الفهرس 
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Abstract
Obesity is a significant health concern due to its widespread prevalence and high risk of complications. The prevalence of obesity increases four-fold with age in both men and women, with a significant rise in persons with a BMI of 35 kg/m2 or higher between 1999 and 2009. Obesity increases the risk of diseases such as type 2 diabetes mellitus, fatty liver disease, hypertension, myocardial infarction, stroke, dementia, osteoarthritis, obstructive sleep apnoea, and several cancers, contributing to a decline in quality of life and life expectancy.
Bariatric surgery is emerging as a powerful weapon against severe obesity and type 2 diabetes mellitus (T2DM). The gastrointestinal tract is a meaningful target for treating T2DM, with evidence suggesting that surgery with gastrointestinal manipulations may result in T2DM remission. Metabolic changes are often observed soon after bariatric surgery, and BS is more effective than dietary control in improving diabetes, even with equivalent weight loss. Changes in gastro-intestinal hormones, such as GLP-1, PYY, and oxyntomodulin, may play a role in inducing and long-term maintenance of weight loss.
One-anastomosis gastric bypass (OAGB) has been assessed in several studies, with most indicating excellent weight loss and improvement in comorbidities after OAGB. However, OAGB can be associated with complications such as bile reflux, marginal ulcers, anemia, and nutritional deficiencies.
The aim of this study was the Comparison of the effect of biliopancreatic limb length (150cm versus 200cm) regarding weight loss, resolution of comorbidities and post-operative complications especially nutritional deficiency along 2 years of follow up.
This Retrospective cohort study was conducted in Ain Shams University Hospitals and Ahmed Maher Teaching Hospital. This study was conducted on 80 patients: 40 patients who underwent OAGB with biliopancreatic limb length 150 cm and 40 patients who underwent OAGB with biliopancreatic limb length 200 cm.
The main results of the study revealed that:
• Regarding Sex, there was no statistically significant difference between the two studied groups (p= 0.654).
• Systolic blood pressure after one year follows up in 150 cm group ranged from 115 to 128 with mean ± SD = 120.6 ± 4.9 while in 200 cm group the Systolic blood pressure after one year follow up ranged from 116 to 130 with mean ± SD = 121.8 ± 5.22 with no statistically significant difference (p= 0.293) between the two groups.
• Diastolic blood pressure after one year follows up in 150 cm group ranged from 81 to 89 with mean ± SD = 82.6 ± 2.36 while in 200 cm group the Diastolic blood pressure after one year follow up ranged from 82 to 90 with mean ± SD = 83.6 ± 2.36 with no statistically significant difference (p= 0.062) between the two groups.
• Fasting blood glucose after one year follow up in 150 cm group ranged from 93 to 138 with mean ± SD = 104.5 ± 14.03 while in 200 cm group the Fasting blood glucose after one year follow up ranged from 94 to 140 with mean ± SD = 105.65 ± 14.34 with no statistically significant difference (p= 0.718) between the two groups.
• Two hours’ post-prandial glucose after one year follow up in 150 cm group ranged from 132 to 208 with mean ± SD = 146.7 ± 21.59 while in 200 cm group the Two hours’ post-prandial glucose after one year follow up ranged from 134 to 210 with mean ± SD = 148.7 ± 21.59 with no statistically significant difference (p= 0.68) between the two groups.
• Regarding HBA1C Remission, there was no statistically significant difference between the two studied groups (p= 0.446).
• Regarding Basal metabolic index Remission, there was no statistically significant difference between the two studied groups (p= 0.88).
• Regarding Estimated weight loss (%) Remission, there was no statistically significant difference between the two studied groups (p= 0.896).
• Mean of EWL after 3 months among the study population was 30%. Mean of EWL after 6 months among the study population was 45.3%. Mean of EWL after 9 months among the study population was 52.7%. Mean of EWL after 1 year among the study population was 59.4%.
• Regarding Cholesterol (mg/dL) Remission, there was a highly significant difference between the two studied groups (p= <.001).
• Regarding Triglycerides (mg/dL) Remission, there was a highly significant difference between the two studied groups (p= <.001).
• Regarding Vit D3 (nmol/L) Deficiency, there was statistically significant difference between the two studiedgroups. (p=0.032).
• Regarding Ferritin (ng/mL) Deficiency, there was statistically significant difference between the two studied groups
(p= 0.0402).
• Regarding Albumin (g/dL) Deficiency, there was statistically significant difference between the two studied groups (p= 0.0425).
• Regarding Ca (mg/dL) Deficiency, there was statistically significant difference between the two studied groups (p= 0.01).
• Regarding Vit B12 (pg/mL) Deficiency, there was statistically significant difference between the two studied groups (p= 0.021).
• Regarding Hyper-Parathyroidism, there was statistically significant difference between the two studied groups (p= 0.023).
• Duration of DM in 150 cm group ranged from 2 to 12 with mean ± SD = 5.88 ± 2.76 while in 200 cm group the Duration of DM ranged from 2.5 to 13 with mean ± SD = 6.32 ± 3.12 with no statistically significant difference (p= 0.497) between the two groups.
• Operative time in 150 cm group ranged from 60 to 140 with mean ± SD = 100.25 ± 22.62 while in 200 cm group the operative time ranged from 65 to 160 with mean ± SD = 113.5 ± 26.46 with statistical significant difference (p= 0.018) between the two groups.
• Regarding Leakage, there was no statistical significant difference between the two studied groups (p= 0.499). Regarding Reflux, there was no statistical significant difference between the two studied groups (p= 0.396). Regarding Bleeding, there was no statistical significant difference between the two studied groups (p= 0.264). Regarding Readmission, there was no statistical significant difference between the two studied groups (p= 0.264). Regarding after one year follow up Antibiotics need, there was no statistical significant difference between the two studied groups (p= 0.264).