Roux-limb Length Does Not Predict Remission of Diabetes After Roux-en-Y Gastric Bypass

Andrew A Taitano, MD, Tejinder P Singh, MD. AMC Bariatric Surgery Group, Albany Medical Center

 INTRODUCTION: The surgical treatment of morbid obesity leads to weight loss and remission of diabetes in most patients with type 2 diabetes mellitus (T2DM). However, it is unknown whether technical factors such as the length of the roux-limb have an impact on remission of diabetes. Our purpose was to investigate the relationship between the length of the roux-limb in gastric bypass patients and remission of T2DM.

METHODS: We evaluated pre- and post-operative data, including demographics, weight at all follow-up encounters, Hemoglobin A1C levels, medication lists, and the length of the roux-limb of patients undergoing laparoscopic roux-en-y gastric bypass (LRYGBP) between March 2003 and December 2009.

RESULTS: 551 patients underwent LRYGBP, of whom 162 (29.4%) had T2DM. Follow-up was possible in 77.8% and averaged 2.4 years. At last follow-up, patients with T2DM achieved 67.2% excess BMI loss and had regained 12.9% of their postoperative weight loss. Average BMI was 47.7 at the time of surgery and 34.1 at last follow-up. 82.5% of patients achieved remission of T2DM.

Comparing patients with remission and those without, there were no significant differences for average age, roux-limb length, BMI at the time of surgery or at last follow-up, percent excess BMI loss, or percent weight regain.

Rates of remission from T2DM did not significantly vary based on the length of the roux-limb (81.3% for 140-150cm, 84.9% for 120-125cm, and 75.0% for 100-110cm). Subgroup analysis did not reveal any further differences between patients who achieved remission and those who did not.

CONCLUSION: LRYGBP resulted in significant excess BMI loss (67.2%) and remission of T2DM (82.5%) at 2.4 years average follow-up. The length of the roux-limb in LRYGBP does not appear to have a significant effect on remission of T2DM. Prospective studies are needed to determine the optimal roux-limb length for LRYGBP.

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