Discussion
comorbidity, nutritional deficit, reduced muscle, diabetes mellitus, OSA, weight reduction, pain, arterial stiffness, hypertension, weight loss
DIABETES MELLITUS, COMPLICATION, INSULIN RESISTANCE, REMISSION, ARTERIAL STIFFNESS, HYPERTENSION
Evidence of the BPL’s function in bariatric surgery is growing as the OAGB gains popularity. In bypass surgeries, such as OAGB and RYGB, the adjustment of limb length helps achieve the target BMI [Many studies have been done to improve outcomes of bypass surgeries by investigating limb lengths.In published studies of OAGB, there have been wide variations in BPL length. The BPL length when Rutledge originally described OAGB was 180 cm [The BPL and AL lengths in patients who underwent RYGB in this study were 150 cm and 75 cm, respectively. A recent meta-analysis showed that shorter ALs (40–100 cm) are as effective for weight loss as longer ones (130–150 cm). Therefore, we thought an AL length of 75 cm was reasonable. The impact of BPL elongation in RYGB has been previously studied. According to a study by Nergaard et al., the diverted-OAGB procedure, which utilizes a longer biliopancreatic limb (BPL) of 200 cm and a shorter alimentary limb (AL) of 60 cm, was found to be more effective in achieving weight loss compared to the traditional RYGB procedure, which uses a shorter BPL of 60 cm and a longer AL of 150 cm over a 7-year follow-up period.Darabi et al. compared three groups: group 1 (BPL: 50 cm and AL: 150 cm), group 2 (BPL: 150 cm and AL: 50 cm), and group 3 (BPL: 100 cm and AL: 100 cm). After 1 year, no change was observed in the EBWL. However, after 3 years, the longer BPL group had a higher EBWL [Numerous studies showed that OAGB outperforms RYGB. A recent meta-analysis of 11 trials demonstrated that OAGB has higher diabetes mellitus remission rates than RYGB and is linked to more significant weight loss at 5 years [In line, the elongation of the BPL during RYGP in the current study yielded comparable short-term weight loss and comorbidity remission in both techniques.As far as we know, only three studies compared OAGB and long BPL RYGB. Two were retrospective [The second study reported no significant differences regarding postoperative BMI and percentage of total weight loss between OAGB and elongated BPL RYGB groups, which is consistent with our findings. However, the study revealed that the OAGB bypass group had significantly higher levels of parathormone and lower levels of hemoglobin, iron, calcium, and vitamin D. This could be due to using a BPL of 250 cm for OAGB, which increases the risk of a severe nutritional deficit.Fouly et al. [The mechanism that enhances weight reduction and diabetes mellitus remission in long BPL RYGB remains uncertain. Extended BPL in RYGB may alter bile acids and intestinal flora in addition to more accentuated stimulation of the distal bowel [It has been suggested that bariatric surgery-related hypertension remission is caused by reduced inflammatory reactions and improved insulin resistance that could lessen arterial stiffness and sodium reabsorption with subsequent normalization of blood pressure levels [Although weight loss improves and, in some cases, resolves OSA [The substantial improvements in joint and back pain reported in the current study could be explained by various factors, including increased physical activity, better subjective well-being and self-perception, and mechanical causes such as reduced muscle and joint load [Bile reflux is the most crucial complication following surgery. It should be treated promptly to prevent further damage to the esophageal mucosa. Due to this complication, many surgeons avoid OAGB for bariatric surgery [The small sample size and short-term follow-up are possible limitations of this study. Nevertheless, our work provides new evidence regarding the comparability of OAGB and long BPL RYGB in weight loss and comorbidity remission. However, OAGB remains superior in terms of technical simplicity.