# Extended Versus Standard Pouch in Roux-en-Y Gastric Bypass: Five To Nine Year Follow-Up Results of a Randomized Controlled Trial

## TL;DR

This study compares two types of gastric bypass surgeries over 5-9 years, finding that the extended pouch version may lead to slightly better weight loss and less weight regain.

## Contribution

The study introduces a modified Roux-en-Y gastric bypass with an extended pouch and evaluates its long-term outcomes compared to the standard procedure.

## Key findings

- EP-RYGB showed a trend toward higher total weight loss compared to S-RYGB, though not statistically significant.
- Fewer EP-RYGB patients experienced recurrent weight gain compared to S-RYGB patients.
- Health-related quality of life and gastrointestinal symptoms were similar between the two groups.

## Abstract

Metabolic bariatric surgery (MBS) such as the Roux-en-Y gastric bypass (RYGB) is effective in the treatment of obesity. However, not every patient achieves optimal clinical response and recurrent weight gain remains a concern. Hypothetically, a narrow longer pouch could lead to better results by preventing pouch dilatation and slowing down gastric emptying rates. The aim of this study is to evaluate the effect of an extended pouch gastric bypass (EP-RYGB) on weight loss and quality of life 5 to9years (median 109 months [104–116]) postoperatively.

Follow-up study of a single-blinded RCT including 62 patients who underwent a standard Roux-en-Y gastric bypass (S-RYGB, n = 30) versus EP-RYGB (n = 32) between September 2014 and October 2015. Outcomes on weight loss, obesity related complications, health-related quality of life (HRQoL), and gastro-intestinal symptomswere compared between S-RYGB and EP-RYGB.

Mean total weight loss (%TWL) was higher in EP-RYGB compared to S-RYGB (26.1 ± 11.2%, versus 24.1 ± 10.1%) although not statistically significant. More patients in the S-RYGB group tended to experience recurrent weight gain compared to EP-RYGB (70% versus 47%, p = 0.07). HRQoL and gastro-intestinal symptoms were comparable between groups (p > 0.05 for all).

EP-RYGB results in slightly better weight loss outcomes and similar HrQoL compared to S-RYGB 5 to 9 years postoperatively. However, due to loss to follow up, the current study is underpowered and a definitive long term advantage of EP-RYGB cannot be concluded.

The online version contains supplementary material available at 10.1007/s11695-026-08528-1.

Extended Pouch Roux-en-Y Gastric Bypass showed a non-significant trend towards better long term TWL compared to Standard Roux-en-Y Gastric Bypass.

Patients who underwent Standard Roux-en-Y Gastric bypass were more prone to developing recurrent weight gain.

Health-related quality of life was similar for Standard versus Extend Pouch Roux-en-Y Gastric Bypass.

Due to loss of long term follow-up compared to the initial trial, the abovementioned key points should be interpreted with caution, since the required number of patients for > 80% of power was no longer reached.

The online version contains supplementary material available at 10.1007/s11695-026-08528-1.