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Ghiassi S, Nimeri A, Aleassa EM, Grover BT, Eisenberg D, Carter J. American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass. Surg Obes Relat Dis 2024; 20:319-335. [PMID: 38272786 DOI: 10.1016/j.soard.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/27/2024]
Abstract
The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Essa M Aleassa
- Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
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Cao L, Liang S, Yu X, Guan B, Yang Q, Ming WK, Chen Y. Change in Mineral Status After Bariatric Surgery: a Meta-analysis. Obes Surg 2023; 33:3907-3931. [PMID: 37872256 DOI: 10.1007/s11695-023-06888-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The risk of protein and vitamin deficiencies after bariatric surgery has been well studied, but the change in mineral status has not gotten enough attention. This study aimed to perform a meta-analysis regarding the change in mineral levels after bariatric surgery and the prevalence of postoperative mineral deficiency, with subgroup analyses of different surgical procedures, study regions, and follow-up time. METHODS CENTRAL, PubMed, and EMBASE were searched for related articles. Meta-analysis, subgroup analysis, and sensitivity analysis were performed if necessary. RESULTS A total of 107 articles with 47,432 patients were included. The most severe mineral deficiency after bariatric surgery was iron (20.1%), followed by zinc (18.3%), copper (14.4%), chlorine (12.2%), phosphorus (7.5%), and calcium (7.4%). Serum concentrations of potassium, sodium, selenium, manganese, and molybdenum showed no significant change before and after surgery. Subgroup analyses revealed that SG had fewer deficiencies in serum iron, calcium, zinc, magnesium, phosphorus, copper, and selenium than RYGB. OAGB showed a higher incidence of serum iron and zinc deficiencies than RYGB. Studies conducted in different regions also found various mineral statuses after surgery. Studies with follow-up ≥ 5 years had a lower prevalence of zinc, copper, and selenium deficiencies than follow-up < 5 years. CONCLUSION A high deficiency rate of serum iron, zinc, copper, chlorine, phosphorus, and calcium was seen after bariatric surgery. The difference in surgical procedures, study regions, and follow-up time may affect postoperative mineral status; more targeted mineral supplement programs are needed considering these influencing factors.
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Affiliation(s)
- Li Cao
- College of Nursing, Jinan University, Guangzhou, 510632, China
| | - Sihua Liang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xuefen Yu
- Comprehensive Special Diagnosis Department, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Bingsheng Guan
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
| | - Qiaohong Yang
- College of Nursing, Jinan University, Guangzhou, 510632, China.
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, 999077, China.
| | - Yanya Chen
- College of Nursing, Jinan University, Guangzhou, 510632, China.
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, 999077, China.
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Chang YC, Hsu CN, Chong K, Yang PJ, Ser KH, Lee PC, Chen SC, Hsuan CF, Lee YC, Hsu CC, Lee HL, Liao KCW, Hsieh ML, Chuang GT, Yang WS, Chu SL, Li WY, Chuang LM, Lee WJ. Roux-en-Y and One-Anastomosis Gastric Bypass Surgery Are Superior to Sleeve Gastrectomy in Lowering Glucose and Cholesterol Levels Independent of Weight Loss: a Propensity-Score Weighting Analysis. Obes Surg 2023; 33:3035-3050. [PMID: 37612578 DOI: 10.1007/s11695-023-06656-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND The superior effects of gastric bypass surgery in preventing cardiovascular diseases compared with sleeve gastrectomy are well-established. However, whether these effects are independent of weight loss is not known. METHODS In this retrospective cohort study, we compared the change in cardiometabolic risks of 1073 diabetic patients undergoing Roux-en-Y gastric bypass (RYGB) (n = 265), one-anastomosis gastric bypass (OAGB) (n = 619), and sleeve gastrectomy (SG) (n = 189) with equivalent weight loss from the Min-Shen General Hospital. Propensity score-weighting, multivariate regression, and matching were performed to adjust for baseline differences. RESULTS After 12 months, OAGB and, to a lesser extent, RYGB exhibited superior effects on glycemic control compared with SG in patients with equivalent weight loss. The effect was significant in patients with mild-to-modest BMI reduction but diminished in patients with severe BMI reduction. RYGB and OAGB had significantly greater effects in lowering total and low-density lipoprotein cholesterol than SG, regardless of weight loss. The results of matching patients with equivalent weight loss yielded similar results. The longer length of bypassed biliopancreatic (BP) limbs was correlated with a greater decrease in glycemic levels, insulin resistance index, lipids, C-reactive protein (CRP) levels, and creatinine levels in patients receiving RYBG. It was correlated with greater decreases in BMI, fasting insulin, insulin resistance index, and C-reactive protein levels in patients receiving OAGB. CONCLUSION Diabetic patients receiving OAGB and RYGB had lower glucose and cholesterol levels compared with SG independent of weight loss. Our results suggest diabetic patients with cardiovascular risk factors such as hypercholesterolemia to receive bypass surgery.
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Affiliation(s)
- Yi-Cheng Chang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, 115, Taiwan
- Center for Obesity, Lifestyle, and Metabolic Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
- Graduate Institute of Molecular Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Chih-Neng Hsu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, 640, Taiwan
| | - Keong Chong
- Department of Medicine, Min-Sheng General Hospital, Taoyuan, 330, Taiwan
| | - Po-Jen Yang
- Center for Obesity, Lifestyle, and Metabolic Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
- Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Kong-Han Ser
- Department of Surgery, Ten-Chen General Hospital, Taoyuan, 326, Taiwan
| | - Po-Chu Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Shu-Chun Chen
- Department of Nursing, Ming-Sheng General Hospital, Taoyuan, 330, Taiwan
| | - Chin-Feng Hsuan
- Department of Internal Medicine, Division of Cardiology, E-Da Hospital, Kaohsiung, 824, Taiwan
- Department of Internal Medicine, Division of Cardiology, E-Da Dachang Hospital, Kaohsiung, 824, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 840, Taiwan
| | - Yi-Chih Lee
- Department of International Business, Chien Hsin University of Science and Technology, Taoyuan, 320, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, 350, Taiwan
| | - Hsiao-Lin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Karen Chia-Wen Liao
- Biological Sciences Division, University of Chicago, Chicago, IL, 60637, USA
| | - Meng-Lun Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan
- Department of Medicinal Chemistry, College of Pharmacy, University of Florida, Gainesville, FL, 32610, USA
| | - Gwo-Tsann Chuang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, 100, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Wei-Shun Yang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, 302, Taiwan
| | - Shao-Lun Chu
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Wen-Yi Li
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, 640, Taiwan
| | - Lee-Ming Chuang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan.
- Graduate Institute of Molecular Medicine, National Taiwan University, Taipei, 100, Taiwan.
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, 100, Taiwan.
| | - Wei-Jei Lee
- Department of Medicine, Min-Sheng General Hospital, Taoyuan, 330, Taiwan.
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, 330, Taiwan.
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AlSabah S, Al Haddad E, Al-Subaie S, Ekrouf S, Almulla A, Alhaddad M, Aljabal MS, Alenezi K. Long-term outcomes of revisional one anastomosis gastric bypass post laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 2023; 408:43. [PMID: 36656465 DOI: 10.1007/s00423-023-02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Revisional bariatric surgeries following laparoscopic sleeve gastrectomy (LSG) have demonstrated a dramatic increase worldwide. Recently, one-anastomosis gastric bypass (OAGB) has become a contender as an appropriate revisional procedure; however, no long-term data currently exist on the effectiveness of it as a revisional surgery post-LSG. METHODS A retrospective analysis was performed on all patients who underwent LSG at a public hospital in Kuwait from 2008 to 2017. A list was obtained of those who underwent revisional OAGB surgery after initial LSG, after which a phone survey was performed and demographics were analyzed. RESULTS A total of 29 patients underwent revisional OAGB post-initial LSG, of which 89.7% were female. Prior to LSG, the mean weight of the patients was 127.5 kg, and the mean BMI was 49.0 kg/m2. The mean weight loss after initial LSG was 43.8 kg, while the average duration until patients underwent revisional OAGB was 5.3 years. The cause for revision was weight regain (86.2%) or inadequate weight loss (13.8%). Prior to undergoing revisional OAGB, the weight and BMI of the patients was 110.9 kg and 42.4 kg/m2, respectively. Revisional OAGB demonstrated a %excess weight loss of 14.5%, 31.9%, 48.0%, 56.3%, 57.2%, and 54.7% at 2 weeks, 3 months, 6 months, 1 year, 4 years, and 5 years, respectively. Twelve morbidities were reported during the follow-up period. CONCLUSION Revisional bariatric surgery is technically demanding and may be associated with a high complication rate. However, OAGB as a revisional procedure has proven to be safe and effective in the long-term outcomes of revisional OAGB patients post-LSG.
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Felsenreich DM, Arnoldner MA, Wintersteller L, Mrekva A, Jedamzik J, Eichelter J, Langer FB, Prager G. Intrathoracic pouch migration in one-anastomosis gastric bypass with and without hiatoplasty: A 3-dimensional-computed tomography volumetry study. Surg Obes Relat Dis 2022; 19:492-499. [PMID: 36566133 DOI: 10.1016/j.soard.2022.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Currently, 4.8% of bariatric operations worldwide are one-anastomosis gastric bypass (OAGB) procedures. If a hiatal hernia is detected in a preoperative gastroscopy, OAGB can be combined with hiatoplasty. Intrathoracic pouch migration (ITM) is common after bypass procedures because the fundus, a natural abutment, is separated from the pouch. OBJECTIVE The aim of this study was to find out whether OAGB or OAGB combined with hiatoplasty carries a higher risk of ITM and, therefore, also gastroesophageal reflux disease (GERD). SETTING University hospital. METHODS Fifty patients (group 1: 25× primary OAGB; group 2: 25× primary OAGB with hiatoplasty) were included in this study. History of weight, GERD, and quality of life were recorded in patient interviews and pouch volume and ITM were evaluated using 3-dimensional-computed tomography volumetry. RESULTS There were no differences in terms of patient characteristics, history of weight, pouch volume, or quality of life between both groups. ITM was found in group 1 in 60% (n = 15) and group 2 in 76% (n = 19) of all patients (P = .152). The ITM mean length was significantly lower in group 1 with .9 ± 1.1 cm than in group 2 with 1.8 ± 1.2 cm (P = .007). Regarding GERD, there was no difference between both groups; nevertheless, significantly more patients with ITM (38.2%; n = 13) had GERD compared with patients without ITM (6.3%; n = 1). CONCLUSION In primary OAGB, an additional hiatoplasty was not associated with higher rates of ITM or GERD; nevertheless, the length of ITM was higher after hiatoplasty. If ITM occurs, patients have a risk of developing GERD.
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Affiliation(s)
- Daniel M Felsenreich
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael A Arnoldner
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Wintersteller
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Arpad Mrekva
- Division of General and Pediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Julia Jedamzik
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Jakob Eichelter
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Felix B Langer
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Prager
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
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Mirzaee S, Golzarand M, Parsaei R, Toolabi K, Amirbeigi A. How accurate is the visual estimation of bowel length by endoscopic surgeons? Front Surg 2022; 9:1001329. [DOI: 10.3389/fsurg.2022.1001329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
BackgroundMeasurement of small bowel length is an essential step in performing bariatric surgery. Surgeons need to measure bowel length in order to create alimentary and biliopancreatic limbs. Inaccurate bowel measurement may affect the outcome of surgery. However, it is not clear how accurate the measurement of bowel length is by surgeons.MethodsTwo image quizzes marking certain lengths of jejunum were sent to participants. They were asked to estimate the length of marked bowels in maze quizzes. The Error of estimation, prevalence of significant error (error greater than 30 percent of actual length), and the relationship between different participant characteristics was investigated.ResultsA total of 86 participants answered the questionnaire. The mean error of estimation was 4.62 cm (27%). Twenty-eight participants (33%) had significant errors in estimation of bowel length.ConclusionWhile there are surgeons that can estimate bowel length with decent accuracy, significant errors in estimation of bowel length are not uncommon among surgeons. Surgeons should consider adopting techniques for accurate measurement of the small intestine.
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Li M, Liu Y, Lee WJ, Shikora SA, Robert M, Wang W, Wong SKH, Kong Y, Tong DKH, Tan CH, Zeng N, Zhu S, Wang C, Zhang P, Gu Y, Bai R, Meng F, Mao Z, Zhao X, Wu L, Liu Y, Zhang S, Zhang P, Zhang Z. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for type 2 diabetes remission (ORDER): protocol of a multicentre, randomised controlled, open-label, superiority trial. BMJ Open 2022; 12:e062206. [PMID: 36175102 PMCID: PMC9528602 DOI: 10.1136/bmjopen-2022-062206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Previous studies have demonstrated that one anastomosis gastric bypass (OAGB) is not inferior to Roux-en-Y gastric bypass (RYGB) in treating obesity. However, high level evidence comparing the efficacy and safety of both procedures in type 2 diabetes (T2D) treatment is still lacking, which is another main aim of bariatric surgery. The presented trial has been designed to aim at investigating the superiority of OAGB over the reference procedure RYGB in treating T2D as primary endpoint. And diabetes-related microvascular and macrovascular complications, cardiovascular comorbidities, weight loss, postoperative nutritional status, quality of life and overall complications will be followed up for 5 years as secondary endpoints. METHODS AND ANALYSIS This prospective, multicentre, randomised superiority open-label trial will be conducted in patients of Asian descent. A total of 248 patients (BMI≥27.5 kg/m2) who are diagnosed with T2D will be randomly assigned (1:1) to OAGB or RYGB with blocks of four. The primary endpoint is the complete diabetes remission rate defined as HbA1c≤6.0% and fasting plasma glucose≤5.6 mmol/L without any antidiabetic medications at 1 year after surgery. All secondary endpoints will be measured at different follow-up visit points, which will start at least 3 months after enrolment, with a continuous annual follow-up for five postoperative years in order to provide solid evidence on the efficacy and safety of OAGB in patients with T2D. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of leading centre (Beijing Friendship Hospital, Capital Medical University, no. 2021-P2-037-03). The results generated from this work will be disseminated to academic audiences and the public via publications in international peer-reviewed journals and conferences. The data presented will be imported into a national data registry. Findings are expected to be available in 2025, which will facilitate clinical decision-making in the field. TRIAL REGISTRATION NUMBER NCT05015283.
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Affiliation(s)
- Mengyi Li
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yang Liu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taiwan, China
| | - Scott A Shikora
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Maud Robert
- Department of Digestive and Bariatric Surgery, Hôpital Edouard Herriot, Lyon, France
| | - Weu Wang
- Department of Surgery, Taipei Medical University Hospital, Taiwan, China
| | | | - Yuanyuan Kong
- Clinical Epidemiology & EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - Chun Hai Tan
- Surgicare Bariatric and General Surgery Clinic, Singapore
| | - Na Zeng
- School of Public Health, Peking University, Beijing, China
| | - Shaihong Zhu
- Department of General Surgery, The Third Xiangya Hospital of Central South University, Hunan, China
| | - Cunchuan Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jinan University, Guangdong, China
| | - Pin Zhang
- Division of Bariatric and Metabolic Surgery, Department of General Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, China
| | - Yan Gu
- Department of General Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Rixing Bai
- Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fanqiang Meng
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhongqi Mao
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Jiangsu, China
| | - Xiangwen Zhao
- Department of General Surgery, Xiaolan People's Hospital, Guangdong, China
| | - Liangping Wu
- Division of Metabolic and Bariatric Surgery, Department of General Surgery, Jinshazhou Hospital of Guangzhou, University of Chinese Medicine, Guangdong, China
| | - Yanjun Liu
- Center of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University & Research Center for Obesity and Metabolic Disease, School of Medicine, Southwest Jiaotong University, Sichuan, China
| | - Songhai Zhang
- Department of General Surgery, The First Affiliated Hospital of Henan University of Science and Technology, Henan, China
| | - Peng Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Singla V, Kumar A, Gupta M, Manohar M, Monga S, Agarwal S, Sharma AK, Aggarwal S. Gastrointestinal Quality of Life in Morbidly Obese Patients Undergoing One Anastomosis Gastric Bypass (OAGB): Derivation of a "Mini GIQLI" Score. Obes Surg 2022; 32:2332-2340. [PMID: 35488108 DOI: 10.1007/s11695-022-06080-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is now one of the mainstream bariatric surgical procedures with proven safety and efficacy. However, data on the gastrointestinal quality of life following OAGB is lacking. METHODS This is a retrospective analysis of a prospectively collected database, performed at a single tertiary care teaching hospital from January 2016 until March 2021. All patients undertook the Gastrointestinal Quality of Life Index (GIQLI) questionnaire. GIQLI was correlated with various parameters. Principal component analysis (PCA) was used to assess the importance of each question in the questionnaire and devise a "Mini GIQLI score". RESULTS A total of 60 patients were included. The %TWL at 3 and 5 years was 26.2 ± 11.9%, 31.7 ± 11 respectively. The mean weight regain was 5.6 ± 8.5 kg. The mean GIQLI score was 125 ± 13.1. The mean scores for questions pertaining to gastrointestinal, social, psychological, and physical domains were 3.49, 3.7, 3.45, and 3.27 respectively. Scree plot of principal component analysis showed that a new score ("Mini GIQLI") combining only 5 questions had good correlation with the overall GIQOL score (r = 0.842). The five questions related to anxiety, fatigue, feeling unwell, loss of endurance, and feeling unfit. CONCLUSIONS Patients report a good score on GIQLI assessment following OAGB. The Mini GIQLI score is a quicker tool with good correlation to the full-length GIQLI score.
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Affiliation(s)
- Vitish Singla
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Amardeep Kumar
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Mehul Gupta
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Manav Manohar
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Sukhda Monga
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Kumar Sharma
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines All India Institute of Medical Sciences, New Delhi, India.
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Akpinar EO, Nienhuijs SW, Liem RS, Greve JWM, Marang- van de Mheen PJ. Conversion to RYGB versus OAGB after a failed primary gastric band: matched nationwide study. Surg Obes Relat Dis 2022; 18:948-956. [DOI: 10.1016/j.soard.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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Effect of Biliopancreatic Limb Length on Weight Loss, Postoperative Complications, and Remission of Comorbidities in One Anastomosis Gastric Bypass: a Systematic Review and Meta-analysis. Obes Surg 2022; 32:892-903. [PMID: 35091899 DOI: 10.1007/s11695-021-05848-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/29/2021] [Accepted: 12/13/2021] [Indexed: 02/06/2023]
Abstract
Aimed to evaluate the effects of biliopancreatic limb (BPL) length on weight loss, postoperative complications, and remission of comorbidities in OAGB.. An extensive search was conducted in PubMed, Scopus, EMBASE, and Google Scholar databases to find related OAGB articles. Both BPL length < 200 cm (by - 17.79, 95% CI - 19.23, - 16.34) and BPL length ≥ 200 cm (by - 14.93, 95% CI - 15.66, - 14.20) significantly decreased BMI. Regarding the effect of BPL length on comorbidities and postoperative complications, it was shown that BPL length < 200 cm is safer and more effective. Therefore, standardization of BPL length < 200 cm is suggested. Bypassing ≥ 200 cm of the small bowel does not ameliorate weight loss or resolve comorbidities significantly, and it is related to more frequent postoperative complications and nutritional deficiencies. Registration number in PROSPERO: PROSPERO 2021 CRD42021225499.
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Quality of Life After Bariatric Surgery-a Systematic Review with Bayesian Network Meta-analysis. Obes Surg 2021; 31:5213-5223. [PMID: 34633614 PMCID: PMC8595157 DOI: 10.1007/s11695-021-05687-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/11/2022]
Abstract
Objective Comprehensive analysis and comparison of HRQoL following different bariatric interventions through systematic review with network meta-analysis. Background Different types of bariatric surgeries have been developed throughout the years. Apart from weight loss and comorbidities remission, improvement of health-related quality of life (HRQoL) is an important outcome of metabolic surgery. Methods MEDLINE, EMBASE, and Scopus databases have been searched up to April 2020. Inclusion criteria to the analysis were (1) study with at least 2 arms comparing bariatric surgeries; (2) reporting of HRQoL with a validated tool; (3) follow-up period of 1, 2, 3, or 5 years. Network meta-analysis was conducted using Bayesian statistics. The primary outcome was HRQoL. Results Forty-seven studies were included in the analysis involving 26,629 patients and 11 different surgeries such as sleeve gastrectomy (LSG), gastric bypass (LRYGB), one anastomosis gastric bypass (OAGB), and other. At 1 year, there was significant difference in HRQoL in favor of LSG, LRYGB, and OAG compared with lifestyle intervention (SMD: 0.44; 95% CrI 0.2 to 0.68 for LSG, SMD: 0.56; 95% CrI 0.31 to 0.8 for LRYGB; and SMD: 0.43; 95% CrI 0.06 to 0.8 for OAGB). At 5 years, LSG, LRYGB, and OAGB showed better HRQoL compared to control (SMD: 0.92; 95% CrI 0.58 to 1.26, SMD: 1.27; 95% CrI 0.94 to 1.61, and SMD: 1.01; 95% CrI 0.63 to 1.4, respectively). Conclusions LSG and LRYGB may lead to better HRQoL across most follow-up time points. Long-term analysis shows that bariatric intervention results in better HRQoL than non-surgical interventions. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05687-1.
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Assurance of surgical quality within multicenter randomized controlled trials for bariatric and metabolic surgery: a systematic review. Surg Obes Relat Dis 2021; 18:124-132. [PMID: 34602346 DOI: 10.1016/j.soard.2021.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/30/2021] [Accepted: 08/21/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND Surgical quality assurance methods aim to ensure standardization and high quality of surgical techniques within multicenter randomized controlled trials (RCTs), thereby diminishing the heterogeneity of surgery and reducing biases due to surgical variation. This study aimed to establish the measures undertaken to ensure surgical quality within multicenter RCTs investigating bariatric and metabolic surgery, and their influence upon clinical outcomes. METHODS An electronic literature search was performed from the Embase, Medline, and Web of Science databases to identify multicenter RCTs investigating bariatric and metabolic surgery. Each RCT was evaluated against a checklist of surgical quality measures within 3 domain: (1) standardization of surgical techniques; (2) credentialing of surgical experience; and (3) monitoring of performance. Outcome measures were postoperative weight change and complications. RESULTS Nineteen multicenter RCTs were included in the analysis. Three studies undertook pretrial education of surgical standard. Fourteen studies described complete standardization of surgical techniques. Four studies credentialed surgeons by case volume prior to enrollment. Two studies used intraoperative or video evaluation of surgical technique prior to enrollment. Only two studies monitored performance during the study. Although there were limited quality assurance methods undertaken, utilization of these techniques was associated with reduced overall complications. Standardization of surgery was associated with reduced re-operation rates but did not influence postoperative weight loss. CONCLUSION The utilization of methods for surgical quality assurance are very limited within multicenter RCTs of bariatric and metabolic surgery. Future studies must implement surgical quality assurance methods to reduce variability of surgical performance and potential bias within RCTs.
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IFSO Update Position Statement on One Anastomosis Gastric Bypass (OAGB). Obes Surg 2021; 31:3251-3278. [PMID: 33939059 DOI: 10.1007/s11695-021-05413-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022]
Abstract
The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued a position statement on the role of one anastomosis gastric bypass (OAGB) in the field of bariatric/metabolic surgery in 2018 De Luca et al. (Obes Surg. 28(5):1188-206, 2018). This position statement was issued by the IFSO OAGB task force and approved by the IFSO Scientific Committee and IFSO Executive Board. In 2018, the OAGB task force recognized the necessity to update the position statement in the following 2 years since additional high-quality data could emerge. The updated IFSO position statement on OAGB was issued also in response to inquiries to the IFSO by society members, universities, hospitals, physicians, insurances, patients, policy makers, and media. The IFSO position statement on OAGB has been reviewed within 2 years according to the availability of additional scientific evidence. The recommendation of the statement is derived from peer-reviewed scientific literature and available knowledge. The IFSO update position statement on OAGB will again be reviewed in 2 years provided additional high-quality studies emerge.
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One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Obesity: a Systematic Review and Meta-Analysis of Randomized Clinical Trials. Obes Surg 2021; 30:1211-1218. [PMID: 31749109 DOI: 10.1007/s11695-019-04288-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION We aim to compare the efficacy and safety outcomes of one anastomosis gastric bypass (OAGB) with Roux-en-Y gastric bypass (RYGB). METHODS We searched Ovid Medline, Ovid Embase, and the Cochrane Library from inception to May 14, 2019, without language restrictions, for randomized clinical trials comparing OAGB with RYGB in obesity. Quality of included trials was assessed by Cochrane Collaboration's tool; quality of evidence was evaluated by GRADE approach. The primary outcome was excess body mass index (BMI) loss at 2 years. RESULTS We identified 206 reports; after exclusions, three trials with a total of 733 patients were eligible for analysis. Compared with RYGB, OAGB was associated with more excess BMI loss at 2 years (mean difference (MD), 10.22; 95% CI, 3.05 to17.40; I2 = 95%; low-quality evidence), with benefit seen in OAGB using non-obese patients (MD, 17.10; 95% CI, 15.76 to18.44; P for interaction = 0.007 ) and no benefit in OAGB using standard length of biliopancreatic limb (MD, 6.49; 95% CI, - 1.09 to 14.08). Moreover, individuals allocated to OAGB compared with RYGB had a higher remission rate of type 2 diabetes(T2D) (risk ratio (RR), 1.13; 95% CI, 1.01 to 1.27; I2 = 0%). No statistically significant difference was found between the two surgical groups in adverse events. CONCLUSION OAGB is possibly associated with more body weight loss compared with RYGB in patients with obesity, despite the low quality of evidence caused by inconsistent of the effect of biliopancreatic limb length in OAGB group. This benefit appears to be confined to OAGB using the extended length of the biliopancreatic limb but not to OAGB using the standard length of the biliopancreatic limb, compared with RYBG. Additional large clinical studies are needed to assess the impact of limb length in OAGB.
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Efficacy and Drawbacks of Single-Anastomosis Duodeno-Ileal Bypass After Sleeve Gastrectomy in a Tertiary Referral Bariatric Center. Obes Surg 2021; 31:2691-2700. [PMID: 33834374 PMCID: PMC8113294 DOI: 10.1007/s11695-021-05323-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/13/2022]
Abstract
Background The need for revisional procedures after sleeve gastrectomy (SG) for insufficient weight loss or weight regain, gastroesophageal reflux, or other complications is reported to be 18–36% in studies with 10-year follow-up. Single-anastomosis duodeno-ileal bypass (SADI) may be performed as a revisional procedure after SG. This study aims to evaluate the short- and mid-term outcomes of SADI after SG in a referral center for bariatric surgery. Materials and Methods Data of patients who underwent SADI between March 2015 and March 2020 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, 106 patients underwent SADI after a previous SG. The timeframe between SG and SADI was 50 ± 31.3 months. Postoperative mortality was observed in two cases (1.8%) and morbidity in 15.1% of patients. At 24 months, %total weight loss was 37.6 ± 12.3 and %excess weight loss 76.9 ± 25.2 (64 patients). Three patients were treated for malnutrition during follow-up, two with medical treatment and one with SADI reversal. Conclusion SADI after SG provides effective weight loss results in the short-term, even if in the present series the postoperative complication rate was non-negligible. Further trials are needed to establish the more advantageous revisional bariatric procedure after failed SG. Supplementary Information The online version contains supplementary material available at 10.1007/s11695-021-05323-y.
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Bariatric Surgery-How Much Malabsorption Do We Need?-A Review of Various Limb Lengths in Different Gastric Bypass Procedures. J Clin Med 2021; 10:jcm10040674. [PMID: 33578635 PMCID: PMC7916324 DOI: 10.3390/jcm10040674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 12/18/2022] Open
Abstract
The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different bypass procedures exist alongside each other today and each type of bypass is performed using a distinct technique. Furthermore, the length of the bypassed intestine may differ as well. One might add that the operations are performed differently in different parts of the world and have been changing and evolving over time. This review evaluates the most frequently performed bariatric bypass procedures (and their variations) worldwide: Roux-en-Y Gastric Bypass, One-Anastomosis Gastric Bypass, Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy, Biliopancreatic Diversion + Duodenal Switch and operations due to weight regain. The evaluation of the procedures and different limb lengths focusses on weight loss, remission of comorbidities and the risk of malnutrition and deficiencies. This narrative review does not aim at synthesizing quantitative data. Rather, it provides a summary of carefully selected, high-quality studies to serve as examples and to draw tentative conclusions on the effects of the bypass procedures mentioned above. In conclusion, it is important to carefully choose the procedure and small bowel length excluded from the food passage suited best to each individual patient. A balance has to be achieved between sufficient weight loss and remission of comorbidities, as well as a low risk of deficiencies and malnutrition. In any case, at least 300 cm of small bowel should always remain in the food stream to prevent the development of deficiencies and malnutrition.
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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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Abdallah E, Emile SH, Zakaria M, Fikry M, Elghandour M, AbdelMawla A, Rady O, Abdelnaby M. One-anastomosis gastric bypass (OAGB) with fixed bypass of the proximal two meters versus tailored bypass of the proximal one-third of small bowel: short-term outcomes. Surg Endosc 2021; 36:328-335. [PMID: 33479836 DOI: 10.1007/s00464-020-08284-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: 10/23/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) is an effective bariatric procedure that confers satisfactory weight loss and improvement in comorbidities. The present study aimed to compare OAGB with fixed bypass of the proximal 200 cm of small bowel and tailored bypass of the proximal 1/3 of bowel. METHODS Patients with class II/III obesity underwent OAGB with either fixed bypass of the proximal two meters or tailored bypass of the proximal 1/3 of bowel. The main outcomes of the study were weight loss, improvement in comorbidities, complications, and changes in nutritional parameters after each technique. RESULTS The present study included 80 patients (62 female) of a mean age of 41 years and mean body mass index (BMI) of 50.9 kg/m2. The tailored bypass group was followed by a significantly lower BMI and significantly higher excess weight loss and total weight loss at 6 and 12 months postoperatively. There was no significant difference between the two groups in terms of improvement in comorbidities. The fixed bypass group was associated with a significantly higher complication rate than the tailored bypass group (22.5 vs. 5%, P = 0.04). Both groups were associated with similar changes in the nutritional parameters at 12 months postoperatively, except for the higher serum albumin levels after the tailored bypass than the fixed bypass. CONCLUSIONS OAGB with tailored bypass of the proximal one-third of bowel was associated with greater weight loss and comparable improvement in comorbidities as compared to fixed bypass of the proximal two meters of intestine.
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Affiliation(s)
- Emad Abdallah
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt
| | - Sameh Hany Emile
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt.
| | - Mahmoud Zakaria
- General Surgery Department, Ain Shams University Hospitals, Ain Shams University, Cairo, Egypt
| | - Mohamed Fikry
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt
| | - Mohamed Elghandour
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt
| | - Ahmed AbdelMawla
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt
| | - Omar Rady
- General Surgery Department, Mansoura General Hospital, Mansoura, Egypt
| | - Mahmoud Abdelnaby
- General Surgery Department, Mansoura University Hospitals, Mansoura University, Elgomhuoria Street, Mansoura, Egypt
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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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Omega Loop Gastroileal Bypass (OLGIBP/SAGI) Versus One Anastomosis Gastric Bypass (OAGB): Medium-Term Results. Obes Surg 2021; 31:1597-1602. [PMID: 33409980 DOI: 10.1007/s11695-020-05165-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In bariatric surgery, new surgical techniques are continually being developed. The one anastomosis gastric bypass (OAGB) has become increasingly common since 2001. However, some patients experience bile reflux or excessive weight loss. This study aimed to assess a new bariatric procedure designed to avoid some of the drawbacks of conventional OAGB. MATERIAL AND METHODS To lower the complication rate and pathophysiological impact after OAGB, we performed an omega loop gastroileal bypass (OLGIBP/SAGI) with a 300-cm common limb. We compared this technique with OAGB. RESULTS Seventeen patients underwent OLGIBP and 23 underwent OAGB. Mean operative time was 108 min for OLGIBP vs 103 min for OAGB. The mean hospital length of stay was 3 days (1 to 7). No complications related to the gastroenterostomy occurred. At 3 years, among OAGB patients, there were 5 (21.7%) cases of bile reflux including 2 (8.7%) requiring a revision to Roux-en-Y gastric bypass. Among OLGIBP patients, there were 3 (17.6%) cases of bile reflux 1 (5.9%) requiring a revision to Roux-en-Y gastric bypass. There was no albumin deficiency. At 3 years, % of total weight loss (TWL) was 43.6 + - 6.2 in the OAGB group vs 48.2 + - 7.4 in the OLGIBP group. CONCLUSIONS The bariatric and metabolic outcomes of OLGIBP are expected to be similar to those of OAGB. The OLGIBP technique should reduce the risks of malnutrition and bile reflux. The two techniques can be safely performed and offer alternatives in bariatric surgery.
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Revisional One-Anastomosis Gastric Bypass After Restrictive Index Surgery-a Metaanalysis and Comparison with Revisional Roux-en-Y Gastric Bypass. Obes Surg 2020; 31:949-964. [PMID: 33159293 DOI: 10.1007/s11695-020-05094-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) was established as a recognized bariatric procedure in the 2018 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) position statement. This study evaluates the outcomes of revisional OAGB (rOAGB) after a restrictive index procedure, and to compare it to revisional RYGB (rRYGB). METHODS A literature search was performed according to the PRISMA guidelines on papers published from inception till February 2020. Original studies involving patients who underwent rOAGB after a primary failed restrictive procedure were included. The primary outcome measured was postrOAGB weight loss. Secondary outcome measures include comorbidity resolution, operative duration, length of stay, morbidity, and mortality. RESULTS A total of 21 studies with 1377 patients were included. Five studies compared rOAGB versus rRYGB. Majority of the patients (76%) were female, with mean age of 43.5 years old. Mean body mass index (BMI) before revisional surgery was 41.6 kg/m2. The most common biliopancreatic limb length was 200 cm. Percentage of excess weight loss after rOAGB increases to a maximum of 76.0% at 48 months postsurgery. rOAGB resulted in a pooled prevalence of diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea resolution of 74.9%, 48.4%, 63.2%, and 75.7% respectively. When compared to rRYGB, rOAGB demonstrated greater weight loss, comparable metabolic syndrome resolution, but with a shorter operating time. Morbidity and mortality rates were low across all studies. CONCLUSIONS rOAGB has potential as an alternative revisional surgery, with weight loss profiles and rates of metabolic syndrome resolution that are comparable to rRYGB.
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