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Background

Severe protein calorie malnutrition is estimated to occur in approximately 1-2% of patients after duodenal switch. It is proposed that lengthening the alimentary limb, or limb lengthening, can improve albumin levels in this patient population. Techniques for lengthening include the non-divided and divided enteroenterotomy.

Methods

All patients undergoing a limb lengthening procedure at a single institution were evaluated. A Braun (non-divided) enteroenterotomy technique was utilized in the majority of cases, adding 100-150 cm of biliopancreatic limb anastomosed to 25-50 cm of distal roux limb. Baseline characteristics as well as albumin levels pre-operative and post-operatively were compared.

Results

From 2018 to 2021, 38 (2%) patients underwent limb lengthening after duodenal switch. 26 (68.4%) were women and the average pre-operative common channel length was 125 cm. The average pre-operative albumin level was 2.5 g/dL. The average post-operative albumin level was 3.4 g/dL. The average change in albumin level was 0.6 g/dL. The majority of patients, 28 (73.7%), were supported with pre-operative enteral feeding or total parental nutrition.

Conclusions

Laparoscopic limb lengthening with a Braun enteroenterotomy technique improves protein absorption effectively and increases albumin levels in patients with severe malnutrition after duodenal switch. In our series, 170 cm was added on average to the alimentary limb.