Efficacy and safety of limb distalization after Roux-en-Y gastric bypass: a retrospective cohort study.

INTRODUCTION: Limb distalization (LD) is an option for highly selected patients with suboptimal clinical response after Roux-en-Y gastric bypass (RYGB). This study assessed the effectiveness and safety of LD in a cohort of post-RYGB patients with suboptimal results, focusing on weight loss, obesity-related diseases remission, and nutritional outcomes. METHODS: Retrospective observational study of patients who underwent LD between 2011 and 2023 at our institution. Only patients with recurrent weight gain after RYGB were selected. Outcomes assessed included the percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), remission of obesity-related diseases, and morbidity. Nutritional deficiencies were also evaluated. RESULTS: A total of 22 patients underwent LD. The interval between RYGB and LD was 116.8 months. The average BMI pre-LD was 39.0 kg/m2. At 12 months, mean %EWL and %TWL were 58.2% and 19.6%, respectively. At 60 months or more, %EWL was 49.9%, and %TWL was 19%. Remission of type 2 diabetes mellitus, dyslipidemia, and arterial hypertension occurred in 75%, 60%, and 40% of patients, respectively. The rate of early complications was 0%, while the rate of late complications was 27%. Protein malnutrition occurred in 9.1% of patients, with no cases of reversal surgery. CONCLUSION: LD was linked to substantial and sustained weight loss and significant remission of obesity-related metabolic diseases. Nutritional deficiencies remain a concern, particularly in patients with shorter total alimentary limb lengths, emphasizing the importance of individualized limb length and close follow-up.