Abstract

The optimal biliopancreatic limb (BPL) length in One Anastomosis Gastric Bypass (OAGB) remains debated, largely due to limited long-term outcome data. The primary objective of this study was to evaluate five-year results of weight loss, metabolic outcomes, and complication rates following OAGB with a fixed 150 cm BPL. This retrospective study was conducted at a high-volume bariatric center within the National Health Service (NHS) in the United Kingdom. We reviewed patients who underwent OAGB with a fixed 150 cm BPL between December 2015 and June 2019. Perioperative care followed the standard bariatric protocol of our institution. Patients were followed at six-month intervals for two years, and again at five years post-operatively. 274 patients were included, with a five-year follow-up rate of 73.7%. At two years, Mean %Excess Weight Loss (%EWL) was 77.0% (95% CI: 73.5-80.5) and Mean %Total Weight Loss (%TWL) was 35.0% (95% CI: 33.5-36.5). At five years, mean %EWL was 64.1% (95% CI: 60.7-67.5) and %TWL was 29.4% (95% CI: 27.9-30.9). Remission rates for type 2 diabetes, hypertension, and dyslipidemia were 55.8%, 32.2%, and 22.7%, respectively. The marginal ulcer rate was 4.5% (n = 9). Conversion to Roux-en-Y configuration (RYC) occurred in 5.9% (n = 12) of patients, and the malnutrition rate at five years was 0.5% (n = 1). OAGB with a 150 cm BPL demonstrated effective outcomes with acceptable complication rates and a favorable balance between efficacy and safety, with a low incidence of severe malnutrition. [Abstract copyright: © 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.]