Effect of Limb Length on Weight Loss Outcomes Following Biliopancreatic Diversion with Duodenal Switch: A Multi-Centered Study

Purpose: The effectiveness of biliopancreatic diversion with duodenal switch (BPD/DS) for weight loss is well established, yet there remains ongoing debate over optimal limb lengths to maximize weight loss without compromising safety. We aimed to evaluate the impact of BPD/DS limb lengths on weight loss outcomes and comorbidity resolution.

Material and methods: A multicenter review of patients who underwent primary BPD/DS between 2008 and 2022. Patient demographics, common channel (CC) length, Roux limb (RL) length, and weight loss outcomes at 6, 12, and 24 months were collected. Postoperative complications and comorbidity resolution were reported.

Results: A total of 720 patients (60 with 100-cm CC/150-cm RL length, 596 with 125-cm CC/125-cm RL length, 64 with 150-cm CC/150-cm RL length) were included with a mean follow-up of 21 ± 19 months. The %TWL at 24 months was higher in the 100/150 (44.1 ± 10.3%) and 125/125 (40.6 ± 10.6%) groups compared to the 150/150 group (35.9 ± 10.8%) (p < 0.001). After adjusting for age, preoperative BMI, gender, and diabetes status, CC length was independently associated with %TWL, showing a 1.8% decrease at 24 months for every 10-cm increase in CC length (p < 0.001). The 100/150 group had higher remission rates for T2DM (p = 0.007), OSA (p < 0.001), and HTN (p = 0.036) but also higher late complications (28.5% vs. 12.5%, 7%, p < 0.001). No significant early complications were observed (p = 0.149).

Conclusion: A shorter CC length of 100 cm is associated with greater weight loss and comorbidity resolution in BPD/DS patients up to 2 years after the surgery. Careful consideration of long-term risks is needed to minimize a higher prevalence of late complications. Further studies are necessary for sustained long-term weight loss outcomes.