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...

Overview

Journal Obes Surg

Date 2020 Sep 21

PMID 32955672

Citations 5

Authors

Ralph P M Gadiot

M Leeman

L Ulas Biter

Martin Dunkelgrun

Jan A Apers

Gerhard Vant Hof

Pierre B Feskens

Guido H Mannaerts

Affiliations

Soon will be listed here.

Abstract

Purpose: Although the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the gold-standard bariatric procedure, it remains uncertain what the optimal bowel limb lengths are to accomplish maximal weight loss while minimizing nutritional deficiencies and related gastro-intestinal complaints. The aim of this randomized controlled multicenter trial is to investigate the effect of significant lengthening of the length of the Roux limb (RL) at the cost of the length of the common channel (CC) while keeping the biliopancreatic limb (BPL) lengths the same on both study arms.

Methods: Four hundred forty-four patients were randomized to receive either a Very Long Roux Limb LRYGB (VLRL-LRYGB) (variable RL length, BPL 60 cm, and CC 100 cm) or a Standard LRYGB (S-LRYGB) (RL 150 cm, BPL 60 cm, and a variable CC length). Results at 1-year follow-up for weight loss, effect on obesity-related comorbid conditions, complications, re-operation rate, malnutrition rate, and re-admission rate were investigated.

Results: Weight loss at 1-year showed no significant differences for %EWL (84.3% versus 85.3%, p = 0.72) and %TWL (34.2% versus 33.6%, p = 0.359) comparing VLRL-LRYGB versus S-LRYGB. Malabsorption requiring surgical bowel length adjustment was observed in 1.4% in VLRL-LRYGB group versus 0.9% in S-LRYGB group (p = 0.316).

Conclusion: Significant lengthening of the RL at the cost of the common channel seems to have no effect on the weight loss at 1-year follow-up, which supports the theory that absorption of nutrients also occurs in the RL. Nevertheless, long-term results of the VLRL-LRYGB have to be awaited to draw final conclusions as part of the discussion towards optimal limb length in LRYGB surgery.

Citing Articles

A Longer Biliopancreatic Limb and Shorter Common Channel Enhance Weight Loss But May Have Harmful Effects in Mouse Models of Roux-en-Y Gastric Bypass.

Lau R, Stevenson M, Tirumalasetty M, Lee J, Hall C, Miao Q Obes Surg. 2024; 35(1):141-152.

PMID: 39516446 DOI: 10.1007/s11695-024-07578-7.

Long-term Outcome of the Dutch Common Channel Trial (DUCATI): Preservation of Superior Weight Loss Results Without Significant Malnutrition Side Effects.

Gadiot R, Biter L, Feskens P, Dunkelgrun M, Apers J, t Hof G Obes Surg. 2024; 34(11):4136-4145.

PMID: 39356397 DOI: 10.1007/s11695-024-07424-w.

Long-term weight loss of distal gastric bypass is moderately superior compared to proximal gastric bypass in patients with a BMI of 37-44 Kg/m.

Cereser T, Heil J, Schob O, Schlumpf R, Gantert W, Infanger D Langenbecks Arch Surg. 2024; 409(1):162.

PMID: 38771517 PMC: 11108920. DOI: 10.1007/s00423-024-03348-2.

Distalization of Standard Roux-en-Y Gastric Bypass: Indications, Technique, and Long-Term Results.

Ngomba Muakana J, Thissen J, Loumaye A, Thoma M, Deswysen Y, Navez B Obes Surg. 2023; 33(5):1373-1381.

PMID: 36892751 DOI: 10.1007/s11695-023-06524-3.

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.

Kakela P, Rantanen T, Virtanen K Obes Surg. 2021; 31(7):3291-3295.

PMID: 33914241 PMC: 8175306. DOI: 10.1007/s11695-021-05421-x.

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