There is currently no consensus on the total small bowel length that should be bypassed during performance of the Roux-en-Y gastric bypass and on the relative proportion of the biliopancreatic limb and the alimentary limb. The reported lengths of the biliopancreatic limb and the alimentary limb vary widely from 10–250 to 35–250 cm, respectively.

Nevertheless, there are no real standard measurement method or standard bowel limb lengths. The lengths reported by different surgeons are very difficult to compare. In bariatric surgery, bowel length determines the caloric absorptive capacity of the bowel and its ability to absorb micronutrients. The ratio between different bowel limb lengths and total small bowel length is of utmost importance for the success of bariatric surgery. An erroneous evaluation can have catastrophic consequences.

In this lecture, Jacques Himpens reviews the literature on the the true importance of the length of the alimentary and biliary limbs, its influence on metabolic changes, and the use of a longer alimentary limb in special cases.

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Dr. Jacques Himpens IFSO Senior Past President, Chief bariatric unit, CHIREC Hospitals, Attending surgeon, Saint Pierre university hospital, Brussels, Belgium Bariatric Surgery