This retrospective cohort study compared tailored BPL length (30% of total small bowel length, mean ~277 cm) versus fixed BPL length (200 cm) in 200 patients undergoing revisional one-anastomosis gastric bypass (OAGB) after failed sleeve gastrectomy, followed at 6, 12, and 24 months.
Tailored BPL produced superior weight loss at every time point: %EWL of 92% vs. 66% at 24 months (p < 0.001), and %TWL of 45% vs. 33% at 24 months (p < 0.001). Micronutrient deficiency was far less common with tailored BPL (4% vs. 26%, p < 0.001), and quality of life favored the tailored group, though mild bile reflux was more frequent.
Retrospective design limits causal inference and introduces selection bias. Only 200 patients at what appears to be a single center, limiting generalizability. Follow-up is limited to 24 months, leaving long-term durability of weight loss and nutritional outcomes unknown.
For revisional OAGB after sleeve gastrectomy, tailoring BPL to 30% of total small bowel length—rather than a fixed 200 cm—appears to offer meaningfully better weight loss and far lower rates of micronutrient deficiency. Surgeons should counsel patients about a modestly higher risk of mild bile reflux with this approach.
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