{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:47:16Z","timestamp":1785822436274,"version":"3.56.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Limb distalization (LD) is an option for highly selected patients with suboptimal clinical response after Roux-en-Y gastric bypass (RYGB). This study assessed the effectiveness and safety of LD in a cohort of post-RYGB patients with suboptimal results, focusing on weight loss, obesity-related diseases remission, and nutritional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective observational study of patients who underwent LD between 2011 and 2023 at our institution. Only patients with recurrent weight gain after RYGB were selected. Outcomes assessed included the percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), remission of obesity-related diseases, and morbidity. Nutritional deficiencies were also evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 22 patients underwent LD. The interval between RYGB and LD was 116.8 months. The average BMI pre-LD was 39.0\u2005kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . At 12 months, mean %EWL and %TWL were 58.2% and 19.6%, respectively. At 60 months or more, %EWL was 49.9%, and %TWL was 19%. Remission of type 2 diabetes mellitus, dyslipidemia, and arterial hypertension occurred in 75%, 60%, and 40% of patients, respectively. The rate of early complications was 0%, while the rate of late complications was 27%. Protein malnutrition occurred in 9.1% of patients, with no cases of reversal surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LD was linked to substantial and sustained weight loss and significant remission of obesity-related metabolic diseases. Nutritional deficiencies remain a concern, particularly in patients with shorter total alimentary limb lengths, emphasizing the importance of individualized limb length and close follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1860731","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T05:36:33Z","timestamp":1785821793000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of limb distalization after Roux-en-Y gastric bypass: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Egon","family":"Rodrigues","sequence":"first","affiliation":[{"name":"Department of General Surgery, Local Health Unit Entre o Douro e Vouga","place":["Santa Maria da Feira, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Bandeira","sequence":"additional","affiliation":[{"name":"UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto","place":["Porto, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui Ferreira","family":"de Almeida","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Local Health Unit Entre o Douro e Vouga","place":["Santa Maria da Feira, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rio","family":"Nora","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Local Health Unit Entre o Douro e Vouga","place":["Santa Maria da Feira, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana P.","family":"Monteiro","sequence":"additional","affiliation":[{"name":"UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto","place":["Porto, Portugal"]},{"name":"ITR - Laboratory for Integrative and Translational Research","place":["Porto, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia S.","family":"Pereira","sequence":"additional","affiliation":[{"name":"UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto","place":["Porto, Portugal"]},{"name":"ITR - Laboratory for Integrative and Translational Research","place":["Porto, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Local Health Unit Entre o Douro e Vouga","place":["Santa Maria da Feira, Portugal"]},{"name":"UMIB - Unit for Multidisciplinary Research in Biomedicine, ICBAS - School of Medicine and Biomedical Sciences, University of Porto","place":["Porto, Portugal"]},{"name":"ITR - Laboratory for Integrative and Translational Research","place":["Porto, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"B1","volume-title":"IFSO 8th Global Registry Report","author":"Brown","year":"2023"},{"key":"B2","doi-asserted-by":"publisher","first-page":"39","DOI":"10.17476\/jmbs.2022.11.2.39","article-title":"Definition, mechanisms and predictors of weight loss failure after bariatric surgery","volume":"11","author":"Kim","year":"2022","journal-title":"J Metab Bariatr Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1007\/s11695-018-3610-4","article-title":"Lack of standard definitions of primary and secondary (non)responders after primary gastric bypass and gastric sleeve: a systematic review","volume":"29","author":"Bonouvrie","year":"2019","journal-title":"Obes Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1560","DOI":"10.1001\/jama.2018.14433","article-title":"Comparison of the performance of common measures of weight regain after bariatric surgery for association with clinical outcomes","volume":"320","author":"King","year":"2018","journal-title":"JAMA"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1755","DOI":"10.1007\/s11695-020-05160-5","article-title":"Weight regain and insufficient weight loss after bariatric surgery: definitions, prevalence, mechanisms, predictors, prevention and management strategies, and knowledge gaps-a scoping review","volume":"31","author":"Ansari W","year":"2021","journal-title":"Obes Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"3623","DOI":"10.1007\/s11695-021-05458-y","article-title":"How sustained is Roux-en-Y gastric bypass long-term efficacy? 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