{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T01:48:10Z","timestamp":1790905690542,"version":"4.1.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100006095","name":"South-Eastern Norway Regional Health Authority","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006095","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Identifying the optimal metabolic bariatric surgery approach for patients with severe obesity with a BMI \u226550\u2005kg\/m2 remains challenging. The aim of this long-term follow-up of a randomized clinical trial (RCT) was to compare distal long alimentary limb Roux-en-Y gastric bypass (RYGB) with standard RYGB for 10-year weight loss and nutritional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Secondary analysis of a 10-year follow-up of an RCT with initially 113 patients (BMI 50\u201360\u2005kg\/m2) randomized to either standard (n = 57, 50\u2005cm biliopancreatic\/150\u2005cm alimentary limb) or distal long alimentary limb RYGB (n = 56, 50\u2005cm biliopancreatic\/150\u2005cm common limb) from March 2011 to April 2013 at two Norwegian hospitals. The final data collection date was 15 August 2023. The primary focus was weight loss (BMI reduction, %total weight loss) and other secondary outcomes included cardiometabolic risk factors, nutritional status, and health-related quality of life (HRQOL).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 113 patients, 79 (69.9%, mean age 50 (s.d. 8.7) years, 50 (63%) females) patients were available for 10-year follow-up (41 standard RYGB, 38 distal RYGB). The 10-year mortality rate was 3.5% (4\/113) and all deaths occurred after distal RYGB. One death may have been associated with the surgery in a patient with previously undiagnosed liver cirrhosis at the time of operation. Mean BMI reduction from baseline was 12.0\u2005kg\/m2 (95% c.i., 10.8 to 13.2) after standard RYGB and 14.7\u2005kg\/m2 (95% c.i., 13.5 to 15.9) after distal RYGB with a between-group difference of 2.7\u2005kg\/m2 (95% c.i., 1.0 to 4.5, P = 0.002). The mean percentage total weight loss from baseline was 23.0% (95% c.i., 20.8 to 25.2) after standard RYGB and 28.2% (95% c.i., 26.0 to 30.5) after distal RYGB, with a between-group difference of 5.3% (95% c.i., 2.1 to 8.4, P = 0.001). The distal RYGB group had higher rates of malnutrition (1\/57 standard versus 5\/56 distal; P = 0.12), diarrhoea (7\/57 standard versus 15\/56 distal; P = 0.05), and vitamin D deficiency (24\/41 standard versus 32\/38 distal; P = 0.01). There were no differences between the groups in the prevalence of type 2 diabetes, hypertension, dyslipidaemia, or metabolic syndrome at 10-year follow-up. Four patients underwent revisional surgery due to malnutrition after distal RYGB. There were no statistically significant differences in HRQOL scores between the groups at 10 years (SF-36 physical 44.2 versus 44.1, mental 50.3 versus 47.3; OWLQOL 63 versus 61; all P &amp;gt; 0.2).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Distal long alimentary limb RYGB resulted in greater weight loss after 10 years with a higher risk of malnutrition, diarrhoea, and vitamin D deficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>Clinicaltrials.gov NCT00821197<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjs\/znaf285","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:06:00Z","timestamp":1765458360000},"source":"Crossref","is-referenced-by-count":1,"title":["Effect of standard\n                    <i>versus<\/i>\n                    long alimentary limb distal Roux-en-Y gastric bypass on weight loss and nutritional outcomes at 10 years in patients with BMI 50\u201360\u2005kg\/m2\u2014a secondary analysis of a randomized clinical trial"],"prefix":"10.1093","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9437-3902","authenticated-orcid":false,"given":"Odd Bj\u00f8rn","family":"Salte","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital , Oslo ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9389-4140","authenticated-orcid":false,"given":"Rolf E","family":"Hagen","sequence":"additional","affiliation":[{"name":"Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]},{"name":"Department of Gastrointestinal Surgery, Vestfold Hospital Trust , T\u00f8nsberg ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Svanevik","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, Vestfold Hospital Trust , T\u00f8nsberg ,","place":["Norway"]},{"name":"Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, EASO Collaborating Adult and Pediatric Centre for Obesity Management , T\u00f8nsberg ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten Wang","family":"Fagerland","sequence":"additional","affiliation":[{"name":"Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilde","family":"Risstad","sequence":"additional","affiliation":[{"name":"Department of Health Services, Norwegian Institute of Public Health , Oslo 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