Eleven-Year Outcomes of a Randomized Controlled Trial Comparing Standard and Distal Roux-en-Y Gastric Bypass in...

Long-term outcomes of standard Roux-en-Y gastric bypass (RYGB) compared with distal Roux-en-Y gastric bypass (DRYGB) in patients with BMI > 50 kg/m² remain inadequately defined. This study presents 11-year follow-up results from a previously published randomized controlled trial comparing standard RYGB with DRYGB configured with a 200 cm biliopancreatic limb and 150 cm common channel.

One hundred and forty patients with BMI > 50 kg/m² were randomized to standard RYGB (n = 76) or DRYGB (n = 64). Primary outcomes were long-term weight loss and resolution of associated medical problems. Secondary outcomes included surgical complications, nutritional deficiencies, and gastrointestinal symptoms. Follow-up involved individual interview and laboratory analyses.

After 11.1 (± 1.4) years, DRYGB yielded a greater reduction in BMI units (20.7 vs. 15.5) and higher total weight loss (37.1% vs. 29.4%) than standard RYGB, with fewer cases of suboptimal weight loss (15% vs. 35%) and a higher proportion achieving BMI < 40 kg/m² (78.8% vs. 54.4%). Diabetes remission was achieved in 91.7% of DRYGB patients compared with 78.6% following standard RYGB. Nutritional deficiencies (albumin, ferritin, vitamin E, zinc and parathyroid hormone) were more common after DRYGB. Greater severity of dumping and increased stool frequency were observed after DRYGB, whereas diarrhea rates were comparable between groups.

DRYGB resulted in superior weight loss and metabolic outcomes compared to standard RYGB, while maintaining a manageable profile of nutritional deficiencies. These findings endorse DRYGB as a durable surgical option in patients with BMI > 50 kg/m², contingent upon structured lifelong follow-up.