Background

In biliopancreatic diversion BPD, length of the alimentary limb (AL) and of the common limb (CL) is constant (200 and 50 cm), whereas the biliopancreatic limb (BPL) length varies, according to total intestinal length (TL).Aim of the study is an evaluation of intestinal limb lenghts in morbidly obese patients submitted to BPD, and to analyze correlations between BPL length, weight loss and incidence of nutritional complications, as a proxy of intestinal absorption.517 patients submitted to standard BPD between 1984 and 1988 were included in the study. Peri-operative fatalities (n=11) and revisional surgery cases (n= 1) have been excluded.Nutritional complications were defined as occurrence of clinically relevant anemia, ostheoporosis, protein malnutrition and fat-soluble vitamin deficiencies.Intestinal limb lengths of complicated (C) and uncomplicated (UC) patients have been compared.209 (41.4%) patients experienced complications during a 30-year follow-up. BMI, age and gastric volume in C and UC patients were 47 e 46 kg/m2, 28 and 36 years, and 377ml and 403 ml, respectively (p= n.s.). Postoperative BMI of C vs. UC patients was 26 vs. 28 kg/m2.Mean TL and BPL length in C and UC patients were 795 vs. 760 cm, and 540 vs. 510 cm, respectively (p= <0.05, Student's t).Patients submitted to standard BPD who experienced long-term nutritional complications had longer TL and BPL lengths than uncomplicated patients, and achieved greater weight loss, despite identical AL and CL lenghts. Intestinal absorption surface is not the only determinant of energy and nutrient absorption after malabsoprtive bariatric surgery.