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Aljaroudi ME, Makki M, Almulaify M, Alshabib A, Alfaddagh H, Alzahrani H, Alghamdi S, Alsualiman W, Alsalman J, Alhaddad MJ. Endoscopic Assessment Prior to Bariatric Surgery in Saudi Arabia. Cureus 2023; 15:e36157. [PMID: 37065321 PMCID: PMC10101814 DOI: 10.7759/cureus.36157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND There are marked local inconsistencies in the Arabian Peninsula about the role of preoperative esophagogastroduodenoscopy (EGD) in bariatric surgery. Thus, this study was conducted to determine the frequency of endoscopic and histological findings in the Saudi population presenting for pre-bariatric surgery evaluation. MATERIAL AND METHODS This was a retrospective study that included all the patients who were evaluated by EGD at Dammam Medical Complex, Dammam, Saudi Arabia, between 2018 and 2021 as a part of their pre-bariatric-surgery evaluation. RESULTS A total of 684 patients were included. They consisted of 250 male and 434 female patients (36.5% and 63.5%, respectively). The mean ± standard deviation for the patients' age and body mass index (BMI) were 36.4±10.6 years and 44.6±5.1 kg/m2, respectively. Significant endoscopic or histopathological findings as defined by the presence of large (≥ 2 cm) hiatus hernia, esophagitis, gastroesophageal reflux disease (GERD), Barrett esophagus, gastric ulcer, duodenal ulcer, or intestinal metaplasia were found in 143 patients (20.9%); 364 patients (53.2%) were diagnosed to have Helicobacter pylori infection. CONCLUSION The high number of significant endoscopic and histopathological findings in our study supports the routine use of preoperative EGD in all bariatric surgery patients. However, omitting EGD before Roux-en-Y gastric bypass (RYGB) in asymptomatic patients is still reasonable as the most frequently found significant findings, esophagitis, and hiatus hernia, are less likely to impact the operative plans in RYGB. Similarly, active surveillance and treatment of H. pylori infections in obese patients are important but it is not clear whether H. pylori eradication should be done before bariatric surgery.
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Liagre A, Benois M, Queralto M, Boudrie H, Van Haverbeke O, Juglard G, Martini F, Petrucciani N. Ten-year outcome of one-anastomosis gastric bypass with a biliopancreatic limb of 150 cm versus Roux-en-Y gastric bypass: a single-institution series of 940 patients. Surg Obes Relat Dis 2022; 18:1228-1238. [PMID: 35760675 DOI: 10.1016/j.soard.2022.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/08/2022] [Accepted: 05/13/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Long-term outcomes of one-anastomosis gastric bypass (OAGB) need to be compared with those of Roux-en-Y gastric bypass (RYGB). OBJECTIVE The present study evaluates the long-term outcomes at 10-year follow-up of OAGB with a biliopancreatic limb of 150 cm versus RYGB. SETTING Private practice, France. METHODS Data of patients who underwent OAGB or RYGB as primary or secondary procedures between 2010 and 2011 at a referral center were collected prospectively and analyzed retrospectively. RESULTS A total of 940 patients underwent OAGB (n = 405) or RYGB (n = 535). Operative time was significantly shorter in the OAGB group. Postoperative morbidity occurred in 17.2% of patients after RYGB versus 8.1% after OAGB (P ≤ .0001). Patients in the RYGB group had a significantly higher rate of kinking of the jejuno-jejunal anastomosis, stenosis of the gastrojejunal anastomosis, and dysphagia for early ulcers. At long term, no differences were found in the rate of severe malnutrition. Cumulated morbidity was significantly higher after RYGB, with higher incidence of internal hernia, anastomotic ulcer, blind-loop syndrome, and hypoglycemia. Conversion to RYGB and laparoscopic exploration for chronic pain were more frequent after OAGB. Surgery for weight regain was significantly more frequent after RYGB. Patients in the OAGB group had significantly lower weight, body mass index, and greater percentage excess, and total weight losses at 120 months. No significant differences were detected in co-morbidity outcomes. CONCLUSION After 10 years, both RYGB and OAGB are effective procedures. However, OAGB is associated with shorter operative times and better results in short- and long-term morbidity and weight loss outcomes.
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Affiliation(s)
- Arnaud Liagre
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Marine Benois
- Department of Digestive Surgery, CHU Félix Guyon, Saint-Denis, France
| | - Michel Queralto
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Hubert Boudrie
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Olivier Van Haverbeke
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Gildas Juglard
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Francesco Martini
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.
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Conversion of One Anastomosis Gastric Bypass to Roux-en-Y Gastric Bypass: Results of a Retrospective Multicenter Study. Obes Surg 2022; 32:1842-1848. [PMID: 35212908 DOI: 10.1007/s11695-022-05963-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) may expose the patient to certain specific complications. Here, we report the results of conversion of OAGB to Roux-en-Y gastric bypass (RYGB) in terms of outcomes and weight loss. METHODS Between January 2009 and January 2019, all patients undergoing conversion of OAGB to RYGB because of complications due to OAGB (n = 23) were included. The primary efficacy endpoint was the effectiveness of converting OAGB to RYGB. The secondary endpoints were overall mortality and morbidity during the first 3 postoperative months, specific morbidity, reoperation, length of hospitalization, weight loss, and progression of comorbidities related to obesity at 2-year follow-up. RESULTS Indications for conversion were bile reflux (n = 14; 60.9%), severe malnutrition (n = 3; 13%), gastro-gastric fistula (n = 4; 17.4%), and anastomotic leak (n = 2; 8.7%). The median time interval between OAGB and conversion to RYGB was 34 months (0-158). At the time of RYGB, median body mass index (BMI) was 28.0 kg/m2 (18.2-50.7), representing a median BMI change of 14.0 (- 1.7-43.5). Fifteen surgeries (65.1%) were completed laparoscopically. Five complications (21.7%) were recorded, including 2 major ones (8.7%). Reoperation rate was 4.3% (n = 1). At 24 months of follow-up (n = 18; 78.3%), median BMI was 28.7 kg/m2 (19.4-35.4), representing a median BMI change of 19.5 (12.2-43.1). No patient complained of bile reflux or persistent malnutrition. CONCLUSION RYGB performed as revisional surgery for complications after OAGB is an effective procedure with no major weight regain at 2 years of follow-up.
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Inocian EP, Nolfi DA, Felicilda-Reynaldo RFD, Bodrick MM, Aldohayan A, Kalarchian MA. Bariatric surgery in the Middle East and North Africa: narrative review with focus on culture-specific considerations. Surg Obes Relat Dis 2021; 17:1933-1941. [PMID: 34332910 DOI: 10.1016/j.soard.2021.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/19/2021] [Accepted: 06/18/2021] [Indexed: 12/26/2022]
Abstract
There is an increasing volume of bariatric surgeries in the Middle East and North Africa (MENA), but the context of bariatric surgery in the region is not fully understood. Incorporating culture-specific considerations in the provision of care to patients who undergo bariatric surgery may help to optimize outcomes after surgery. We conducted a narrative review of published research studies on bariatric surgery in the MENA region, highlighting cultural and contextual aspects relevant to the care of bariatric surgery patients who undergo surgery in this geographic area. The authors searched the following online databases: PubMed, CINAHL, Embase, and Academic Search Elite from 2010-2020 for studies conducted in 18 countries in the MENA region. This narrative review identifies cultural-specific considerations that may affect bariatric care and outcomes in 6 domains: knowledge of bariatric surgery; mental health, body image, and quality of life; influence of family; religion and lifestyle; preoperative practices; and healthcare access. Provision of culturally congruent care may help patients to achieve the best possible outcomes after bariatric surgery. Results may inform efforts to provide safe and culture-specific care in the MENA region, as well as those who migrate or seek care in other countries. More research is warranted on this heterogeneous population to optimize postsurgery weight trajectory and psychosocial adjustment.
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Affiliation(s)
- Ergie P Inocian
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania.
| | - David A Nolfi
- Gumberg Library, Duquesne University, Pittsburgh, Pennsylvania
| | | | - Mustafa M Bodrick
- Health Academy, Saudi Commission for Health Specialties, Riyadh, Saudi Arabia
| | - Abdullah Aldohayan
- Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
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Liagre A, Martini F, Kassir R, Juglard G, Hamid C, Boudrie H, Van Haverbeke O, Antolino L, Debs T, Petrucciani N. Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50? Obes Surg 2021; 31:3966-3974. [PMID: 34176036 PMCID: PMC8397657 DOI: 10.1007/s11695-021-05499-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 01/23/2023]
Abstract
Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract ![]()
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Affiliation(s)
- Arnaud Liagre
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Francesco Martini
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Gildas Juglard
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Celine Hamid
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Hubert Boudrie
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Olivier Van Haverbeke
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Laura Antolino
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Tarek Debs
- Department of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.
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Haddad A. Reply: Severe Protein Malnutrition After Bariatric Surgery and Liver Failure: a Dangerous Sequence. Obes Surg 2021; 31:3862-3863. [PMID: 33876344 DOI: 10.1007/s11695-021-05409-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ashraf Haddad
- Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC)-Jordan Hospital, Queen Noor St., 4th Circle, Amman, P.O BOX 3073, Amman, 11181, Jordan.
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Petrucciani N, Martini F, Kassir R, Juglard G, Hamid C, Boudrie H, Van Haverbeke O, Liagre A. Internal Hernia After One Anastomosis Gastric Bypass (OAGB): Lessons Learned from a Retrospective Series of 3368 Consecutive Patients Undergoing OAGB with a Biliopancreatic Limb of 150 cm. Obes Surg 2021; 31:2537-2544. [PMID: 33830446 PMCID: PMC8113202 DOI: 10.1007/s11695-021-05269-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/27/2021] [Accepted: 02/03/2021] [Indexed: 12/13/2022]
Abstract
Background Internal hernia (IH) represents a relatively common and well-known complication after Roux-en-Y gastric bypass. IH after one anastomosis gastric bypass (OAGB) is less frequent and rarely reported in the literature. This study presents a series of IH after OAGB observed in a high-volume bariatric center. Methods Data of patients who underwent OAGB with an afferent limb of 150 cm between May 2010 and September 2019 were prospectively collected and retrospectively analyzed. Data of patients undergoing surgery for IH during follow-up were collected and analyzed. Results Ninety-six patients out of 3368 with a history of OAGB had intestinal incarceration in the Petersen’s orifice (2.8%). Specificity and sensitivity of computed tomography scans in the diagnosis of IH were 59% and 76%, respectively. The mean timeframe between OAGB and surgery for IH was 21.9±18.3 months. Mean body mass index at the time of IH surgery was 24.7 ± 3.6. Surgery was completed laparoscopically in 96.8% of cases. Nine patients (9.3%) had signs of bowel hypovascularization. In all patients, the herniated bowel was repositioned, and the Petersen’s orifice was closed, without the need for bowel resection. Mean hospital stay was 1.9 ± 4.8 days. The postoperative morbidity rate was 8.3%. Long-term IH relapse was observed in 14 patients; signs of bowel hypovascularization due to incarceration in a small orifice was observed in eight of these patients (57%). Conclusions Incidence of IH after OAGB is 2.8%. IH is associated with a low rate of bowel ischemia and the need for intestinal resection.
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Affiliation(s)
- Niccolo Petrucciani
- Bariatric Surgery Unit, Ramsay Générale de Santé, Clinique des Cedres, Cornebarrieu, France
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, via di Grottarossa 1035-9, 00189 Rome, Italy
| | - Francesco Martini
- Bariatric Surgery Unit, Ramsay Générale de Santé, Clinique des Cedres, Cornebarrieu, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Gildas Juglard
- Bariatric Surgery Unit, Ramsay Générale de Santé, Clinique des Cedres, Cornebarrieu, France
| | - Celine Hamid
- Bariatric Surgery Unit, Ramsay Générale de Santé, Clinique des Cedres, Cornebarrieu, France
| | - Hubert Boudrie
- Bariatric Surgery Unit, Ramsay Générale de Santé, Clinique des Cedres, Cornebarrieu, France
| | - Olivier Van Haverbeke
- Bariatric Surgery Unit, Ramsay Générale de Santé, Clinique des Cedres, Cornebarrieu, France
| | - Arnaud Liagre
- Bariatric Surgery Unit, Ramsay Générale de Santé, Clinique des Cedres, Cornebarrieu, France
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Omar I, Sam MA, Pegler ME, Pearson EJB, Boyle M, Mahawar K. Effect of One Anastomosis Gastric Bypass on Haematinics, Vitamin D and Parathyroid Hormone Levels: a Comparison Between 150 and 200 cm Bilio-Pancreatic Limbs. Obes Surg 2021; 31:2954-2961. [PMID: 33594592 DOI: 10.1007/s11695-021-05281-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is little data on the effect of one anastomosis gastric bypass (OAGB) on haematinics, vitamin D and parathyroid hormone levels. It is further unclear if an OAGB with a bilio-pancreatic limb (BPL) of 150 cm (OAGB-150) would deliver better outcomes than that with a BPL of 200 cm (OAGB-200). MATERIALS AND METHODS We investigated our records to obtain information on patients who underwent an OAGB-200 or OAGB-150 until 31st July 2018 in our unit. RESULTS A total of 405 patients underwent either an OAGB-200 (n = 234) or OAGB-150 (n = 171). The mean age was 46 ± 10.98 years and 276 (68.1%) were females. The mean preoperative weight and the body mass index (BMI) were 139 ± 29.96 kg and 49 ± 8.14 kg/m2 respectively. With OAGB-200, there was a significant increase in anaemia rates at 1 and 2 years compared to preoperative levels with a significant fall in haemoglobin levels. After OAGB-150, there was a significant fall in haemoglobin levels at 1 and 2 years but the increase in anaemia rate was only significant at 2 years. There was a significant increase in PTH levels and the number of abnormal values at 1 and 2 years with OAGB-200. With OAGB-150, PTH changes were significant at 2 years only. CONCLUSION We found that both OAGB-200 and OAGB-150 are associated with a significant increase in anaemia and secondary hyperparathyroidism. Our findings should prompt the evaluation of supplementation protocols with higher dosages than we recommend for iron, folate and calcium. Consideration should also be given to evaluating shorter BPL lengths than 150 cm with OAGB.
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Affiliation(s)
- Islam Omar
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK.
| | - Miraheal Adadzewa Sam
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK
| | - Maya Elizabeth Pegler
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK
| | - Emma Jane Bligh Pearson
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK
| | - Maureen Boyle
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Trust, Sunderland, SR4 7TP, UK
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Haddad A. Comment on: Revisional bariatric surgery to single anastomosis gastric bypass: a large multi-institution series. Surg Obes Relat Dis 2021; 17:1087-1088. [PMID: 33750668 DOI: 10.1016/j.soard.2021.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/30/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Ashraf Haddad
- Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center, Jordan Hospital, Amman, Jordan
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Haddad A, Bashir A, Fobi M, Higa K, Herrera MF, Torres AJ, Himpens J, Shikora S, Ramos AC, Kow L, Nimeri AA. The IFSO Worldwide One Anastomosis Gastric Bypass Survey: Techniques and Outcomes? Obes Surg 2021; 31:1411-1421. [PMID: 33517557 DOI: 10.1007/s11695-021-05249-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION One anastomosis gastric bypass (OAGB) has become one of the most commonly performed gastric bypass procedures in some countries. OBJECTIVES To assess how surgeons viewed the OAGB, perceptions, indications, techniques, and outcomes, as well as the incidence of short- and long-term complications and how they were managed worldwide. METHODS A questionnaire was sent to all IFSO members in all 5 chapters to study the pattern of practice and outcomes of OAGB. RESULTS Seven hundred and forty-two surgeons responded. The most commonly performed procedures were sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and OAGB. Preoperatively, 70% of the surgeons performed endoscopy routinely. In regards to weight loss, 83% (570 surgeons) responded that OAGB produces better weight loss than SG, and 49% (342 surgeons) responded that OAGB produces better weight loss than RYGB. The most common length of the biliopancreatic limb (BPL) utilized was 200 cm. Sixty-seven percent of surgeons did not measure the total length of the small bowel. In patients with reflux disease and history of smoking, 53% and 22% of surgeons respectively still offered OAGB as a treatment option. Postoperatively, leak was documented in 963 patients, and it was the leading cause for mortality. Leak management was conservative in 35%. Conversion to RYGB was performed in 31%. In 16% the anastomosis was reinforced, 6% of the patients were reversed, and other procedures were performed in 12%. Revision of OAGB for malnutrition/steatorrhea or severe bile reflux was reported at least once by 37% and 45% of surgeons, respectively (200 cm was the most commonly encountered biliopancreatic limb BPL in those revised for malnutrition). Most common strategy for revision was conversion to RYGB (43%), reversal to normal anatomy (32%), shortening of the BPL (20%), and conversion to SG (5%). Nevertheless, 5 out of 98 mortalities (5%) were due to liver failure/malnutrition. CONCLUSION There are infrequent but potentially severe specific complications including malnutrition, liver failure, and bile reflux that may require surgical correction after OAGB.
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Affiliation(s)
- Ashraf Haddad
- Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC) -Jordan Hospital, Queen Noor St., 4th Circle, P.O BOX 3073, Amman, 11181, Jordan.
| | - Ahmad Bashir
- Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC) -Jordan Hospital, Queen Noor St., 4th Circle, P.O BOX 3073, Amman, 11181, Jordan
| | - Mathias Fobi
- Clinical Affairs and Research, Mohak Bariatric and Robotics, Indore, India
| | - Kelvin Higa
- Advanced Laparoscopic Surgery Associates, University of California San Francisco-Fresno, Fresno Heart and Surgical Hospital, Fresno, CA, USA
| | - Miguel F Herrera
- Endocrine and Bariatric Surgery, UNAM at INCMNSZ, Mexico City, México
| | - Antonio J Torres
- General and Bariatric Surgery, Complutense University of Madrid, Hospital Clinico "San Carlos", Madrid, Spain
| | - Jacques Himpens
- Metabolic-Bariatric Surgery, CHIREC Delta Hospital, Brussels, Belgium
- St Pierre University Hospital, Brussels, Belgium
| | - Scott Shikora
- Harvard Medical School, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Almino Cardoso Ramos
- Gastro-Obeso-Center Institute of Metabolic Optimization, Bela Vista, São Paulo, SP, Brazil
| | - Lilian Kow
- Adelaide Bariatric Centre, 12 The Parade, Norwood, SA, 5067, Australia
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Haddad A, Bashir A. The Hardship of Recovering a Patient from Liver Failure after One Anastomosis Gastric Bypass. Obes Surg 2021; 31:1395-1398. [PMID: 33417102 DOI: 10.1007/s11695-020-05210-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The one anastomosis gastric bypass (OAGB) was first described in 2001 as a safe and effective procedure that meets the criteria for the "ideal" weight loss operation. However, revisions for malnutrition and liver failure were reported. CASE REPORT We report a patient who was transferred to our institution with protein calorie malnutrition and liver failure after undergoing OAGB. METHODS A 42-year-old morbidly obese female patient underwent a laparoscopic sleeve gastrectomy (LSG) in 2012 followed by conversion to OAGB in 2018 for weight regain at another institution. Nine months after conversion, she was transferred to our institution with dehydration, vomiting, dysphagia, generalized edema, and steatorrhea (7 times/day). She had become wheelchair bound. On examination, there was gross edema, protein-calorie malnutrition, dermatitis, and muscle wasting. She had anemia (8 g/dl) reference range (11.5-15.5 g/dl), bilirubin (1.8 mg/dl) (0.2-1.2 mg/dl), hypoalbuminemia (1.4 g/dl) (3.5-5 g/dl), and elevated international normalized ratio (INR). The patient was admitted to the hospital and was started on total parenteral nutrition (TPN), with thiamine, vitamins, iron injections, and trace mineral replacement. Her course was complicated by multiple episodes of line sepsis and bacteremia. After 6 weeks, we succeeded in raising her albumin to 2.9 g/dl and proceeded with surgery. TECHNIQUE Laparoscopic exploration started with identifying the anatomy and measuring the biliopancreatic limb (BPL = 430 cm) and the common channel (CC = 380 cm). First, we restored the continuity of the small bowel. Then the long gastric pouch was trimmed. Finally, the patient was converted to a Roux-en-Y gastric bypass (RYGB) with a 30 cm BP limb and 70 cm Roux limb. The patient had an uneventful recovery and was discharged home on the fourth postoperative day. At 3 months of follow-up, her symptoms resolved, her laboratory work up normalized, and she regained mobility. CONCLUSION Malnutrition and liver failure after OAGB are not uncommon. It is encountered with configurations of longer BP limb. BPL length of 150 to 200 cm seems to reduce such complications. Preoperative nutritional optimization is key. Conversion to a proximal RYGB is a safe and feasible approach.
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Affiliation(s)
- Ashraf Haddad
- Gastrintestinal, Bariatric, and Metabolic Center (GBMC), Jordan Hospital, Queen Noor St., 4th Circle, P.O BOX 3073, Amman, 11181, Jordan.
| | - Ahmad Bashir
- Gastrintestinal, Bariatric, and Metabolic Center (GBMC), Jordan Hospital, Queen Noor St., 4th Circle, P.O BOX 3073, Amman, 11181, Jordan
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Liagre A, Debs T, Kassir R, Ledit A, Juglard G, Chalret du Rieu M, Lazzati A, Martini F, Petrucciani N. One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm: Weight Loss, Nutritional Outcomes, Endoscopic Results, and Quality of Life at 8-Year Follow-Up. Obes Surg 2020; 30:4206-4217. [DOI: 10.1007/s11695-020-04775-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Comparing the Efficacy and Safety of Roux-en-Y Gastric Bypass with One-Anastomosis Gastric Bypass with a Biliopancreatic Limb of 200 or 160 cm: 1-Year Results of the Tehran Obesity Treatment Study (TOTS). Obes Surg 2020; 30:3528-3535. [DOI: 10.1007/s11695-020-04681-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kassir R, Petrucciani N, Debs T, Juglard G, Martini F, Liagre A. Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) for Biliary Reflux Resistant to Medical Treatment: Lessons Learned from a Retrospective Series of 2780 Consecutive Patients Undergoing OAGB. Obes Surg 2020; 30:2093-2098. [DOI: 10.1007/s11695-020-04460-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ruiz-Mar G, Ruelas-Ayala A, Ornelas-Oñate LA, Ramirez-Velasquez JE. THE ONE ANASTOMOSIS GASTRIC BYPASS TECHNIQUE: RESULTS AFTER ONE YEAR OF FOLLOW-UP. ACTA ACUST UNITED AC 2019; 32:e1476. [PMID: 31859929 PMCID: PMC6918756 DOI: 10.1590/0102-672020190001e1476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/01/2019] [Indexed: 12/01/2022]
Abstract
Background: Obesity is a major health problem. One anastomosis-gastric bypass (OAGB) is a
restrictive and malabsorptive weight loss surgery that carries the same
characteristics of Roux-en-Y gastric bypass in its status as a weight loss
mechanism; but, its results remain controversial. Aim: To describe the technique and outcomes of OAGB and its effects on weight loss
and remission of comorbidities. Methods: Retrospective review of all patients who underwent OAGB procedure from
January 2017 to January 2018. Patients’ baseline characteristics were
recorded. The routine in follow-up were at 1, 3, 6 and 12 months. Results: A total of 51 patients underwent OAGB. The mean age was 43.8±9.3 years, mean
weight was 125±31 and mean BMI was 55.8±12 kg/m2. With regard to
comorbidities, 64.7% had type 2 diabetes mellitus (T2DM), 43.1% systemic
arterial hypertension (SAH) and 51% dyslipidemia. The BMI decreased for
48.4±1.3 to 31±4.4 at 12 months (p=0.0001) and we obtained an average
decreased of 65% excess weight loss (EWL) at 12 months of follow-up. There
was improvement in the values of total cholesterol (CT) (p=0.348);
triglycerides (TGC) (p=0.0001); LDL (p=0.06), HDL (p=0.029) and A1C
(p=0.405). Remission of T2DM al 12 months follow-up after surgery was 57%
(p=0.124), remission of SAH 37% (p=0.040) and remission of dyslipidemia of
43% (p=0.967). Conclusions: OAGB is a commonly performed and safe procedure. Short term results appear
promising; however, long-term follow-up is necessary to evaluate
complications and possible nutritional effects.
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Affiliation(s)
- Gabriela Ruiz-Mar
- Department of Bariatric Surgery, Hospital General de Mexico, Ciudad de México, CDMX, Mexico
| | - Alondra Ruelas-Ayala
- Department of Bariatric Surgery, Hospital General de Mexico, Ciudad de México, CDMX, Mexico
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