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Background There is a controversy on the suitable bariatric procedure for patients with BMI &gt; 50 kg/m 2 . Many surgeons prefer the Roux en-Y gastric bypass (RYGB) while others resort to long biliopancreatic limb (BPL) one anastomosis gastric bypass (OAGB). Methods This study included patients with BMI &gt; 50 kg/m 2  who underwent 250-cm BPL OAGB with total bowel length (TBL) &gt; 6 m and completed 24-month follow-up from July 2015 to November 2021. Demographic data with preoperative weight, BMI, hypertension (HTN), DM (HbA1C), Hb, iron, calcium, albumin, vitamin D, and parathormone levels (PTH) were recorded. Operative time, total bowel length (TBL), residual length (RBL), complications and postoperative weight, BMI, % of total weight loss (%TWL), HTN, DM, and alkaline reflux as well as Hb, iron, calcium, albumin, vitamin D, and PTH levels were recorded at 6, 12, 18, and 24 months. Results OAGB had a significant decrease in weight, BMI (25.6 ± 3.4 kg/m 2  at 24 months) with %TWL of 48 ± 5% at 24 months. TBL and RBL were 6.7 ± 0.65 and 4.2 ± 0.65 m respectively. %BL (RBL/TBL*100) was 62.4 ± 3.3%. The HbA1C, HTN, and alkaline reflux incidence were 5.5 ± 0.29 gm%, 1.4%, and 3.7% respectively at 24 months. Hb, iron, calcium, albumin, and vitamin D showed a significant decrease but still within normal range, and PTH showed a significant increase at 24 months. Conclusion Long BP (250 cm) OAGB in patients with BMI &gt; 50 kg/m 2  with TWL &gt; 6 m had good results in the achievement of weight loss and weight maintenance goals with remission of associated comorbidities as HTN and DM. Graphical abstract

obesity surgery

Outcomes and Effects of 250-cm Biliopancreatic Limb One Anastomosis Gastric Bypass in Patients with BMI &gt; 50 kg/m2 with Total Bowel Length &gt; 6 m: a 2-Year Follow-up