarrete Salvador
Department of General Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
J Clin Med. 2025 Jul 25;14(15):5262. doi: 10.3390/jcm14155262.
Despite being one of the most performed bariatric procedures, there is no consensus regarding optimal limb lengths for Roux-en-Y gastric bypass (RYGB), which may impact weight loss and obesity-related comorbidity resolution. We hypothesize that a ratio-adjusted small bowel to Roux and BP limb lengths in RYGB results in superior outcomes. This study aims to define total intestinal length (TIL) and the feasibility of its intraoperative measurement during RYGB. The findings will serve as a foundation for a subsequent randomized trial evaluating different limb length ratios and their effect on postoperative outcomes. This was a single-center prospective cohort study conducted at Cleveland Clinic Foundation-Main Campus, a tertiary referral center in the United States. Between January and June 2023, 25 patients with BMI > 40 undergoing RYGB were enrolled. Total small bowel length was measured intraoperatively, and feasibility of measurement was assessed. Patient outcomes, including total weight loss, 30-day complications, and comorbidities at 1 year were captured. Mean preoperative BMI was 47.6 ± 8.0 kg/m. Mean total small bowel length was 592 ± 93.3 cm, with a mean biliopancreatic (BP) limb length of 109 ± 29 cm (18.86% ± 5.84 of total length) and Roux limb length of 103 ± 15 cm (17.71% ± 3.06 of total length). Measurement added an average of 11.5 min to operative time. Measurement feasibility was rated as "moderate" or easier in 80% of cases. One-year postoperative outcomes included a mean total weight loss of 31% and significant reductions in antihypertensive and anti-diabetic medication use. Total small bowel length measurement during RYGB is safe and feasible. High variability in bowel length was observed, with no significant correlation to demographic factors. Establishing individualized limb length ratios may improve weight loss outcomes and comorbidity resolution. Further studies are warranted to evaluate the impact of tailored limb length strategies.
尽管胃旁路手术（RYGB）是最常施行的减肥手术之一，但对于该手术中最佳的肠袢长度尚无共识，这可能会影响体重减轻以及肥胖相关合并症的缓解情况。我们推测，在RYGB手术中，经比例调整后的小肠与 Roux 袢及胆胰袢长度可带来更好的手术效果。本研究旨在确定全肠长度（TIL）及其在RYGB手术中进行术中测量的可行性。这些研究结果将为后续评估不同肠袢长度比例及其对术后效果影响的随机试验奠定基础。这是一项在美国三级转诊中心克利夫兰诊所基金会主院区开展的单中心前瞻性队列研究。2023年1月至6月期间，纳入了25例BMI>40且接受RYGB手术的患者。术中测量全小肠长度，并评估测量的可行性。记录患者的手术效果，包括总体重减轻情况、30天并发症以及1年时的合并症情况。术前平均BMI为47.6±8.0kg/m²。平均全小肠长度为592±93.3cm，平均胆胰（BP）袢长度为109±29cm（占总长度的18.86%±5.84%），Roux袢长度为103±15cm（占总长度的17.71%±3.06%）。测量使手术时间平均增加了11.5分钟。80%的病例中测量可行性被评为“中等”或更易操作。术后1年的效果包括平均总体重减轻31%，以及抗高血压和抗糖尿病药物使用量显著减少。在RYGB手术中测量全小肠长度是安全可行的。观察到肠长度存在高度变异性，且与人口统计学因素无显著相关性。确定个体化的肠袢长度比例可能会改善体重减轻效果和合并症的缓解情况。有必要进一步开展研究以评估定制肠袢长度策略的影响。
