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Obesity and type 2 diabetes mellitus (T2DM) are reaching epidemic proportions in the developed world. In morbidly obese patients only surgical treatment (bariatric operations) leads to a sustained weight loss and relief of co-morbidities in the majority of patients. One of the most frequently performed operations is the laparoscopic proximal Roux-en-Y gastric bypass (LRYGB). There is still lack of knowledge why some patients respond much better than others to an identically performed procedure. Therefore, a number of variations of this operation have been introduced over the past 50 years. Increasing the length of small bowel being bypassed has the potential to improve the effect of the operation but buries the risk of nutrient deficiencies. The metabolic effect of LRYGB occurs, in part, independently of weight loss. The mechanisms underlying metabolic improvement through metabolic surgery are not yet fully understood.
Our aim is to investigate whether a longer biliopancreatic limb (BPL) length in LRYGB leads to better weight loss and remission of comorbidities in morbidly obese patients without compromising its safety compared to a standard LRYGB. Furthermore, we would like to investigate underlying mechanisms in humans by measuring gut hormones, bile acids and differences in metabolite patterns (metabolomics) in a subpopulation of patients.