Long biliopancreatic one-anastomosis gastric bypass vs Roux-en-Y gastric bypass in super obese: is there a difference?

Context
There is a controversy on the optimum limb lengths in Roux-en-Y gastric bypass and one-anastomosis gastric bypass, especially in patients with body mass index (BMI) >50 kg/m.
Aims
To study the outcomes of 250-cm biliopancreatic one-anastomosis gastric bypass and 150-cm biliopancreatic Roux-en-Y gastric bypass in patients with;Deg;BM;Deg;I >50 kg/m.
Settings and design
This was a retrospective cohort study.
Methods and material
This study included patients with BMI >50 kg/m, of whom 49 underwent 250-cm biliopancreatic limb one-anastomosis gastric bypass and 53 patients underwent 150-cm biliopancreatic and 100-cm alimentary limb Roux-en-Y gastric bypass with common limb of 350–400 cm. Weight, BMI, hypertension, HbA1C, hemoglobin, iron, calcium, albumin, vitamin D, and parathormone levels were recorded preoperatively and also at 6, 12, 18, and 24 months postoperatively. Operative time, complications, postoperative percent of total weight loss, and incidence of alkaline reflux were recorded at 6, 12, 18, and 24 months.
Statistical analysis
Mean±SD and range were used for parametric numerical data, whereas frequency and percentage were used to describe nonnumerical data.
Results
One-anastomosis gastric bypass and Roux-en-Y gastric bypass achieved BMI of 29.15 ± 1.9 and 29.16 ± 1.5, respectively, and percent of total weight loss of 46.9 ± 3.096% and 47.5 ± 2.59%, respectively, at 24 months. One-anastomosis gastric bypass had an alkaline reflux of 4.1% at 24 months. One-anastomosis gastric bypass had significantly lower levels of hemoglobin, iron, calcium, and vitamin D with higher levels of parathormone. Differences in albumin levels were nonsignificant.
Conclusions
Long biliopancreatic Roux-en-Y gastric bypass is recommended for patients with BMI >50 kg/m, especially with a long total small intestinal length of 600–650 cm with less effect on the nutritional status of the patients and avoiding the incidence of alkaline reflux in comparison with one-anastomosis gastric bypass.