Surgery News - November 2008 - (Page 17)

NOVEMBER 2008 • SURGERY NEWS GENERAL SURGERY 17 Long Roux Limb May Be Best for Weight Loss B Y J E F F E VA N S Else vier Global Medical Ne ws N A T I O N A L H A R B O R , M D . — Longer Roux limbs may yield significantly greater weight loss to patients undergoing Rouxen-Y gastric bypass than do shorter Roux limbs, regardless of the patients’ initial body mass index, according to a retrospective series. Since 1992, studies of Roux limb lengths in both morbidly obese and superobese patients have found in some instances that a long Roux limb increases weight loss, whereas in others it has provided no difference, Dr. John J. Gleysteen said at the annual meeting of the American Society for Metabolic and Bariatric Surgery. To further determine the effects of having a longer Roux limb, Dr. Gleysteen split his series of open Roux-en-Y gastric bypass patients into three groups, based on the time period and length of their Roux limb. During 1980-1992, 112 patients received short Roux limbs with an average length of 45 cm (range, 41-61 cm). In 1993-1999, 132 patients received long Roux limbs that averaged 145 cm in morbidly obese patients and 160 cm in superobese patients (range, 130-160 cm overall). During 1999-2003, another group of 100 patients received Roux limbs constructed to be one-third of the total length of the bowel (limb range, 114-254 cm). The biliopancreatic limb ranged in length from 18 cm to 30 cm for all patients, Continued from previous page frey Mechanick, representing the American Association of Clinical Endocrinologists. “However, anything outside the framework of research we as a society are unable to endorse at the present time, primarily because of the lack of sufficient long-term data on benefits and, particularly, the risks of surgery specifically for diabetes,” said Dr. Mechanick of the division of endocrinology, diabetes, and bone disease and director of metabolic support, Mount Sinai School of Medicine, New York. Dr. Sue Kirkman, vice president of clinical affairs for the American Diabetes Association (ADA), expressed concerns about the “straw poll” two-thirds majority procedures followed in the Rome conference and said the ADA may assemble its own consensus conference. “We wholeheartedly endorse the document. We welcome more research—but we feel that we have sufficient research to go forward,” said Dr. Scott Shikora, an ACS Fellow who is chief of bariatrics and minimally invasive surgery, Tufts University, Boston, and the president of ASMBS. Several physicians disclosed potential conflicts of interest. Dr. Apovian is on the advisory board and is a clinical investigator for companies including Sanofi-Aventis and Amylin Pharmaceuticals Inc.; Dr. Buse is a clinical investigator or consultant for numerous companies and for the National Institutes of Health; Dr. Schauer is on the advisory board of Ethicon Inc. and receives educational grants from Allergan Inc. and Covidien; and Dr. Shikora is a research consultant to Covidien and Ethicon. ■ said Dr. Gleysteen, an ACS Fellow with the department of surgery at the University of Alabama at Birmingham. In all of the groups at 12 months, superobese patients (defined as those with a body mass index of 50 kg/m2 or greater) lost more weight than did morbidly obese patients. However, at 24 and 48 months, BMI was not associated with any differences in weight loss among the three groups. At those times, patients who received a long Roux limb or a Roux limb measuring one-third of the total bowel length lost significantly more weight than did patients with a short Roux limb. The results also indicate that total bowel length measurements are unnecessary, because Roux limb lengths that equal onethird of the total bowel length proved to have no weight loss advantage over predetermined longer Roux limb lengths, Dr. Gleysteen said. Although the study supports the concept of a longer Roux limb leading to better weight loss, it does span nearly 25 years’ worth of cases, and shorter Roux limbs were performed in the earliest time span, observed Dr. Myriam J. Curet, who commented on the study. “Other changes in technique, workup, education, or follow-up could account for the differences in weight loss seen in the study,” said Dr. Curet, an ACS Fellow and professor of surgery at Stanford (Calif.) University. She added that the predetermined length of around 130-160 cm “seems sufficient to maximize weight loss and may suggest that this length should be standardized for all gastric bypass procedures.” ■ http://www.surgitel.com http://www.surgitel.com

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Surgery News - November 2008 Contents News:�Without a Stitch The 20/20 Vision:�Med School Mix News From the College:�New President General Surgery: Diabetes Debate

Surgery News - November 2008

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