Biliopancreatic Limb Length as a Potential Key Factor in Superior Glycemic Outcomes After Roux-en-Y Gastric Bypass in Patients with Type 2 Diabetes: A Meta-analysis

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posted on 2022-12-01, 21:04 authored by Yeongkeun Kwon, Sungho Lee, Dohyang Kim, Ahmad ALRomi, Shin-Hoo Park, Min Chang Lee, Jong-Han Kim, Sungsoo Park

BACKGROUND: Optimal length of biliopancreatic (BP) and Roux limb in Roux-en-Y gastric bypass (RYGB) for improved glycemic control are not known. PURPOSE: To investigate how the lengths of the BP and Roux limbs in RYGB differentially affect postoperative glycemic outcomes in patients with type 2 diabetes. DATA SOURCES: Systematic literature search using the PubMed, EMBASE, and the Cochrane Library databases. STUDY SELECTION: Studies that reported glycemic outcomes after RYGB and lengths of the BP and Roux limbs. DATA EXTRACTION: Twenty-eight articles were included for data extraction. Glycemic outcomes after RYGB were assessed using two definitions: remission and improvement. DATA SYNTHESIS: We categorized the included studies into four groups according to the BP and Roux limb lengths. The type 2 diabetes remission/improvement rates (95% confidence interval [CI]) were as follows: long BP‒long Roux group, 0.80 (0.70‒0.90)/0.81 (0.73‒0.89); long BP‒short Roux group, 0.76 (0.66‒0.87)/0.82 (0.75–0.89); short BP‒long Roux group 0.57 (0.36‒0.78)/0.64 (0.53‒0.75); short BP‒short Roux group, 0.62 (0.43‒0.80)/0.53 (0.45‒0.61). Meta-regression analysis also showed that a longer BP limb resulted in higher postoperative type 2 diabetes remission and improvement rates, whereas a longer Roux limb did not. There was no significant difference or heterogeneity in baseline characteristics, including diabetes-related variables, among the four groups. LIMITATIONS: Not all included studies were randomized controlled trials. CONCLUSIONS: Longer BP limb length led to higher rates of type 2 diabetes remission and improvement by 1 year after RYGB than the longer Roux limb length.