Effect of different limb lengths on quality of life, eating patterns and gastrointestinal symptoms after Roux-en-Y gastric bypass in superobese patients: randomized study

Abstract

Background: Distal Roux-en-Y gastrojejunal bypass (DRYGJB) gives better weight reduction than standard Roux-en-Y gastric bypass (RYGB) but at the risk of increased malnutrition side-effects. This study compared the effects of RYGB and DRYGJB on gastrointestinal symptoms, eating patterns and health-related quality of life (QoL).

Methods: This was a single-blind RCT from a university-affiliated obesity centre. Patients with a BMI of 50 kg/m2 or above were invited to participate. Treatment arms were standard gastric bypass with an alimentary limb of 150 cm and a biliopancreatic limb of 60 cm, with a variable common channel length, or DRYGJB with biliopancreatic limb of 200 cm, common channel limb of 150 cm and variable alimentary limb length. Baseline and follow-up data to 5 years on quality of life, obesity-related problems and gastrointestinal symptoms were collected using prospectively created and validated questionnaires.

Results: Some 140 patients were included. Those with a DRYGJB had better weight loss at 5 years (mean(s.d.) 68·3(21·8) kg versus 55·7(19·8) kg for standard RYGB; P = 0·011). Eating patterns improved, with no difference between the groups. Gastrointestinal symptoms (diarrhoea, indigestion) worsened significantly in both groups, but only patients with DRYGJB had significantly worse diarrhoea at the end of the study than at baseline (P = 0·006). Both groups had improved perceived generic QoL over baseline, and obesity-related problems were markedly reduced.

Conclusion: Standard RYGB and both improved generic and disease-specific QoL and eating behavioural pattern. Diarrhoea was increased more following DRYGJB than after RYGB. Registration number: NCT01514799 (https://clinicaltrials.gov).

© 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society.

Figures

Fig. 1

CONSORT diagram showing enrolment of patients in the study RYGB, Roux‐en‐Y gastric bypass; DRYGJB, distal Roux‐en‐Y gastrojejunal bypass; SF‐36®, Short Form 36; OP‐9, Obesity‐related Problems scale; TFEQ, Three‐Factor Eating Questionnaire; GSRS, Gastrointestinal Symptom Rating Scale.

Fig. 2

Change over time in the domains of the Gastrointestinal Symptom Rating Scale for the two treatment groupsa Distal Roux‐en‐Y gastrojejunal bypass (DRYGJB); b Roux‐en‐Y gastric bypass (RYGB). Increases over baseline scores for diarrhoea and indigestion were statistically significant for the DRYGJB group (P = 0·006 and P = 0·031 respectively, Wilcoxon test).

Fig. 3

Change over time in Three‐Factor Eating Questionnaire scores for the two treatment groupsa Distal Roux‐en‐Y gastrojejunal bypass (DRYGJB); b Roux‐en‐Y gastric bypass (RYGB). Each variable within the Three‐Factor Eating Questionnaire was compared between patient groups at four points in time using the Mann–Whitney U‐test. RYGB patient values were higher (P = 0·018) at 2 years, but did not differ between groups at any other time point. There were no differences between groups for the other variables.

Fig. 4

Developments over time in the various domains of the Short Form 36 questionnaire for the two treatment groupsa Distal Roux‐en‐Y gastrojejunal bypass (DRYGJB); b Roux‐en‐Y gastric bypass (RYGB). Higher values indicate better quality of life.

Fig. 5

Compound scores for the Obesity‐related Problems scale for the two treatment groups Lower values indicate fewer problems (higher quality of life). OP, Obesity‐related Problems scale. Reduction from baseline values to 1‐, 2‐ and 5‐year scores was highly significant. There were no differences between distal Roux‐en‐Y gastrojejunal bypass (DRYGJB) and standard Roux‐en‐Y gastric bypass (RYGB) groups at any time point.