Does the length of the biliary limb influence medium-term laboratory remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass in morbidly obese patients?

INTRODUCTION: The Roux-en-Y gastric bypass (RYGB) is an effective treatment of morbid obesity leading to type 2 diabetes mellitus (T2DM) resolution. However, evidence demonstrates that standard limb lengths can have a limited impact on long-term weight loss and durable T2DM remission. AIM: The authors evaluated the impact of biliary limb (BL) length on the T2DM laboratory markers in 2-year follow-up. MATERIAL AND METHODS: The data of 93 obese patients with T2DM who underwent RYGB between 2008 and 2010 were collected from prospectively designed database. The length of BL was standard in one group of 51 patients (S-BL: 50–75 cm) and longer in another group of 42 patients (L-BL: 100–150 cm). The laboratory parameters defining T2DM remission – fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA(1c)) – were measured 3, 6, 12 and 24 months after surgery. RESULTS: The average level of FPG and HbA(1c) remained non-diabetic 24 months after the RYGB in both groups. A statistical difference was not observed in direct FPG, HbA(1c), ΔFPG and ΔHbA(1c) comparisons at any follow-up point. However, a significantly higher proportion of patients in L-BL than in S-BL reached the laboratory remission criteria without anti-diabetic medicaments. Additional analysis revealed a strong correlation between the measured T2DM parameters and length of the common limb (CL) in both groups. CONCLUSIONS: A longer BL can intensify the anti-diabetic effect of RYGB. The length of CL rather than BL influences the medium-term T2DM remission. Long-term observation is needed to fully assess whether introduced technical aspects of RYGB provide a durable effect of T2DM resolution.