Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of General Surgery

The mechanism by which all gastric bypass surgeries induce weight loss includes a restrictive and a malabsorptive component; the created small gastric pouch limits the amount of food that can be ingested, and the bypass of a segment of duodenum and small bowel provides a degree of malabsorption. With no contact between the food bolus and the biliopancreatic secretions until reaching the efferent limb, absorption of nutrients is markedly reduced in the afferent limb.Thus, the degree of malabsorption can be modified by altering the length of the afferent and efferent limbs.1 To achieve weight loss benefit due to malabsorption, bariatric surgeons should focus on the length of the efferent limb rather than the afferent limb when constructing a gastric bypass especially in the superobese population where failure rates after gastric bypass are higher.1 Even though many authors have reported using 200 cm afferent limb length as the standard length in single anastomosis gastric bypass, there is currently no consensus on the optimum length of afferent and efferent limbs with single anastomosis gastric bypass, and the reported lengths vary from 150 cm (afferent limb) on the shorter side to variable length formulae using significantly longer limbs for heavier patients. It is currently unclear if there is a link between the severe protein{u2013}calorie malnutrition with single anastomosis gastric bypass and the length of the afferent limb. In the absence of such data, it has proved difficult to standardize the length of the afferent limb with this operation

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