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SAGES 2026 Annual Meeting Emerging Technology Session
March 25-28, 2026 | Tampa, FL, USA
P252
Assessment of Small Bowel Limb Lengths and Weight Loss Outcomes in Revisional Bariatric Surgery: RYGB Distalization Versus Conversion of Sleeve to RYGB
Poster Presenter
Part of Topic
Bariatric
Background: To date, there is no consensus on optimal Roux-en-Y gastric bypass (RYGB) limb lengths in revisional bariatric surgery (RBS), particularly in the setting of Recurrent Weight Gain (RWG) after initial bariatric surgery.
Objectives: This study aimed to analyze small bowel limb lengths and compare weight loss outcomes between RYGB distalization (RYGB-D) and conversion of sleeve to RYGB (SG-RYGB) in patients with RWG following primary sleeve gastrectomy (SG) and RYGB.
Methods: Retrospective cohort study including all patients who underwent RBS for RWG after SG and RYGB (2018-2023). RYGB-D consisted of elongating the biliopancreatic limb (BPL) while shortening the common channel (CC). Conversion of SG-RYGB consisted of the construction of a de novo BPL and alimentary limb (AL). Limb lengths, postoperative bariatric outcomes, and complications were analyzed at 2 years.
Results: A total of 420 patients were included. Of these, 42.9% (n=180) underwent RYGB-D and 57.1% (n=240) underwent SG-RYGB. After RYGB distalization, the median BPL was 180 cm (IQR:150-220 cm), CC was 270 cm (IQR: 250-300 cm), total alimentary limb length (TALL) was 400 cm (IQR: 355-440 cm), and total small bowel length (TSBL) was 580 cm (IQR: 550-625 cm). For SG-RYGB, the median BPL was 75 cm (IQR: 75-100 cm), while the AL was standardized at 150 cm. Mean preoperative body mass index (BMI) was 43.6 Kg/m2 for RYGB-D and 45.1 Kg/m2 for SG-RYGB. At one and two years, BMI was 35.9 Kg/m2 for RYGB-D at both time points, and 35.6 and 37.1 Kg/m2 for SG-RYGB, respectively. The total weight loss (%TWL) at one and two years was 17.5% and 17.6% for RYGB-D, compared to 20.1% and 18.6% for SG-RYGB (p=0.006 and p=0.54, respectively). The overall complication rate was 3.8% (n=16) with no difference between groups (5.3% vs 4.4, p=0.708).
Conclusions: Both procedures are safe and effective, with substantial weight loss and minimal complications at two years. Conversion of SG-RYGB is associated with greater weight loss at one year, with comparable outcomes by the second year. Improved weight loss in RYGB distalization was observed with a median BPL of 180 cm, CC of 270 cm, and TALL of 400 cm, while SG-RYGB showed similarly favorable outcomes with a BPL of 75 cm and AL of 150 cm.