EFFECTS OF STANDARD VERSUS VERY LONG ROUX LIMB ROUX-EN-Y GASTRIC BYPASS ON NUTRIENT STATUS: A 1 YEAR FOLLOW-UP REPORT FROM THE DUCATI STUDY.

Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is considered the gold standard for surgical treatment of morbid obesity. It is hypothesized that reducing the length of the common limb positively affects the magnitude and preservation of weight loss, but may also impose a risk of malnutrition. The aim of this study was to compare patients' nutrient and vitamin deficiencies in standard RYGB with a Very Long Roux Limb RYGB (VLRL-RYGB). This study was part of the multicenter randomized controlled trial (DUCATI), including 444 patients undergoing a RYGB or a VLRL-RYGB. Laboratory results, use of multivitamin supplements and reoperations were collected at baseline and one year postoperative. Primary outcome measure was nutrient deficiency after one year postoperative. Secondary outcome measure was the reoperation rate due to malabsorption. In total, 227 patients underwent RYGB and 196 patients underwent VLRL-RYGB. Most common deficiencies at one year postoperative were Ferritin(17.2-18.2%), Iron(23.4-35.6%), Potassium(7.4-15.2%), Vitamin B12(9.0-9.9%) and Vitamin D(22.7-34.5%). Patients undergoing VLRL-RYGB had slightly but significantly lower levels of calcium, iron and vitamin D compared to patients undergoing RYGB at 1 year postoperative, but significantly higher levels of folic acid and sodium. Reoperation rates due to malabsorption were not significantly different between RYGB(2/227, 0.9%) and VLRL-RYGB(7/196, 3.6%)(p=0.088). We concluded that patients undergoing VLRL-RYGB had significantly lower levels of calcium, iron and vitamin D compared to patients undergoing RYGB at one year postoperative, but higher levels of folic acid and sodium. Reoperation rates did not differ. Close monitoring on nutrient deficiencies should be performed in patients undergoing VLRL-RYGB.