Tailored Versus Fixed Biliopancreatic Limb Length in Redo One-Anastomosis Gastric Bypass After Sleeve…

Cohort studyJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract· Aug 2026

Tailored Versus Fixed Biliopancreatic Limb Length in Redo One-Anastomosis Gastric Bypass After Sleeve Gastrectomy: A Retrospective Cohort Study.

Mohamed Abosheisha, Islam Omar, Mohamed Ismaiel … Mohamed Elemawy

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Bariatric & Metabolic SurgeryCohort studyTreatmentQ1IF 2.0

Tailored biliopancreatic limb length linked to greater weight loss at 24 months.

Tailored Versus Fixed Biliopancreatic Limb Length in Redo One-Anastomosis Gastric Bypass After Sleeve Gastrectomy: A Retrospective Cohort Study.

Mohamed Abosheisha … Mohamed Elemawy

Journal of gastrointestinal surgery · Aug 2026 · Q1 in Surgery

Background

Revisional one-anastomosis gastric bypass (one-anastomosis gastric bypass) is an available intervention after failed sleeve gastrectomy (sleeve gastrectomy), but the optimal biliopancreatic limb (biliopancreatic limb) length remains uncertain.

Purpose

This study compared tailored versus fixed biliopancreatic limb length in revisional one-anastomosis gastric bypass after sleeve gastrectomy, with emphasis on weight loss, nutritional outcomes, gastrointestinal symptoms.

Methods

Were assigned according to operative strategy into a tailored biliopancreatic limb group (n = 100) and a fixed biliopancreatic limb group (n = 100).

n = 200 patients

Results

at 2 years, tailored-limb patients had lost most of their excess weight

Tailored

4%

Fixed

26%

More results

Weight loss outcomes significantly favored the tailored group at all follow-up points.

Mean %TWL was also greater in the tailored group: 18% ± 5% versus 14% ± 3% at 6 months, 33% ± 5% versus 25% ± 6% at 12 months, and 45% ± 5% versus 33% ± 7% at 24 months (all p < 0.001).

More results

Quality-of-life outcomes also favored the tailored approach, although mild bile reflux was reported more often in this group.

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Conclusion

Our findings suggest that in revisional one-anastomosis gastric bypass after sleeve gastrectomy, tailoring the biliopancreatic limb to 30% of total small bowel length is associated with greater weight loss, better nutritional preservation, and improved quality of life compared with a fixed 200cm limb.

Tailored Versus Fixed Biliopancreatic Limb Length in Redo One-Anastomosis Gastric Bypass After Sleeve Gastrectomy: A Retrospective Cohort Study.

Tailored Versus Fixed Biliopancreatic Limb Length in Redo One-Anastomosis Gastric Bypass After Sleeve Gastrectomy: A Retrospective Cohort Study.

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