Impact of biliopancreatic length following revision of sleeve gastrectomy to one anastomosis gastric bypass.

Abstract

Objective: To evaluate the early Impact of Biliopancreatic Length on the outcome in revisional bariatric surgeries. Study Design: Retrospective Review. Setting: Lady Reading Hospital, Peshawar. Period: 1^st March 2017 to 28^th February 2022. Methods: Prospectively maintained data of 43 patients with the BMI of less than 50, who underwent laparoscopic OAGB Patients were placed in three groups including Group A 180cm, B 220cm and C 250 cm respectively corresponding to the biliopancreatic limb length. The patients were set for follow-up at 7th, 14th, 28th postoperative days for the first one month and then subsequently at 3 months and 6 months. All data was evaluated on SPSSR version 22.0 and is depicted in tabulated form. Continuous data was compared using Student t tests and Mann Whitney U test. In low figures from a 2X2 table Fischer’s exact test was performed and the significance of a test was considered as a p value of lower than 0.05. Multivariate analysis was performed to exclude confounding elements such as gender and pre-operative data. Results: A total of 43 patients were included in the study. Patients who completed 6-months of follow-up were analyzed. Preoperative weight after LSG & before REVISION OAGB were 113 ± 28.5 kg (180cm), 106.9+22.7 (220cm), 117.1+17.3 (250cm) and BMI were 45.8 +4.1 (180), 41.9 +5.3 (220cm), 44.3 +4.7 (250cm). A total of 43(%) patients attended the 6 months follow-up after revision OAGB (clinical and hematological) (group A = 18; group B = 12, group C = 13). A total of 43 (%) TWL achieved in 180 cm, 220 cm, and 250 cm groups were 27.4(+19.1), 17.8(+14), and 28.9(+9.5) respectively (p=0.81). There was no protein deficiency reported at 6 months of follow-up. Regarding albumin levels in group A at 1st,03^rd & 06^th month was 3.4 ±0.3, 3.3 ±0.4, & 3.6 ±0.3 respectively while Albumin in Group B at 1^st, 3^rd, & 6^th month was reported as 3.2 ±0.4, 3.2 ±0.3, & 2.8 ±0.4 respectively and Albumin levels in Group C at 1^st, 3^rd, & 6^th Month was 3.6 ±0.3, 3.1 ±0.4, 2.7 ±0.5 respectively(p=0.07). A significant difference was noted in the long lengths of Biliopancreatic group C with a mean figure of 22.1g/ml. (p=0.01). Conclusion: Results in terms of weight loss and its relationship to length of biliopancreatic limb while performing one anastomosis Gastric Bypass (OAGB) has no significant benefit. A modest Biliopancreatic limb length attains similar results after revision from Sleeve gastrectomy to OAGB. Adding length to the bypassed bowel confers nutritional complications especially Serum Ferritin.