Effect of biliopancreatic limb length on Glycemic control following Roux-EN-Y Gastric bypass.

Abstract

Objective: To compare the effect of short versus long biliopancreatic limb length (BPL) on glycemic control following Roux-en-Y gastric bypass (RYGB) in patients with type 2 diabetes mellitus. Study Design: Quasi-Experimental Clinical Study. Setting: Department of Surgery, Shifa International Hospital, Islamabad. Period: October 2025 to January 2026. Methods: A total of 140 patients aged 30–60 years with type 2 diabetes mellitus undergoing Roux-en-Y gastric bypass were considered. Patients were non-randomly allocated into two groups based on biliopancreatic limb length: Group A underwent short biliopancreatic limb bypass, while Group B underwent long biliopancreatic limb bypass. Baseline demographic and clinical characteristics were recorded. HbA1c levels were measured preoperatively and six months postoperatively. The primary outcome was mean reduction in HbA1c at six months. A P-value of less than 0.5 was considered as significance following analysis through SPSS. Results: The two study groups didn’t differ significantly in terms of baseline clinical characters. The mean preoperative HbA1c was 8.1 ± 1.0 in the short limb group and 8.3 ± 1.4 in the long limb group (p = 0.58). At six months postoperatively, mean HbA1c decreased to 6.5 ± 0.9 in the short limb group and 6.1 ± 0.8 in the long limb group (p = 0.01). The mean HbA1c level was significantly reduced in the long biliopancreatic limb group versus the short limb group (2.2 ± 0.8% vs. 1.9 ± 0.7%; p = 0.002). Significantly high number patients of long limb control reported glycemic control (HbA1c < 6.5%) when compared with short limb group (84.2% vs 60%, p = 0.01). Conclusion: A longer BPL length in RYGP was associated with a significantly greater reduction in HbA1c and improved glycemic control at six months postoperatively compared to a shorter biliopancreatic limb.