One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Obesity: a Systematic Review and Meta-Analysis of Randomized Clinical Trials

Conversion of one-anastomosis gastric bypass to Roux-En-Y gastric bypass: mid-term results from the United Arab Emirates

BACKGROUND

One-Anastomosis Gastric Bypass (OAGB) is becoming popular, but some patients may need to convert to Roux-en-Y Gastric Bypass (RYGB) due weight-related difficulties or postoperative complications. The data on conversions is currently limited to 30-day or short-term follow-up studies. As such, the objective of this study was to evaluate the indications and mid-term outcomes for OAGB conversions to RYGB at a tertiary referral center in the United Arab Emirates.

METHODS

A retrospective analysis was conducted on patients who underwent conversion from OAGB to RYGB between February 2016 and May 2023. Demographic information, indications for conversion, intraoperative details, and mid-term outcomes were collected and analyzed.

RESULTS

Sixty-four patients underwent conversion from previous OAGB to RYGB. The cohort was 73.4% female (n = 47) with a mean age of 40.8 years. Indications for conversion included acid reflux (n = 28, 43.7%), intractable nausea/vomiting (n = 20, 31.2%), protein-calorie malnutrition (n = 7, 10.9%), anastomotic ulcer (n = 6, 9.3%) and weight recidivism (n = 3, 4.7%). The mean operative time was 238 ± 78.3 min. During the procedure, three intraoperative complications occurred: two cases of bleeding and one case of bowel perforation; all successfully addressed during surgery. The median hospital stay was 3 ± 15.8 days. Three patients (4.6%) experienced major postoperative complications comprising 2 anastomotic leaks and 1 small bowel obstruction. The mean follow-up time was 26.2 ± 19.7 months, with 96.2% of patients reporting resolution of symptoms. There were no mortalities.

CONCLUSIONS

Acid reflux is representing 43.7% of the indications for conversion from OAGB to RYGB. The symptom resolution rate holds significance, standing at a remarkable 96.8%. Despite surgical technique advancements, the complication rate after conversions remains significant at 4.6%, with no mortality reported. OAGB patients should be informed about these risks prior to undergoing conversions from OAGB to RYGB.

Adding Evidence to an Evidence-Based Classification for Recurrent Weight Gain after Bariatric and Metabolic Surgery from a Norwegian National Registry

BACKGROUND

In 2023, the first evidence-based classification for recurrent weight gain (RWG) after metabolic and bariatric surgery was introduced. It uses early and late follow-up weight loss benchmarks based on standard deviations (SD) of percentage total weight loss(%TWL) results from the large Dutch Audit for Treatment of Obesity (DATO) registry (n > 18,000). We aimed to validate this classification and confirm its clinical relevance with an external cohort.

METHODS

The DATO-based classification defines all RWG as grade 1, as long as weight-loss does not drop below DATO's late-follow-up minus one SD benchmark (20%TWL). Grade 3 represents clear outliers whose RWG evolves below DATO's late follow-up minus two SD benchmark (10%TWL), with grade 2 in-between. Grades 2a/3a represent initial suboptimal clinical response, with nadir %TWL never exceeding DATO's early-follow-up minus one SD benchmark (25%TWL). Grades 2b/3b represent late clinical deterioration from nadir weight loss ≥ 25%TWL. We compared baseline characteristics, SD based benchmarks, RWG and comorbidities from the Scandinavian Obesity Surgery Registry Norway (SOReg-N) with these DATO-derived grades.

RESULTS

The SOReg-N population (n = 3064) was comparable at baseline, with more sleeve gastrectomies (54% versus DATO 22.5%). The SD benchmarks were at early follow-up minus one SD 25.8%TWL, at 5 years minus one SD/minus two-SD 17.2%TWL/7.0%TWL (DATO 25%TWL/20%TWL/10%TWL). Percentage of patients and amount of RWG were similar to DATO. In line with DATO, comorbidities were predominant in grades 2a/3a, with least improvement in grade 3a. Also, grade 3b showed more favorable characteristics at baseline.

CONCLUSION

The SOReg-N cohort confirmed the weight-loss benchmarks defining the DATO-derived grades, the distribution of patients and their RWG across the grades, and correlations between grades and comorbidities. Male gender, older age and comorbidities were predominant among patients with initial suboptimal clinical response (RWG grades 2a/3a), but not for late clinical deterioration (RWG grades 2b/3b). This classification can be used for populations with diverse weight loss trajectories and offers an evidence-based guide for clinical decision-making and standardization.

Novel Surgical Interventions for the Treatment of Obesity

Metabolic and bariatric surgery is widely recognized as the most effective and durable treatment for the disease of obesity and its associated comorbidities. In recent years, the field has seen significant advancements, introducing numerous innovative surgical options. This review aims to comprehensively examine these emerging surgical techniques, which have recently received endorsement from the American Society for Metabolic and Bariatric Surgery (ASMBS). Additionally, we will explore new technologies and methodologies supported by the latest scientific evidence. Our analysis will include a critical evaluation of the efficacy, safety, and long-term outcomes of these novel approaches, providing a detailed update on the current state of metabolic and bariatric surgery, highlighting key developments and their potential implications for clinical practice.

American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass

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.

Variation in HbA1c in Patients with Obesity and type 2 Diabetes Mellitus 12 months after Laparoscopic One-Anastomosis Gastric Bypass and Laparoscopic Roux-en-Y Gastric Bypass: a Retrospective Matched Cohort Study

BACKGROUND

Glycemic control is an important goal of bariatric surgery in patients with type 2 diabetes mellitus (T2DM) and obesity. The laparoscopic one-anastomosis gastric bypass (OAGB) has potential metabolic benefits over the laparoscopic Roux-en-Y gastric bypass (RYGB). Aim of this study is to examine whether RYGB or OAGB grants better glycemic control 12 months post-surgery.

METHODS

For this retrospective cohort study, patients with T2DM and obesity, who underwent primary OAGB between 2008 and 2017 were reviewed. For each OAGB patient, three primary RYGB patients were matched for age, gender and body mass index (BMI). Glycemic control was expressed by the glycated hemoglobin (HbA1c), which was measured pre- and 12 months post-operatively. Weight loss was reported in percentage total weight loss (%TWL).

RESULTS

A total of 152 patients, of whom 38 had OAGB and 114 RYGB, were included. Mean (standard deviation (SD)) HbA1c was 7.49 (1.51)% in the OAGB group and 7.56(1.23)% in the RYGB group at baseline. Twelve months after surgery the mean (SD) HbA1c dropped to 5.73 (0.71)% after OAGB and 6.09 (0.76)% after RYGB (adjusted p = 0.011). The mean (SD) BMI was reduced from 42.5(6.3) kg/m2 to 29.6(4.7) kg/m2 after OAGB and 42.3(5.8) kg/m2 to 29.9 (4.5) kg/m2 after RYGB; reflecting 30.3 (6.8) %TWL post-OAGB and 29.0 (7.3) %TWL post-RYGB (p = 0.34).

CONCLUSION

This study indicates that OAGB leads to lower HbA1c one year after surgery compared to RYGB, without a difference in weight loss. Prospective (randomized) studies are needed to ascertain the most optimal metabolic treatment for patients with obesity and T2DM.

ReSleeve or revisional one anastomosis gastric bypass for failed primary sleeve gastrectomy with dilated gastric tube: a retrospective study

BACKGROUND

Revisional bariatric surgery (RBS) has been increasingly performed due to weight loss failure (WLF). Many revisional procedures have been proposed after primary laparoscopic sleeve gastrectomy (pLSG) failure, including ReSleeve gastrectomy (ReLSG), and laparoscopic one anastomosis gastric bypass (LOAGB). Choosing the RBS post-pLSG failure represents a challenge. WLF without gastric tube (GT) dilation is undoubtedly converted to a malabsorptive procedure, but the presence of GT dilation makes it more difficult to select a RBS. This study aimed to compare two relatively simple revisional procedures after pLSG failure with dilated GT to help decision making on which procedure better done to which patient.

METHODS

Data of 52 patients who completed one year follow-up (FU) after their RBS (ReLSG: 27 or LOAGB: 25) for their failed pLSG were collected, assessed, correlated to weight loss (WL) and compared.

RESULTS

Mean operative time was 97 ± 18.4 min. with revisional LOAGB (RLOAGB) and 62 ± 11 min. with ReLSG. Six patients (11.5%) had seven postoperative procedure-specific complications. Significant hemorrhage occurred in three patients. Two cases of leakage were encountered with each procedure. LOAGB Patients had lower mean final weight (76.2 ± 10.5 vs 85.3 ± 13), lower mean Final BMI (26.4 ± 2.5 vs 29.7 ± 2.9) and higher mean percentage of excess weight loss (EWL%) (83.6 ± 13.5% vs 60.29 ± 14.6%). All RLOAGB patients and 77.8% of ReLSG patients had EWL% > 50%. RLOAGB patients had higher EWL% compared to ReLSG (p < 0.001). Insufficient WL (IWL) patients had higher EWL% compared to weight regain (WR) patients (p = 0.034).

CONCLUSION

Both procedures (RLOAGB and ReLSG) were relatively safe and effective in terms of WL. RLOAGB led to higher WL compared to ReLSG in all types of patients despite higher Caloric intake. IWL patients had more WL compared to WR patients. WL was not related to GT dilation type. Large-scale longer-FU studies are still needed.

TRIAL REGISTRATION

PACTR202310644487566 (retrospectively registered).

Five-Year BAROS Score Outcomes for Roux-en-Y Gastric Bypass, One Anastomosis Gastric Bypass, and Sleeve Gastrectomy: a Comparative Study

PURPOSE

Metabolic and bariatric surgery (MBS) has been shown to enhance the quality of life (QoL) in individuals with obesity. The Bariatric Analysis and Reporting Outcome System (BAROS) is a highly reliable scoring system utilized to assess weight loss, obesity-associated medical conditions, and QoL following MBS. This study aimed to assess the efficacy of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) in improving health outcomes for individuals with severe obesity, employing the BAROS questionnaire.

METHODS

A retrospective study was conducted, enrolling 299 patients with a body mass index (BMI) of 40 or higher who had undergone primary MBS (RYGB, OAGB, or SG) and had a 5-year follow-up. Patients were evaluated using the BAROS scoring system, which included measures of % excess weight loss (%EWL), improvement and remission of obesity-related medical problems, and postoperative short-term and long-term complications.

RESULTS

The mean age and pre-op BMI of the patients was 39.4 ± 9.4 years and 44.6± 6.5 kg/m2, respectively. The total BAROS score was significantly higher in patients who underwent OAGB compared to those who underwent RYGB and SG (P, 0.02). However, no significant differences were observed in other aspects of the BAROS score, such as QoL.

CONCLUSION

This study demonstrated that all three common metabolic and bariatric surgical procedures (SG, RYGB, and OAGB) significantly improved the QoL after surgery. Furthermore, patients who underwent OAGB had a significantly higher total BAROS score at the 5-year follow-up compared to those who underwent RYGB and SG.

Initial experience with laparoscopic gastric bypass in an Australian general foregut surgery unit

BACKGROUND

Laparoscopic gastric bypass (LGB) is an increasingly utilized approach to bariatric surgery in Australia. A high proportion of those procedures are revisional due to Australia's legacy of laparoscopic adjustable gastric banding (LAGB), which is not the case internationally. The aim of this study was to compare post-operative outcomes in an Australian general foregut surgery unit against benchmarks published in the literature.

METHODS

This is retrospective cohort study of morbidly obese patients undergoing primary or revisional laparoscopic Roux-en-Y gastric bypass (RYGB) or laparoscopic one anastomosis gastric bypass (OAGB) with the two senior authors between 5 May 2015 and 27 June 2019. Perioperative data for the unit's first 100 cases were collected prospectively, stored on a unit database and analysed. Post-operative complications at 30 days, 90 days, mortality, length of hospital stay, and Defined Adverse Events were chosen as indicators of the perioperative outcome (as defined in the Monash Bariatric Surgery Registry).

RESULTS

In this cohort, 35% of procedures were RYGB and 65% were OAGB. The majority (58%) were revisional procedures. Most patients (74%) were female. The median age was 50. The comorbidity profile of the population was similar to those published internationally. The median hospital stay was 4 days. There was no mortality. Early complications occurred in 9% of patients, with 3% occurring late.

CONCLUSION

Outcomes of our first 100 cases are comparable with those recorded in the literature, notwithstanding a much higher proportion of revisional cases. LGB can be safely introduced in Australian general foregut surgery units by experienced laparoscopic surgeons.

Combined laparoscopic pouch and loop resizing as a revisional procedure for weight regain after primary laparoscopic one-anastomosis gastric bypass

Introduction

One-anastomosis gastric bypass (OAGB) presents a satisfactory long-term outcome in terms of weight loss, amelioration of comorbidities and low morbidity. However, some patients may present insufficient weight loss or weight regain. In this study, we tackle a case series evaluating the efficiency of the combined laparoscopic pouch and loop resizing (LPLR) as a revisional procedure for insufficient weight loss or weight regain after primary laparoscopic OAGB.

Materials and Methods

We included eight patients with a body mass index (BMI) ≥30 kg/m2 with a history of weight regain or insufficient weight loss after laparoscopic OAGB, who underwent revisional laparoscopic intervention by LPLR between January 2018 and October 2020 at our institution. We conducted a 2 years' follow-up. Statistics were performed using International Business Machines Corporation® SPSS® software for Windows version 21.

Results

The majority of the eight patients were males (62.5%), with a mean age of 35.25 at the time of the primary OAGB. The average length of the biliopancreatic limb created during the OAGB and LPLR were 168 ± 27 and 267 ± 27 cm, respectively. The mean weight and BMI were 150.25 ± 40.73 kg and 48.68 ± 11.74 kg/m2 at the time of OAGB. After OAGB, patients were able to reach an average lowest weight, BMI and per cent of excess weight loss (%EWL) of 89.5 ± 28.85 kg, 28.78 ± 7.47 kg/m2 and 75.07 ± 21.62%, respectively. At the time of LPLR, patients had a mean weight, BMI and %EWL of 116.12 ± 29.03 kg, 37.63 ± 8.27 kg/m2 and 41.57 ± 12.99%, respectively. Two years after the revisional intervention, the mean weight, BMI and %EWL were 88.25 ± 21.89 kg, 28.44 ± 4.82 kg/m2 and 74.51 ± 16.54%, respectively.

Conclusion

Combined pouch and loop resizing is a valid option for revisional surgery following weight regain after primary OAGB, leading to adequate weight loss through enhancement of the restrictive and malabsorptive effect of OAGB.

Comparison of Efficacy and Safety Between Roux-en-Y Gastric Bypass (RYGB) vs One Anastomosis Gastric Bypass (OAGB) vs Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): a Systematic Review of Bariatric and Metabolic Surgery

In recent years, combined restrictive and hypo-absorptive procedures have gained widespread acceptance. The rationale of this systematic review is to compare the safety and efficacy between Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB) and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Eighteen eligible studies were finalized for this review. Weight loss outcomes were greater with SADI-S (5 years) and OAGB (10 years). SADI-S offered better resolution of diabetes whereas hypertension and dyslipidaemia resolution were better with OAGB. Although early complications and mortality were higher with SADI-S, late complications were more frequent with RYGB. Both SADI-S and OAGB are as effective as RYGB for weight loss, but OAGB offers lesser complications. However, more data is imperative to determine the next gold standard procedure.

One Anastomosis Gastric Bypass for Revisional Bariatric Surgery: Assessment of Short-Term Safety

PURPOSE

With the continued increase in bariatric procedures being performed in the USA, a growing percentage are revisions for weight regain after sleeve gastrectomy (SG) and gastric banding (LAGB). Standard practice in the USA involves conversion to Roux-en-Y gastric bypass (RYGB). Internationally, one anastomosis gastric bypass (OAGB) has become a popular and effective alternative. Without the jejuno-jejunal anastomosis, OAGB has reduced potential related long-term complications. The purpose of this study is to compare the short-term safety of revision to OAGB versus RYGB.

MATERIALS AND METHODS

Patients who underwent conversion to OAGB from LAGB or SG for weight regain from January 2019 to October 2021 were compared to BMI, sex, and age-matched patients who underwent conversion to RYGB.

RESULTS

In our study, 82 patients were included, 41 in each cohort (41 OAGB vs. 41 RYGB). The majority in both groups underwent conversion from SG (71% vs. 78%). Operative time, estimated blood loss, and length of stay were comparable. There was no difference in 30-day complications (9.8% vs. 12.2%, p = .99) or reoperation (4.9% vs. 4.9%, p = .99). Mean weight loss at 1 month was also comparable (7.91 lbs vs 6.36 lbs).

CONCLUSIONS

Patients undergoing conversion to OAGB for weight regain had similar operative times, post-operative complication rates, and 1-month weight loss compared to those who underwent RYGB. While more research is needed, this early data suggests that OAGB and RYGB provide comparable outcomes when used as conversion procedures for to failed weight loss. Therefore, OAGB may present a safe alternative to RYGB.

WEIGHT LOSS AND QUALITY OF LIFE AFTER ONE ANASTOMOSIS GASTRIC BYPASS: A 2-YEAR FOLLOW-UP STUDY

•One anastomosis gastric bypass (OAGB) led to significant weight loss after 2 years. •OAGB associated was well-succeeded in regards to weight loss in most individuals. •OAGB led to significant improvement of quality of life (QoL) assessed by the BAROS system. •"Self-steem" and "work capacity" were the most positively affected QoL domains after OAGB. Background - Studies assessing quality of life (QoL) after one anastomosis gastric bypass (OAGB) are currently scarce. Objective - To analyze the main weight loss outcomes and QoL in individuals undergoing OAGB during a 2-year follow-up. Methods - This is a retrospective study based on a prospectively collected database including individuals which underwent OAGB at a tertiary-level university hospital. After 2-years, excess weight loss was assessed, and post-surgical therapeutical success was determined using Reinhold's criteria. QoL was assessed through the Bariatric Analysis and Reporting Outcomes System (BAROS). Results - Out of 41 participants, 90.2% were female and the average age was 38±8.3 years old. The average body mass index significantly decreased from 37.1±5.6 kg/m2 to 27±4.5 kg/m2 after 2-years (P< 0.001). The mean percentage of excess weight loss was 84.6±32.5%. Regarding weight loss outcomes, 61% were considered "excellent", while 26.8% were "good" according to Reinhold's criteria. With regards to QoL assessed by BAROS, most individuals achieved a score classified as either "excellent" (26.8%), "very good" (36.6%), or "good" (31.7%). The highest degrees of satisfaction achieved were in the domains "self-esteem" and "work capacity", in which 75.6% and 61%, respectively, were classified as "much better". Conclusion - OAGB associated with significant weight loss and resolution of obesity-related medical conditions, as well as relevant QoL improvement assessed by the BAROS system.

Health-related quality of life outcomes following Roux-en-Y gastric bypass versus one anastomosis gastric bypass

PURPOSE

Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are effective standard bariatric surgeries with comparable weight loss and remission of obesity-related comorbidities. As procedure-specific health-related quality of life (HrQoL) outcomes have not been directly compared thus far, we conducted this questionnaire-based study.

METHODS

Two hundred forty patients after undergoing either RYGB or OAGB between 2011 and 2016 were contacted and asked to fill out SF36 and BAROS questionnaires. All statistical analysis was performed with Microsoft Excel and GraphPad Prism. Primary objectives were procedure-dependent differences in HrQoL. Secondary objectives were weight loss and remission of comorbidities.

RESULTS

One hundred nineteen of 240 contacted patients (49.6%) replied, 58 after RYGB (48.7%) and 61 after OAGB (51.3%). Follow-up period was < 24 months in 52 and > 24 months in 64 evaluable patients. The mean age was 46 years (range 23 to 71). Regarding the < 24 months groups, both physical and psychological SF36 sum scales were comparably high. Only the subcategory "general health perception" was significantly better after RYGB. Significantly higher excess weight loss (EWL) after RYGB (88.81%) compared to OAGB (66.25%) caused significantly better global < 24 months BAROS outcomes, whereas remission of comorbidities and HrQoL was similar. Both > 24 months groups showed high SF36-HrQoL sum scales. Global mean BAROS results after > 24 months were "very good" in both procedures. EWL in RYGB (80.81%) and in OAGB (81.36%) were comparably excellent.

CONCLUSION

Concerning SF36 and BAROS evaluated HrQoL in early and late postoperative phases, both procedures demonstrated comparable and relevant improvements. Further (preferably randomized) studies should include evaluation of preoperative HrQoL.

Endoscopic and histopathological assessment of individuals undergoing one anastomosis gastric bypass: a 2-year follow-up

BACKGROUND

There is much debate over the occurrence of biliary reflux to the gastric pouch after one anastomosis gastric bypass (OAGB) and its potential risks.

OBJECTIVE

To assess endoscopic and histopathological findings following a standardized protocol of biopsy collection two years after OAGB.

METHODS

A historical cohort study was conducted, based on a prospectively collected database, which involved 39 participants who underwent OAGB. Participants underwent clinical evaluation and esophagogastroduodenoscopy at the time of surgery and 24 months afterward. Post-operatively, biopsy specimens in esophagogastric junction, pouch, and anastomosis were systematically collected.

RESULTS

92.3% of the participants were female and the mean age was 37 ± 8.5 years. The mean body mass index (BMI) significantly decreased from 37.6 ± 5.7 kg/m² to 27 ± 4.1 kg/m² after 2 years (p < 0.001). The mean %TWL was 27.2 ± 10.5%. The prevalence of non-erosive gastritis significantly increased from 25.6 to 51.3% (p = 0.02). Erosive gastritis significantly decreased from 28.2 to 10.3% (p = 0.04). Four cases of marginal ulcers were identified (10.3%). The commonest histopathological finding was mild inflammation in 74.3% (esophagogastric junction), 58.9% (pouch), and 71.8% (anastomosis). There was one case of focal intestinal metaplasia in each site of interest and no cases of dysplasia or severe inflammation.

CONCLUSIONS

Using a standardized protocol of post-operative biopsy collection, low rates of severe endoscopic and histopathological abnormalities were observed two years after OAGB. Nevertheless, as most patients have histologically proven inflammation, bile in the gastric pouch, and endoscopic gastritis, long-term surveillance is essential because of the uncertain risk of these abnormalities.

Safety and efficacy of OAGB/MGB during the learning curve: setting a benchmark in a bariatric center of excellence

Very little has been published on the learning curve (LC) of the One Anastomosis /Mini Gastric Bypass (OAGB/MGB). Aim of this study was to compare perioperative outcomes of OABG/MGBs performed during the LC of an experienced laparoscopic surgeon to global benchmark cut-offs. First 200 patients undergoing OAGB/MGB at our university hospital from 2010 to 2016 were retrospectively included in this study. LC of the surgeon was divided in two groups of 100 consecutive patients each and perioperative outcomes were compared to abovementioned global benchmarks for LSG and RYGB. A cumulative sum (CUSUM) analysis was performed for operative time and hospital stay. Uneventful postoperative recovery was recorded in 95% of patients. All benchmark values for RYGB were met in group 2. Comparison with cut-offs for LSG showed longer hospital stay and operative time in both groups but postoperative rate of complications resulted lower even for Group 1. CUSUM graph of the operative time runs randomly above the predetermined limit till the 40th cases but reaches the plateau after the 115th operation. CUSUM curve of the hospital stay reaches the plateau after the 57th case. OAGB/MGB confirms to be a feasible procedure, which can be safely and effectively performed during the learning curve. However, at least 100 hundred cases are required to reduce operative time and hospital stay.

Efficacy and Safety of One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Obesity: a Meta-analysis and Systematic Review

The objective of this review is to systematically review the efficacy and safety outcomes of one anastomosis gastric bypass (OAGB) with Roux-en-Y gastric bypass (RYGB). From inception to July 4, 2022, a systematic literature search was performed using PubMed, Embase, and Cochrane Library for randomized clinical trials comparing OAGB with RYGB in obesity. A meta-analysis performed using the RevMan 5.4.1 software evaluations was completed. We identified 1217 reports; after exclusions, eight trials with a total of 931 patients were eligible for analysis. Compared with RYGB, OAGB had multiple advantageous indexes. Examples include percent of excess weight loss (%EWL) at 12 months (P = 0.009), body mass index (BMI) at 2 years (P < 0.00001), early postoperative complication (P = 0.04), remission of dyslipidemia (P < 0.0001), and operative time (P < 0.00001). No significant statistical difference was observed in BMI at 6 months, %EWL at 6 months, BMI at 12 months, percent of excess body mass index loss (%EBMIL) at 2 years, BMI at 5 years, intraoperative complications, late postoperative complications, remission of type 2 diabetes mellitus, and dyslipidemia or gastroesophageal reflux disease remission between OAGB and RYGB. OAGB is no less effective than RYGB; no significant differences in weight loss efficacy were observed, and more large and long-term randomized controlled trials are needed to verify this. In addition, studies have shown that OAGB has a shorter operation time, fewer early postoperative complications, and a shorter learning curve, making it easier for young surgeons to perform.

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

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.

Revisional Roux-en-Y Gastric Bypass Versus Revisional One-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy: a Randomized Controlled Trial

Background

High rates of revision surgery have been reported for laparoscopic sleeve gastrectomy (LSG), with weight regain (WR) as the most frequently reported cause. Roux-en-Y gastric bypass (RYGB) is the most commonly performed revision procedure, whereas one-anastomosis gastric bypass (OAGB) is a less popular approach.

Methods

A single-blinded randomized controlled trial was conducted. One hundred seventy-six patients were enrolled and randomized. After loss to follow-up, 80 patients for RYGB and 80 patients for OAGB were analyzed, with a 2-year follow-up. Patients with grade B or higher gastroesophageal reflux disease (GERD) were excluded. Early and late postoperative complications were recorded. Body mass index (BMI), percentage of excess BMI loss (%EBMIL), nutritional laboratory test results, and the resolution of associated medical problems were assessed after revision surgery.

Results

After 2 years, both groups achieved significantly lower BMI than their post-LSG nadir BMI (p < 0.001). The %EBMIL changes showed significantly faster weight loss in the OAGB group than in the RYGB at the 6-month follow-up (mean difference: 8.5%, 95% confidence interval [CI]: 0.2 to 16.9%). However, at 1-year and 2-year follow-ups, the differences were statistically insignificant (p > 0.05). Early and late complications were similar between two groups. Both groups showed improvement or resolution of associated medical problems, with no statistically significant differences after 2 years (p = 1.00).

Conclusion

Both revisional RYGB and OAGB have comparable significant weight loss effects when performed for WR after LSG. After a 2-year follow-up, both procedures were safe, with no significant differences in the occurrence of complications and nutritional deficits.

Graphical abstract

Nutritional Status after Roux-En-Y (Rygb) and One Anastomosis Gastric Bypass (Oagb) at 6-Month Follow-Up: A Comparative Study

Introduction: Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are two effective bariatric surgical procedures with positive outcomes in terms of weight loss, comorbidities remission, and adverse events profiles. OAGB seems to carry a higher risk of malnutrition, but existing data are controversial. The aim of this study is to objectively evaluate and compare malnutrition in patients undergoing RYGB and OAGB. Methods: Retrospective monocentric study of obese patients undergoing RYGB or OAGB between the 15 September 2020 and the 31 May 2021. Nutritional status was assessed using the Controlling Nutritional Status (CONUT) score and compared between groups. The primary outcome was the mean CONUT score at 6 months. The secondary outcomes included the incidence of malnutrition, comorbidities, including hypertension, insulin resistance and type II diabetes mellitus, and weight loss. Results: 78 patients were included: 30 underwent RYGB and 48 underwent OAGB. At 6-Month Follow-Up there was no difference between groups in the mean CONUT score nor in incidence of malnutrition. In both groups, the nutritional status significantly worsened 6 months after surgery (preoperative and postoperative score of 0.48 ± 0.9 and 1.38 ± 1.5; p = 0.0066 for RYGB and of 0.86 ± 1.5 and 1.45 ± 1.3; p = 0.0422 for OAGB). Type II Diabetes mellitus (DMII) and hypertension remission were significant in the OAGB group with a 100% relative remission in the DMII-OAGB group (p = 0.0265), and a 67% relative remission in the hypertension-OAGB group (p = 0.0031). Conclusions: No difference in nutritional status has been detected between patients undergoing RYGB or OAGB at the 6-Month Follow-Up. Both procedures may have significant mal-absorptive effects leading to decline in nutritional status. OAGB may be more efficacious in inducing DMII and hypertension remission. Larger prospective studies dedicated specifically to nutritional status after gastric bypass are needed to confirm the impact of different bypass procedures on nutritional status.

Outcomes of 325 one anastomosis gastric bypass operations: an Australian case series

BACKGROUND

The One Anastomosis Gastric Bypass (OAGB) is a relatively novel procedure. Studies have demonstrated that it is at least as effective as other bariatric procedures but with fewer major complications and shorter operating time, yet OAGB is performed less partially due to a paucity of supportive evidence. We report the outcomes of a prospectively maintained database of patients undergoing laparoscopic OAGB.

METHODS

All OAGB procedures performed by two surgeons across two hospitals from 2016 to 2019 were recorded in a prospectively maintained database. Patients with at least 1 year of follow up were included in this study and missing data was obtained from patient records. The primary outcome was percentage excess weight loss (EWL). The secondary outcome was surgical complication rate.

RESULTS

Three hundred and twenty-five patients with a mean pre-operative body mass index of 43.3 kg/m² were included. The majority (85.2%) had a biliopancreatic limb length of 150 cm. The median EWL was 74.2% and 79.4% of patients achieved at least 50% EWL. There were no deaths, the overall re-operation rate was 4.9% and 1.9% of patients developed stomal ulcers. Seven patients went on to have a Roux-en-Y conversion predominantly for symptomatic reflux.

CONCLUSION

OAGB leads to excellent weight loss and is at least as safe as more commonly performed procedures, it may be a suitable treatment for a greater number of patients than it is being offered to at present.

Once in a Bile — the Incidence of Bile Reflux Post-Bariatric Surgery

Purpose

Excellent metabolic improvement following one anastomosis gastric bypass (OAGB) remains compromised by the risk of esophageal bile reflux and theoretical carcinogenic potential. No ‘gold standard’ investigation exists for esophageal bile reflux, with diverse methods employed in the few studies evaluating it post-obesity surgery. As such, data on the incidence and severity of esophageal bile reflux is limited, with comparative studies lacking. This study aims to use specifically tailored biliary scintigraphy and upper gastrointestinal endoscopy protocols to evaluate esophageal bile reflux after OAGB, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

Methods

Fifty-eight participants underwent OAGB (20), SG (15) or RYGB (23) between November 2018 and July 2020. Pre-operative reflux symptom assessment and gastroscopy were performed and repeated post-operatively at 6 months along with biliary scintigraphy.

Results

Gastric reflux of bile was identified by biliary scintigraphy in 14 OAGB (70%), one RYGB (5%) and four SG participants (31%), with a mean of 2.9% (SD 1.5) reflux (% of total radioactivity). One participant (OAGB) demonstrated esophageal bile reflux. De novo macro- or microscopic gastroesophagitis occurred in 11 OAGB (58%), 8 SG (57%) and 7 RYGB (30%) participants. Thirteen participants had worsened reflux symptoms post-operatively (OAGB, 4; SG, 7; RYGB, 2). Scintigraphic esophageal bile reflux bore no statistical association with de novo gastroesophagitis or reflux symptoms.

Conclusion

Despite high incidence of gastric bile reflux post-OAGB, esophageal bile reflux is rare. With scarce literature of tumour development post-OAGB, frequent low-volume gastric bile reflux likely bears little clinical consequence; however, longer-term studies are needed.

Clinical Trial Registry

Australian New Zealand Clinical Trials Registry number ACTRN12618000806268.

Graphical abstract

Remission of Type II Diabetes Mellitus 1-Year Postoperative Following One Anastomosis Gastric Bypass in Correlation with ABCD, DiaRem, and DRS Scores

BACKGROUND

Diabetes mellitus (DM) is a debilitating chronic illness. Roux en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) present a potential solution to type II DM. Several scoring systems predict DM remission as ABCD score, DiaRem score, and diabetes remission score (DRS).

STUDY DESIGN

This was a retrospective study that included 138 patients with DM and underwent OAGB. BMI, HbA1C, insulin, and oral hypoglycemics need were recorded pre- and postoperatively with calculation of ABCD, DiaRem, and DRS scores. Effects of OAGB on DM were observed and correlated with the scoring systems to detect their sensitivity and specificity.

RESULTS

Age, preoperative, and postoperative BMI were 47.38 ± 7.632, 45.096 ± 4.465, and 31.173 ± 3.799 respectively. The preoperative and stimulated C-peptides were 3.357 ± 0.995 and 4.158 ± 0.897 ng/ml respectively. The preoperative and postoperative HbA1C were 7.396 ± 0.743% and 6.564 ± 0.621% respectively. Patients with complete remission were 32 patients (23.2%) and with partial remission were 46 patients (33.3%) adding to 56.5% considered in remission. There was significant decrease of BMI, HbA1C, insulin, and oral hypoglycemic use postoperatively. Receiver operator characteristics (ROC) curve showed that ABCD, DiaRem, and DRS scores had AUC of 0.853 with cut-off > 5, 0.921 with cut-off ≤ 8, and 0.805 with cut-off ≤ 8 respectively. The DiaRem score had the highest AUC followed by ABCD score then DRS score.

CONCLUSION

OAGB significantly reduced BMI and HbA1C values 1 year postoperatively with 56.5% DM remission. DiaRem score had more remission predictive value following OAGB than ABCD and DRS scores especially when ≤ 8 with 90.6% sensitivity and 83% specificity.

A safety study of laparoscopic single-anastomosis duodeno-ileal bypass with gastric plication (SADI-GP) in the management of morbid obesity

Background

Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG.

Methods

Morbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena.

Results

Seventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) =  − 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) =  − 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) =  − 1.914; p = 0.02; p < 0.05) in MMPI-2 data.

Conclusion

According to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00423-021-02276-9.

Network Meta-Analysis of Metabolic Surgery Procedures for the Treatment of Obesity and Diabetes

Background

Metabolic surgery is part of a well-established treatment intensification strategy for obesity and its related comorbidities including type 2 diabetes (T2DM). Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) are the most commonly performed metabolic surgeries worldwide, but comparative efficacy is uncertain. This study employed network meta-analysis to compare weight loss, T2DM remission and perioperative complications in adults between RYGB, SG and OAGB.

Methods

MEDLINE, EMBASE, trial registries were searched for randomised trials comparing RYGB, SG and OAGB. Study outcomes were excess weight loss (at 1, 2 and 3–5 years), trial-defined T2DM remission at any time point and perioperative complications.

Results

Twenty randomised controlled trials were included involving 1803 patients investigating the three metabolic surgical interventions. RYGB was the index for comparison. The excess weight loss (EWL) demonstrated minor differences at 1 and 2 years, but no differences between interventions at 3–5 years. T2DM remission was more likely to occur with either RYGB or OAGB when compared to SG. Perioperative complications were higher with RYGB when compared to either SG or OAGB. Two-way analysis of EWL and T2DM remission against the risk of perioperative complications demonstrated OAGB was the most positive on this assessment at all time points.

Conclusion

OAGB offers comparable metabolic control through weight loss and T2DM remission to RYGB and SG whilst minimising perioperative complications.

Registration number: CRD42020199779 (https:// www.crd.york.ac.uk/PROSPERO)

Graphical abstract

Is duodeno-jejunal bypass liner superior to pylorus preserving bariatric surgery in terms of complications and efficacy?

PURPOSE

Based on recent scientific evidence, bariatric surgery is more effective in the management of morbid obesity and related comorbidities than conservative therapy. Pylorus preserving surgical procedures (PPBS) such as laparoscopic single-anastomosis duodeno-jejunal or duodeno-ileal bypass with sleeve gastrectomy are modified duodenal switch (DS) surgical techniques. The duodeno-jejunal bypass liner (DJBL) is a novel surgical method in the inventory of metabolism focused manual interventions that excludes duodeno-jejunal mucosa from digestion, mimicking DS procedures without the risk of surgical intervention. The aim of this article is to summarize and compare differences between safety-related features and weight loss outcomes of DJBL and PPBS.

METHODS

A literature search was conducted in the PubMed database. Records of DJBL-related adverse events (AEs), occurrence of PPBS-related complications and reintervention rates were collected. Mean weight, mean body mass index (BMI), percent of excess of weight loss (EWL%), percent of total weight loss (TWL%) and BMI value alterations were recorded for weight loss outcomes.

RESULTS

A total of 11 publications on DJBL and 6 publications on PPBS were included, involving 800 and 1462 patients, respectively. The baseline characteristics of the patients were matched. Comparison of DJBL-related AEs and PPBS-related severe complications showed an almost equal risk (risk difference (RD): -0.03 and confidence interval (CI): -0.27 to 0.21), despite higher rates among patients having received endoscopic treatment. Overall AE and complication rates classified by Clavien-Dindo showed that PPBS was superior to DJBL due to an excess risk level of 25% (RD: 0.25, CI: 0.01-0.49). Reintervention rates were more favourable in the PPBS group, without significant differences in risk (RD: -0.03, CI: -0.27 to 0.20). However, PPBS seemed more efficient regarding weight loss outcomes at 1-year follow-up according to raw data, while meta-analysis did not reveal any significant difference (odds ratio (OR): 1.08, CI: 0.74-1.59 for BMI changes).

CONCLUSION

Only limited conclusions can be made based on our findings. PPBS was superior to DJBL with regard to safety outcomes (GRADE IIB), which failed to support the authors' hypothesis. Surgical procedures showed lower complication rates than the incidence of DJBL-related AEs, although it should be emphasized that the low number of PPBS-related mild to moderate complications reported could be the result of incomplete data recording from the analysed publications. Weight loss outcomes favoured bariatric surgery (GRADE IIB). As the DJBL is implanted into the upper gastrointestinal tract for 6 to 12 months, it seems a promising additional method in the inventory of metabolic interventions.

Early Outcomes and Mid-Term Safety of One Anastomosis Gastric Bypass Are Comparable with Roux-en-Y Gastric Bypass: a Single Center Experience

BACKGROUND

The use of one anastomosis gastric bypass (OAGB) has increased in recent years. However, the efficacy and safety outcomes of this procedure remain under debate. Here, we compare our early outcome and mid-term safety of OAGB with primary Roux-en-Y gastric bypass (RYGB).

METHODS

This was a retrospective study using computerized electronic medical records data of patients who underwent RYGB or OAGB as a primary procedure from February 2012 to February 2019 in our bariatric center. Data collected included demographics, weight-outcomes, adverse events, hospital readmission, reoperation rates, and mortality following both procedures.

RESULTS

A total of 314 patients were included (132 RYGB and 182 OAGB). Operative time and costs were significantly lower for OAGB (80 vs. 125 min, p<0.01 and 2018.8 vs. 2912.3 USD, p < 0.01, respectively), but length of hospital stay was longer (4.06 ± 0.67 days vs. 3.58 ± 0.79, p < 0.0001). At 12 months post-surgery, the percentage of excess body mass index loss was comparable between the two groups, but the change in body mass index (BMI) was significantly higher in the OAGB group. Early (< 30 days) and late (> 30 days) surgical adverse events were also similar between the two groups.

CONCLUSION

Comparable short- and mid-term outcomes and adverse events are found for primary OAGB and RYGB. OAGB is not inferior to RYGB as a primary bariatric procedure for the treatment of obesity.

IFSO Update Position Statement on One Anastomosis Gastric Bypass (OAGB)

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.

Changes in Anthropometric Measures, Nutritional Indices and Gastrointestinal Symptoms Following One Anastomosis Gastric Bypass (OAGB) Compared with Roux-en-y Gastric Bypass (RYGB)

Purpose

Bariatric surgery is an effective treatment for obesity with new procedures emerging. However, despite comparable weight loss and improvements in metabolic outcomes, research on nutritional and gastrointestinal symptoms remains limited. Here we compare clinical data on weight, nutritional disorders and gastrointestinal symptoms of patients before and following one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric Bypass (RYGB).

Materials and Methods

In this retrospective study, data on anthropometry, nutritional indices, dietary intake and gastrointestinal symptoms were retrieved in cohorts of patients up to 2 years following OAGB and RYGB.

Results

Seventy-three patients had either a RYGB (28) or an OAGB (45), with 71% seeking these as a revisional procedure. Significant and higher weight loss was observed in the OAGB cohort at 1 year (%TWL 33.0 ± 8.5 vs. 26.6 ± 12.4), albeit comparable at 2 years postoperatively (%TWL 29.0 ± 11.1 vs. 34.1 ± 11.2). Disorders such as vitamin D, active B12, folate, homocystein (Hcy) and hyperparathyroidism were present following both surgeries. Levels of vitamin D, ferritin and total protein significantly worsened over time. Gastrointestinal symptoms of diarrhoea, steatorrhoea and reflux were higher in the OAGB cohort while the RYGB cohort reported more dumping syndrome (DS).

Conclusion

Significant and similar weight loss results are seen following both OAGB and RYGB. Nutritional disorders were common in both cohorts and increased over time. However, the OAGB patients reported more gastrointestinal side effects, which may contribute to poor quality of life and nutritional consequences. Prospective and longer-term studies investigating the nutritional and gastrointestinal health of patients undergoing OAGB is recommended.

Efficacy of Different Procedures of Metabolic Surgery for Type 2 Diabetes in Asia: a Multinational and Multicenter Exploratory Study

INTRODUCTION

Asian patients with diabetes exhibit different characteristics from Western patients. However, limited large-scale data are available on metabolic surgery procedures in Asia. We compared the short-term efficacies of metabolic surgery procedures for the management of Asian patients with different severities of diabetes.

METHODS

We included patients undergoing metabolic surgery in five Asian institutions from January 2008 to December 2015 with at least 1-year postoperative follow-up. Outcomes of weight loss and diabetes control were determined. Diabetes remission rates in different ABCD scores and factors affecting diabetes remission were analyzed.

RESULTS

A total of 1016 patients (mean BMI, 39.0 ± 7.2 kg/m²; HbA1c, 8.3% ± 1.7%) underwent metabolic surgery (197, Roux-en-Y gastric bypass [RYGB]; 171, one anastomosis gastric bypass [OAGB]; 437, sleeve gastrectomy [SG]; 130, SG with duodenal-jejunal bypass [SG-DJB]; and 81, single anastomosis duodenal-jejunal bypass with SG [SA-DJBSG]). The OAGB group exhibited significantly higher 1-year total weight loss (30.5%) and type 2 diabetes mellitus (T2DM) remission (78.4%) rates than did the other groups (p < .001). The patients with higher preoperative ABCD scores exhibited higher T2DM remission rates (81.8-100% and 9.5-46.2% in ABCD score subgroups of 9-10 and 1-2, respectively). In multivariate analysis, bypass was found to be an independent predictor of T2DM remission compared with SG (odds ratio of OAGB vs SG, 3.72; RYGB vs SG, 1.96; SG-DJB vs SG, 2.73; SA-DJBSG vs SG, 2.12).

CONCLUSION

The metabolic surgeries are highly effective in T2DM treatment. However, SG may not be as effective as gastric bypass and duodenal-jejunum bypass.

Metabolic Efficacy and Diabetes Remission Predictors Following 'Sleeve Gastrectomy with Loop Duodenojejunal Bypass' Surgery

PURPOSE

Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SLDJB) is a novel metabolic surgery that is a modification of the single anastomosis duodenoileal bypass with sleeve. Compared to conventional surgeries, SLDJB is highly effective in inducing diabetes remission. This study analyzed the metabolic efficacy of SLDJB.

MATERIALS AND METHODS

Seventy-eight patients with obesity and diabetes who underwent SLDJB between May 2013 and October 2017 were retrospectively analyzed to investigate the efficacy of their surgery and diabetes remission predictors. Complete diabetes remission was defined as an HbA1_c level <6% with cessation of insulin and oral hypoglycemic agents.

RESULTS

Complete diabetes remission occurred in 80.52% and 76.71% of patients at 1- and 3-year follow-ups, respectively. There was no significant difference in the rates of complete diabetes remission between the groups based on gender, preoperative body mass index (BMI), diabetes duration or preoperative insulin use. There was a significantly higher rate of complete remission in patients <50 years of age at the 1-year follow-up. Additionally, the rate of complete remission was significantly less when preoperative glycemic control was poor. Preoperative HbA1_c levels negatively predicted complete remission, but was significant only at the 3-year follow-up.

CONCLUSION

SLDJB is highly effective in treating obesity with type 2 diabetes, and preoperative glycemic control was found to predict complete remission. Patients under 50 years of age had a better short-term response rate; however, the surgery was effective regardless of gender, preoperative BMI, duration of diabetes or preoperative insulin use.

Revisional One-Anastomosis Gastric Bypass After Restrictive Index Surgery-a Metaanalysis and Comparison with Revisional Roux-en-Y Gastric Bypass

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.

Factors Predicting Weight Loss after "Sleeve Gastrectomy with Loop Duodenojejunal Bypass" Surgery for Obesity

Background

Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SG LDJB) is a loop modification of biliopancreatic diversion with duodenal switch. The aim of this study was to analyze weight loss response and factors predicting weight loss outcomes after SG LDJB.

Methods

This was a retrospective study analyzing SG LDJB surgeries performed between May 2013 and December 2017 in 126 Indians suffering from obesity. The collected data was analyzed to understand weight loss efficacy and the factors predicting weight loss. Surgery was considered successful when percentage excess weight loss (%EWL) was ≥50% or percentage total weight loss (%TWL) was ≥25%.

Results

%EWL was 95.77% and 83.84% and %TWL was 34.64% and 30.32% at the 1-year and 3-year follow-up, respectively. %EWL ≥50% was 99.04% and 96.47% and %TWL ≥25% was 91.35% and 75.29% at the 1-year and 3-year follow-up, respectively. Patient age and sex did not independently predict %EWL or %TWL. Preoperative body mass index (BMI), weight, and excess weight negatively predicted %EWL and positively predicted %TWL at the 1-year and 3-year follow-up. Multiple regression analysis showed that these parameters were independent predictors of %EWL and %TWL at 1 year, while preoperative weight and excess weight also independently predicted %EWL at the 3-year follow-up. In diabetic patients, %EWL was significantly lower at the 3-year follow-up and %TWL was significantly lower at the 1-year and 3-year follow-up.

Conclusion

SG LDJB was an effective bariatric surgery to treat obesity. Preoperative BMI, weight, excess weight, and the presence of diabetes were the significant factors associated with the weight loss outcomes.

Fasting Ghrelin and Postprandial GLP-1 Levels in Patients With Morbid Obesity and Medical Comorbidities After Sleeve Gastrectomy and One-anastomosis Gastric Bypass: A Randomized Clinical Trial

BACKGROUND

Sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB) are among the commonly performed bariatric procedures. This randomized study aimed to compare SG and OAGB in terms of weight loss, improvement in comorbidities, and change in serum ghrelin and glucagon-like peptide-1 (GLP-1) levels.

PATIENTS AND METHODS

This was a prospective randomized trial on patients with morbid obesity associated with medical comorbidities who were randomly assigned to 1 of 2 equal groups; group I underwent SG and group II underwent OAGB. Outcome measures were percent of excess weight loss (%EWL), improvement in comorbidities, change in the venous levels of fasting ghrelin and postprandial GLP-1 at 12 months after surgery, in addition to operation time and complications.

RESULTS

Forty patients (38 female) of a mean age of 33.8 years and mean body mass index of 48.6 kg/m2 were included. Operation time in group II was significantly longer than in group I (86 vs. 52.87 min; P<0.001). There were 6 recorded complications (1 in group I and 5 in group II, P=0.18). The %EWL, %total weight loss, and %excess body mass index loss at 6 and 12 months postoperatively were significantly higher in group II than in group I. Both groups had similar rates of improvement in comorbidities. Group I had significantly lower ghrelin and GLP-1 levels postoperatively at 6 and 12 months, respectively, as compared with group II.

CONCLUSIONS

OAGB was associated with significantly higher EWL than SG. The reduction in fasting ghrelin and postprandial GLP-1 serum levels at 12 months after SG was significantly higher than that after OAGB.

One anastomosis gastric bypass vs. Roux-en-Y gastric bypass: a 5-year follow-up prospective randomized trial

BACKGROUND

One anastomosis gastric bypass (OAGB) is a relatively novel technique with excellent outcomes, comparable to most accepted procedures. Our aim was to compare OAGB and Roux-en-Y gastric bypass (RYGB) in terms of percent of excess weight lost (%EWL) and resolution of comorbidities.

METHODS

Thirty-three patients were randomly assigned (1:2) to two groups (OAGB = 9 and RYGB = 24). Patients were analyzed prospectively.

RESULTS

The 5-year follow-up was 85% (28 patients). Both groups were comparable preoperatively in age, weight, body mass index (BMI), and excess weight. One intraoperative complication in OAGB group and no major postoperative complications for both groups were recorded. Progressive decrease in weight, BMI, and %EWL was observed at 1, 6, 12 months, and 5 years, with no differences between groups. Regarding comorbidities, we registered complete remission in type 2 diabetes mellitus (T2DM), insulin resistance, and dyslipidemia with OAGB. RYGB group reported complete remission in T2DM, insulin resistance, dyslipidemia, and gastroesophageal reflux disease (GERD). Mean operative time were 113.3 min ± 41.2 and 143.7 min ± 21.85 for OAGB and RYGB respectively. Mean number of reloads used was 5 for OAGB and 7 for RYGB, which demands further investigations. Postoperative pain was significantly higher in RYGB group. Hospital stay was 3 days for both groups.

CONCLUSION

At 5-year follow-up, patients of both techniques achieved similar outcomes in terms of %EWL and resolution of comorbidities, without early or mid-term major complications and no mortality. OAGB demonstrated less use of surgical stapling and unexplainably less postoperative pain compared to RYGB.