One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm: Weight Loss, Nutritional Outcomes, Endoscopic Results, and Quality of Life at 8-Year Follow-Up

LSG vs OAGB: 7-Year Follow-up Data of a Randomised Control Trial and Comparative Outcome Based on BAROS Score

BACKGROUND

This study aims to evaluate and compare long-term results of laparoscopic sleeve gastrectomy (LSG) and one anastomosis gastric bypass (OAGB) based on bariatric analysis reporting and outcome system (BAROS) score.

MATERIALS AND METHODS

Patients operated for morbid obesity between 2013 and 2015 were randomised to LSG and OAGB groups. Based on inclusion and exclusion criteria, 201 patients (100 LSG and 101 OAGB) were analysed for changes in total body weight (TBW), body mass index (BMI), percent excess weight loss (%EWL), percent total weight loss (%TWL), QoL (quality of life) scores, comorbidity resolution and outcome based on BAROS at 7 years.

RESULTS

Sixty-six LSG and 64 OAGB patients were followed up at 7 years. Mean pre-operative TBW and BMI were 119 ± 28.2 and 44.87 ± 7.71 for LSG group and 113.25 ± 23.74 and 44.71 ± 8.75 for OAGB group respectively. At 7 years after surgery, there was significant drop in mean TBW and BMI in both groups. Mean %EWL for LSG and OAGB patients was 50.78 ± 28.48 and 59.99 ± 23.32 and mean %TWL for LSG and OAGB patients was 23.22 ± 12.66 and 27.71 ± 12.27 respectively. Mean QoL scores at 7 years were significantly higher than the pre-operative scores and most of the patients in both groups had remission or improvement in their comorbidities. 68.76% OAGB patients had very good or excellent outcome on BAROS score while only 36.37% LSG patients had similar outcome.

CONCLUSIONS

LSG and OAGB are successful bariatric procedures over the long term. OAGB outperforms LSG and has significantly higher %EWL and %TWL over the long term.

Conversion of one-anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB) for gastroesophageal reflux disease (GERD): who is more at risk? A multicenter study

BACKGROUND

Although gastroesophageal reflux disease (GERD) affects 0.6% to 10% of patients operated on for one-anastomosis gastric bypass (OAGB), only about 1% require surgery to convert to Roux-en-Y gastric bypass (RYGB) [3-5]. The aim of the present study was to analyze the characteristics of OAGB patients converted to RYGB for GERD not responding to medical treatment.

METHODS

This retrospective multicenter study included patients who underwent conversion from OAGB to RYGB for severe GERD. The conversion was performed with resection of the previous gastro-jejunal anastomosis and the use of the afferent loop as a new biliary loop.

RESULTS

A total of 126 patients were included in the study. Of these patients, 66 (52.6%) had a past medical history of bariatric restrictive surgery (gastric banding, sleeve gastrectomy). A hiatal hernia (HH) was present in 56 patients (44.7%). The association between previous restrictive surgery and HH was recorded in 33 (26.2%) patients. Three-dimensional gastric computed tomography showed an average gastric pouch volume of 242.4 ± 55.1 cm3. Conversion to RYGB was performed on average 60 ± 35.6 months after OAGB. Seven patients (5.5%) experienced an early postoperative complication (4 patients grade IIIb and 3 grade IIb), and 3 (2.4%) a late complication. Patients showed further weight loss after RYGB conversion and an average of 24.8 ± 21.7 months after surgery, with a mean % of total weight loss (%TWL) of 6.9 ± 13.6 kg. From a clinical point of view, the problem of GERD was definitively solved in more than 90% of patients.

CONCLUSIONS

Situations that weaken the esogastric junction appear to be highly frequent in patients operated on for OAGB and converted to RYGB for severe reflux. Similarly, the correct creation of the gastric pouch could play an important role in reducing the risk of conversion to RYGB for GERD.

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.

OAGB Bowel Function in Patients With up to 5 Years Follow-Up: Updated Outcomes

OBJECTIVE

One-anastomosis gastric bypass (OAGB) is considered an effective technique in weight reduction and remission of comorbidities. However, in common with many bariatric and metabolic/bariatric procedures, gastrointestinal side effects are frequently reported, but clinical experience varies. The objective of this study was to analyze the bowel function of patients who undergo OAGB looking at 5-year postoperative outcomes.

METHOD

This study is cross-sectional, descriptive and analytical, developed with individuals undergoing OAGB (n = 208) in yhe period between 2015 and 2020. The time periods evaluated were 1 to 6 months (T1), 6 to 12 months (T2), and 1 to 5 years (T3). Data analysis was performed using SPSS v.28.0, considering a significance level p ≤ 0.05.

RESULTS

114 participants (54.8%), 79.8% women, mean age 47.0 ± 12.6 years, and BMI 40.1 ± 5.6 kg/m2, 51.9% dyslipidemia, 43.6% arterial hypertension, and 19.1% diabetes mellitus. The T1 group had more severe symptoms/nausea than the T2 group. The T2 group had a significantly lower defecation frequency than the T1 and T3 groups. As for the occurrence of diarrhea, associations were not found in the considered groups. The T3 group had a greater severity of constipation associated with greater difficulty in consuming red meat, white meat, rice, vegetables, and salads.

CONCLUSIONS

Gastrointestinal symptoms are prevalent in the first postoperative months. However, diarrhea was not common. The patient selection policy and surgical technique were decisive in this result. Constipation was prevalent in patients between 1 and 5 postoperative years. It was also prevalent in those who had food intolerance, which from a nutritional point of view is an adverse factor for optimal bowel function.

A systematic review and meta-analysis on GERD after OAGB: rate, treatments, and success

INTRODUCTION

This review aims to investigate the gastroesophageal reflux disease (GERD) as one of the important concerns for both surgeons and patients after one anastomosis gastric bypass (OAGB).

METHOD

PubMed, Scopus, Embase, Web of Science, and Cochrane were reviewed by the end of the 2021 with keywords relating to GERD, OAGB, and their equivalents. Data regarding OAGB, number of patients with GERD, treatment for GERD, endoscopy findings, the interval between GERD and OAGB were retrieved by two independent investigators. The primary effect/effect size measure was prevalence.

RESULTS

40 studies examining 17,299 patients were included revealing that 2% of patients experience GERD following OAGB. Reflux after revisional OAGB is six times higher than primary OAGB. Despite being unclear, medical and surgical treatments for GERD after OAGB were used in 60% and 41% of patients with estimated success rate of 85% and 100%, respectively.

CONCLUSION

Based on how GERD was identified after OAGB, its rate ranged from 0 to 55%; the pooled rate of 2% is near to Roux-en-Y gastric bypass. GERD symptoms can be mild to be tolerated without medical treatment, moderate that respond to acid-reducing agents, or severe enough that are categorized as interactable and would need a surgical intervention.

Malnutrition Following One-Anastomosis Gastric Bypass: a Systematic Review

Severe malnutrition following one-anastomosis gastric bypass (OAGB) remains a concern. Fifty studies involving 49,991 patients were included in this review. In-hospital treatment for severe malnutrition was needed for 0.9% (n = 446) of patients. Biliopancreatic limb (BPL) length was 150 cm in five (1.1%) patients, > 150 cm in 151 (33.9%), and not reported in 290 (65%) patients. OAGB was revised to normal anatomy in 126 (28.2%), sleeve gastrectomy in 46 (10.3%), Roux-en-Y gastric bypass in 41 (9.2%), and shortening of BPL length in 17 (3.8%) patients. One hundred fifty-one (33.8%) patients responded to treatment; ten (2.2%) did not respond and was not reported in 285 (63.9%) patients. Eight (0.02%) deaths were reported. Standardisation of the OAGB technique along with robust prospective data collection is required to understand this serious problem.

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.

Nutritional and Lifestyle Behaviors Reported Following One Anastomosis Gastric Bypass Based on a Multicenter Study

This study aimed to describe nutritional and lifestyle parameters following one-anastomosis gastric bypass (OAGB). A multicenter study among OAGB patients across Israel (n = 277) and Portugal (n = 111) was performed. Patients were approached according to the time elapsed since surgery. An online survey with information regarding demographics, anthropometrics, and nutritional and lifestyle aspects was administered in both countries simultaneously. Respondents from Israel (pre-surgery age of 41.6 ± 11.0 years, 75.8% females) and Portugal (pre-surgery age of 45.6 ± 12.3 years, 79.3% females) reported changes in their appetite (≤94.0% and ≤94.6%), changes in their taste (≤51.0 and ≤51.4%), and intolerance to specific foods (i.e., red meat, pasta, bread, and rice). Bariatric surgery-related eating recommendations were generally followed well, but a trend toward lower adherence was evident in groups with longer time elapsed since surgery in both countries. Most respondents from Israel and Portugal reported participation in follow-up meetings with a surgeon (≤94.0% and 100%) and a dietitian (≤92.6% and ≤100%), while far fewer reported participation in any follow-up meeting with a psychologist/social worker (≤37.9% and ≤56.1%). Patients following OAGB might experience changes in appetite, taste, and intolerance to specific foods. Adherence to bariatric surgery-related eating recommendations is not always satisfying, especially in the longer term post-surgery.

Ten-year outcome of one-anastomosis gastric bypass with a biliopancreatic limb of 150 cm versus Roux-en-Y gastric bypass: a single-institution series of 940 patients

BACKGROUND

Long-term outcomes of one-anastomosis gastric bypass (OAGB) need to be compared with those of Roux-en-Y gastric bypass (RYGB).

OBJECTIVE

The present study evaluates the long-term outcomes at 10-year follow-up of OAGB with a biliopancreatic limb of 150 cm versus RYGB.

SETTING

Private practice, France.

METHODS

Data of patients who underwent OAGB or RYGB as primary or secondary procedures between 2010 and 2011 at a referral center were collected prospectively and analyzed retrospectively.

RESULTS

A total of 940 patients underwent OAGB (n = 405) or RYGB (n = 535). Operative time was significantly shorter in the OAGB group. Postoperative morbidity occurred in 17.2% of patients after RYGB versus 8.1% after OAGB (P ≤ .0001). Patients in the RYGB group had a significantly higher rate of kinking of the jejuno-jejunal anastomosis, stenosis of the gastrojejunal anastomosis, and dysphagia for early ulcers. At long term, no differences were found in the rate of severe malnutrition. Cumulated morbidity was significantly higher after RYGB, with higher incidence of internal hernia, anastomotic ulcer, blind-loop syndrome, and hypoglycemia. Conversion to RYGB and laparoscopic exploration for chronic pain were more frequent after OAGB. Surgery for weight regain was significantly more frequent after RYGB. Patients in the OAGB group had significantly lower weight, body mass index, and greater percentage excess, and total weight losses at 120 months. No significant differences were detected in co-morbidity outcomes.

CONCLUSION

After 10 years, both RYGB and OAGB are effective procedures. However, OAGB is associated with shorter operative times and better results in short- and long-term morbidity and weight loss outcomes.

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.

150-cm Versus 200-cm Biliopancreatic Limb One-Anastomosis Gastric Bypass: Propensity Score-Matched Analysis

BACKGROUND

It has been suggested that shortening the length of the biliopancreatic limb (BPL) to 150 cm in one anastomosis gastric bypass (OAGB) would reduce nutritional complication rates without impairing weight loss outcomes. The aim of this study is to compare patients who underwent OAGB with a 200-cm BPL (OAGB-200) to patients with OAGB with a 150-cm BPL (OAGB-150) in terms of weight loss and late morbidity.

METHODS

This is a monocentric retrospective matched cohort study including patients with a body mass index between 35 and 50 kg/m² who underwent an OAGB-150 or an OAGB-200. Patients were matched 1:1 based on age, sex, and body mass index, prior to bariatric surgery.

RESULTS

In total, 784 patients who underwent OAGB were included (OAGB-150 n = 392 and OAGB-200 (n = 392). There was no significant difference in terms of early morbidity. Regarding late morbidity in patients with an OAGB-150, significantly lower rates for marginal ulcer (OR = 0.4, CI 95% [0.2; 0.8], p = 0.006), incisional hernia (OR = 0.5, CI 95% [0.3; 1], p = 0.041), and bowel obstruction (OR = 0.3, CI 95% [0.1; 0.9], p = 0.039) were reported. Likewise, regarding late nutritional deficiencies, post-OAGB-150, a significantly lower number of patients with hypoalbuminemia (OR = 0.3, CI 95% [0.2; 0.7], p = 0.006), low vitamin B9 (OR = 0.5, CI 95% [0.2; 1], p = 0.044), and low ferritin (OR = 0.5, CI 95% [0.3; 0.8], p = 0.005) were observed. There was no significant difference in the percentage of excess BMI loss at 1, 2, 3, 4, and 5 years.

CONCLUSION

Compared to OAGB-200 in patients with BMI ≤ 50 kg/m², OAGB-150 results in fewer nutritional deficiency rates long term, without impairing weight loss.

What Is the Efficacy of Short Length of Biliopancreatic Limb in One-Anastomosis Gastric Bypass? A Systematic Review and Meta-analysis of Short-Term Results

OBJECTIVE

To systematically review the efficacy of short length of biliopancreatic limb (BPL) in laparoscopic one anastomosis gastric bypass (OAGB).

METHODS

By thoroughly investigating in PubMed, Embase, and the Cochrane Library, each research containing the comparison between short BPL and 200-cm BPL was included, inception in July 2021. The research followed the guidance of Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) recommendations.

RESULT

A total of 1288 patients were included for meta-analysis. Results showed that in the short term, compared with 200-cm BPL, percentage excess weight loss (%EWL) did not show significant reduction (p = 0.91), neither did the incidence of vitamin D deficiency (p = 0.87) nor hypoalbuminemia (p = 0.06), while percentage total weight loss (%TWL) was significantly higher in the 200-cm BPL group (p = 0.0005). At 1, 2, and 8 years postoperatively, patients with short BPL still obtained significantly reduced body mass index (BMI).

CONCLUSION

Short BPL shows significant effect of weight loss; however, it seems no significantly lower rates of adverse events in the short term are found. More research with randomized controlled design is encouraged to further address the incidence of adverse events in the long term.

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.

Gastrointestinal Quality of Life in Morbidly Obese Patients Undergoing One Anastomosis Gastric Bypass (OAGB): Derivation of a "Mini GIQLI" Score

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.

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

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.

Laparoscopic Banded One Anastomosis Gastric Bypass: A Single-Center Series

INTRODUCTION

Laparoscopic one anastomosis gastric bypass (LOAGB) is a relatively new procedure for the treatment of morbid obesity and related comorbidities. On average, this procedure results in good postoperative weight loss with a low complication rate. Recent publications suggest that dumping syndrome and weight regain might be reduced by placing a silicone ring over the gastric pouch during the procedure, so called laparoscopic banded one anastomosis gastric bypass (LBOAGB).

METHODS

86 patients undergoing LBOAGB between 2018 and 2020 were enrolled in this retrospective study. Hospital records were used to assess weight loss, comorbidity resolution, and any complications either in the short or medium term.

RESULTS

54 Female and 32 male patients were included with a mean age of 43 years (25-64), preoperative body mass index of 42 kg/m² (35-49), and preoperative weight of 114 kg (86-162). Thirty-four patients presented with type 2 diabetes (39.5%), 42 patients (49%) diagnosed with hypertension, 24 presented with OSAS (28%), and 21 (24%) hypercholesterolaemia patients were included. In total, 36 patients were diagnosed with multiple comorbidities. The operative data showed an average operative time of 48 minutes with 3.4% of patients suffering from early (minor) complications and 2.3% with a late (minor) complication. One patient required reoperation due to intra-abdominal bleeding. The median length of hospital stay was 2.5 days. Median follow-up was 18 months (5-36). In that period, no patient required ring removal or conversion to Roux-en-Y gastric bypass surgery. Food intolerance/vomiting was present in 1 patient (1.1%), bile reflux was present in 1 patient (1.1%), and no stomal ulcers were observed. Mean % excess weight loss at 12 and 24 months was 72% and 80%, respectively. Fifty-two out of 86 patients (60%) had a complete resolution of comorbidities. A CONUT score >2 (mild malnutrition) was found in 40% of patients, while a CONUT score 0-1 was found in 60% of patients.

CONCLUSION

LBOAGB shows promising results in terms of safety and efficacy in the short term. Further prospective studies will be required to evaluate the consistency of the results in the long term.

Conversion from one-anastomosis gastric bypass to Roux-en-Y gastric bypass: when and why-a single-center experience of all consecutive OAGB procedures

BACKGROUND

One-anastomosis gastric bypass (OAGB) is a well-established treatment method in patients with morbid obesity. Its long-term impact on de novo reflux, anastomotic complications, and malnutrition needs further evaluation. Roux-en-Y gastric bypass (RYGB) is a technically feasible procedure in revisional bariatric surgery. This study presents our institutional data on conversion from OAGB to RYGB.

OBJECTIVE

To determine the reasons for conversion, preoperative endoscopic findings, and feasibility of revisional bariatric surgery after OAGB.

SETTING

University hospital in Austria METHODS: Retrospective analysis of a prospectively fed database. All patients undergoing OAGB between January 2012 and December 2019 were included. Screening was carried out for all patients needing conversion to RYGB. Percent total weight loss, percent excess weight loss, time to conversion, postoperative complications, and reasons for conversion were assessed.

RESULTS

Eighty-two of 1,025 patients who underwent OAGB were converted laparoscopically to RYGB. Seven patients were converted early because of anastomotic/gastric tube leakage. Median time to late conversion was 29.1 ± 24.3 months, mean percent excess weight loss was 86.6% ± 33.1% and percent total weight loss was 35.1% ± 13.5%. Forty-two patients were converted because of reflux, 11 because of persistent marginal ulcers, 10 because of anastomotic stenosis, 9 because of malnutrition, and 3 because of weight regain. Seven patients showed Barrett's metaplasia in biopsies at the gastroesophageal junction before conversion.

CONCLUSION

Laparoscopic conversion from OAGB to RYGB is technically feasible with a moderate rate of postoperative complications. Severe (bile) reflux is a serious long-term complication after OAGB, with 4.1% of patients needing conversion to RYGB. Endoscopy after OAGB in patients showing clinical symptoms of gastroesophageal reflux disease is strongly advised to detect underlying pathologic changes.

Revisional One Anastomosis Gastric Bypass with a 150-cm Biliopancreatic Limb After Failure of Adjustable Gastric Banding: Mid-Term Outcomes and Comparison Between One- and Two-Stage Approaches

PURPOSE

Laparoscopic adjustable gastric banding (LAGB) was a common procedure worldwide but associated with a high rate of long-term failure. This study aims to evaluate the safety and effectiveness of conversion to one anastomosis gastric bypass (OAGB) after failed LAGB.

MATERIALS AND METHODS

We undertook a retrospective analysis of a prospectively maintained database in a tertiary referral center for bariatric surgery. All cases of revisional OAGB with a biliopancreatic limb (BPL) of 150 cm after failed LAGB performed between 2010 and 2016 were analyzed.

RESULTS

Overall, 215 patients underwent conversion from LAGB to OAGB. Indication for surgery was primary weight loss (WL) failure in 30.7% of cases and long-term complications in the remaining patients, with or without associated weight regain. At the time of OAGB, the mean age was 43.2 ± 10.5 years and the mean BMI was 42 ± 6.9. Overall postoperative morbidity was 13.5%. The postoperative abscess ± leak rate was 5.9% in the overall population. Two years after OAGB, 9.7% of patients were lost to follow-up, % excess weight loss (EWL) was 88.2 ± 23.9, and % total weight loss (TWL) was 38.7 ± 9.3. At 5 years, 16.6% of patients were lost to follow-up, %EWL was 82.4 ± 25, and %TWL was 36.1 ± 10. There was no statistical difference in complication rates or WL results between the one-stage and two-stage approaches.

CONCLUSION

OAGB with a 150-cm BPL represents a safe and effective option after failed LAGB. Both synchronous OAGB and two-step revisional OAGB guarantee satisfying results in terms of postoperative morbidity and WL outcomes.

Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50?

Purpose

The treatment of people with severe obesity and BMI > 50 kg/m² is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery.

Material and Methods

Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m² between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter.

Results

Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss.

Conclusion

OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m². Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting.

Graphical abstract

Long-Term Results of One Anastomosis Gastric Bypass: a Single Center Experience with a Minimum Follow-Up of 10 Years

PURPOSE

The purpose of this study was to evaluate the efficacy and safety of the OAGB at least 10 years after surgery.

MATERIAL AND METHODS

We retrospectively reviewed our prospectively collected data on consecutive morbid patients with obesity receiving OAGB from January 2005 to December 2007.

RESULTS

A total of 385 patients met the inclusion criteria. The mean follow-up was 149 months. Of all patients, 52% underwent OAGB as a primary procedure and 48% as a revisional procedure. At the 10-year follow-up, the mean body mass index (BMI) was 30.7 ± 11.8, the mean %TWL was 33.4 ± 10.6, and the mean %EWL was 64.1 ± 24.6. We did not find a significant statistical difference in terms of weight loss between primary OAGB and secondary OAGB. In total, 43% of patients achieved a %EWL greater than 75%, while 29% of the patients had an EWL% that was below 50%. All of the comorbidities related to obesity showed a high improvement or fully resolved. Early complications occurred in 9 patients (2.3%), while the overall rate of late complications was 17.1%. Nineteen patients (4.9%) developed an ulcer at the gastrojejunal anastomosis level, nine patients (2.3%) were re-hospitalized for major malnutrition, thirty-eight patients (9.8%) showed a postoperative biliary reflux, and five patients (2.7%) experienced severe anemia, which required several hospitalizations for iron I.V. supplementation.

CONCLUSION

According to results of the present study, we believe that OAGB has shown to be a technique with a reasonable balance between long-term efficacy and undesirable sequelae.

Efficacy and Drawbacks of Single-Anastomosis Duodeno-Ileal Bypass After Sleeve Gastrectomy in a Tertiary Referral Bariatric Center

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.

Internal Hernia After One Anastomosis Gastric Bypass (OAGB): Lessons Learned from a Retrospective Series of 3368 Consecutive Patients Undergoing OAGB with a Biliopancreatic Limb of 150 cm

Background

Internal hernia (IH) represents a relatively common and well-known complication after Roux-en-Y gastric bypass. IH after one anastomosis gastric bypass (OAGB) is less frequent and rarely reported in the literature. This study presents a series of IH after OAGB observed in a high-volume bariatric center.

Methods

Data of patients who underwent OAGB with an afferent limb of 150 cm between May 2010 and September 2019 were prospectively collected and retrospectively analyzed. Data of patients undergoing surgery for IH during follow-up were collected and analyzed.

Results

Ninety-six patients out of 3368 with a history of OAGB had intestinal incarceration in the Petersen’s orifice (2.8%). Specificity and sensitivity of computed tomography scans in the diagnosis of IH were 59% and 76%, respectively. The mean timeframe between OAGB and surgery for IH was 21.9±18.3 months. Mean body mass index at the time of IH surgery was 24.7 ± 3.6. Surgery was completed laparoscopically in 96.8% of cases. Nine patients (9.3%) had signs of bowel hypovascularization. In all patients, the herniated bowel was repositioned, and the Petersen’s orifice was closed, without the need for bowel resection. Mean hospital stay was 1.9 ± 4.8 days. The postoperative morbidity rate was 8.3%. Long-term IH relapse was observed in 14 patients; signs of bowel hypovascularization due to incarceration in a small orifice was observed in eight of these patients (57%).

Conclusions

Incidence of IH after OAGB is 2.8%. IH is associated with a low rate of bowel ischemia and the need for intestinal resection.

Effect of one anastomosis gastric bypass on liver function tests: A comparison between 150 cm and 200 cm biliopancreatic limbs

Context:

Some studies have shown that one anastomosis gastric bypass (OAGB) results in the derangement of liver function tests (LFTs). We wanted to study this in our patients.

Aims:

The aims are to study the effect of OAGB on LFTs and to compare the effect of a biliopancreatic limb (BPL) of 150 cm (OAGB-150) to a BPL of 200 cm (OAGB-200).

Settings and Design:

The study was a retrospective cohort study conducted at a university hospital.

Materials and Methods:

Information was obtained from our prospectively maintained database and hospital's computerised records.

Statistical Analysis:

A P < 0.05 was regarded statistically significant; however, given the number of variables examined, findings should be regarded as exploratory.

Results:

A total of 405 patients underwent an OAGB-200 (n = 234) or OAGB-150 (n = 171) in our unit between October 2012 and July 2018. There were significant improvements in gamma-glutamyl transpeptidase (GGT) levels at 1 and 2 years after OAGB-200 and significant worsening in the levels of alkaline phosphatase (ALP) and albumin at 1 and 2 years. There was a significant improvement in GGT levels at 1 and 2 years after OAGB-150 and in alanine transaminase levels at 1 year. There was a significant worsening in ALP and albumin levels at both follow-up points in this group. OAGB-150 group had a significantly lower bilirubin level at 1 year and significantly fewer abnormal ALP values at 2 years in comparison with OAGB-200 patients.

Conclusions:

This exploratory study demonstrates the overall safety of OAGB with regard to its effect on LFTs, with no remarkable difference between OAGB-150 and OAGB-200.

Nutritional consequences of bariatric surgery - prevention, detection and management

PURPOSE OF REVIEW

Bariatric surgery is an effective treatment option for severe and complex obesity; however, those who undergo such surgery need access to nutritional monitoring and vitamin and mineral supplementation to avoid the development of nutritional deficiencies.

RECENT FINDINGS

The British Obesity and Metabolic Surgery Society and the American Society for Metabolic and Bariatric Surgery have recently updated their recommendations on preoperative and postoperative nutritional monitoring and supplementation. There is a growing interest in the more malabsorptive procedures that are associated with an increased risk of nutritional deficiencies. Nutritional monitoring and prevention of nutritional deficiencies are discussed.Long-term follow-up that includes annual nutritional monitoring and access to a dietetic annual review is recommended; however, in the United Kingdom, many bariatric surgery centres are only commissioned to provide 2 years of follow-up, after which care is transferred to the general practitioner. Consideration should be given to developing shared care models for aftercare and also for the aftercare of malabsorptive procedures to remain with specialist centres.

SUMMARY

Bariatric surgery is a safe and effective treatment option for severe and complex obesity. It is essential that patients have access to lifelong nutritional monitoring adjustment of vitamin and mineral supplements to prevent nutritional issues.

Roux-en-Y gastric bypass versus one anastomosis-mini gastric bypass as a rescue procedure following failed restrictive bariatric surgery. A systematic review of literature with metanalysis

BACKGROUND

Although different procedures have been proposed as revisional surgery for patients who had previously undergone a failed primary restrictive procedure, the ideal revisional procedure is still a matter of debate.

METHODS

A systematic search was performed in all electronic databases to find studies comparing one anastomosis-mini gastric bypass (OAGB-MGB) or Roux-en-Y gastric bypass (RYGB) as revisional bariatric surgery for weight regain or intolerance/complications of a primary restrictive procedure. The data regarding sample size, patients' gender, age, primary surgery type, number of perioperative complications, operative time, pre- and post-revisional body mass index (BMI), and excess weight loss % (EWL%) at 1-year follow-up were extracted. Five studies were included in the analysis.

RESULTS

The primary bariatric procedures were represented by vertical banded gastroplasty (VBG), laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG). About perioperative complications, both RYGB and OAGB-MGB showed a similar rate of leaks but OAGB-MGB had a lower rate of bleedings; considering the progression from pre- to post-revisional BMI, OAGB-MGB reveals a better outcome as well as a shorter operative time.

CONCLUSIONS

Our meta-analysis has shown OAGB-MGB, used as revisional intervention after failed restrictive surgery, achieves outcomes comparable to RYGB in terms of perioperative complications providing a simpler and more effective technique.

Bariatric Surgery-How Much Malabsorption Do We Need?-A Review of Various Limb Lengths in Different Gastric Bypass Procedures

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.

The IFSO Worldwide One Anastomosis Gastric Bypass Survey: Techniques and Outcomes?

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.