Global Technical Variations in Roux-en-Y Gastric Bypass: A Worldwide Survey Among IFSO Members

Area of Science:

• Bariatric Surgery
• Metabolic Surgery
• Surgical Techniques

Background:

• Roux-en-Y gastric bypass (RYGB) is a common metabolic and bariatric surgery (MBS) procedure.
• Significant variability exists in the technical execution of RYGB worldwide.

Purpose of the Study:

• To evaluate global practice patterns in RYGB among International Federation for the Surgery and Other Therapies for Obesity (IFSO) members.
• To identify key variations and factors influencing intraoperative decision-making in RYGB.

Main Methods:

• A cross-sectional survey was distributed to 245 active IFSO members performing RYGB across 47 countries.
• The survey assessed techniques for gastric pouch, intestinal limbs, gastrojejunostomy, ring augmentation, and adjunct use.
• Data were analyzed using descriptive statistics, subgroup comparisons, and multivariable logistic regression.

Main Results:

• Widespread technical variability was observed in gastric pouch length measurement, bougie size selection, and intestinal limb length measurement.
• Ring augmentation use varied significantly by region and surgeon experience.
• Gastrojejunostomy techniques, stoma size, suture materials, and defect closures showed non-uniformity.

Conclusions:

• Global RYGB practices exhibit heterogeneity in critical operative steps.
• Improved reporting of intraoperative technical variables is needed to link variations to outcomes.
• Standardization may be clinically justified in specific areas to improve perioperative and long-term results.