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Quint E, Perry ZH, Elkrinawi N, Kukeev I, Czeiger D, Vakhrushev A, Sebbag G, Dukhno O. Banded One-Anastomosis Gastric Bypass (BOAGB) for Patients Living with Obesity and Extreme Obesity: A Single Institution's Experience. Obes Surg 2024; 34:1756-1763. [PMID: 38557949 DOI: 10.1007/s11695-024-07194-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The prevalence of patients suffering from extreme obesity (body mass index (BMI) ≥ 50) has significantly increased over the past three decades, surpassing the rise in the general population of overweight patients. Weight loss outcomes after bariatric surgery in patients suffering from extreme obesity are less favorable, with a higher incidence of weight regain. Variations of existing bariatric procedures have been proposed to address this issue. One such variation is adding a gastric band to limit the expansion of the newly created pouch. Limited data exist regarding the effectiveness of this procedure, called the banded one-anastomosis gastric bypass (BOAGB) procedure, compared to other bariatric procedures. METHOD In this retrospective study, we compared all patients who underwent the BOAGB procedure at the Bariatric Surgery Unit in our Medical Center with a postoperative follow-up of at least 1 year with patients who underwent a one-anastomosis gastric bypass (OAGB) or sleeve gastrectomy (SG) procedures. Data collected included demographics, comorbidities, surgical outcomes, complications, and postoperative quality-of-life assessments. RESULTS One hundred eleven patients were enlisted to our study during the relevant study period-24 patients underwent the BOAGB procedure, 43 underwent OAGB, and 44 underwent a SG. Lost to follow-up beyond 30 days was 9% (at 1-year post-surgery, we were able to establish contact with 101 patients). The pre-op BMI was significantly higher in the BOAGB group compared to the other procedures. Additionally, a higher prevalence of diabetes was observed in the BOAGB group. The duration of surgery was significantly longer for the BOAGB procedure. No significant differences were found in surgical complications. Overall, all procedures resulted in significant excess weight loss (EWL) or change in BMI, improvement in comorbidities, and improved quality of life postoperatively. CONCLUSIONS The BOAGB procedure, like OAGB and SG, demonstrated favorable weight loss outcomes and weight maintenance 1 year postoperatively without significant differences between the procedures. The BOAGB procedure is relatively new, with good bariatric outcomes and a favorable safety profile. Long-term study is needed to evaluate these various bariatric procedures' efficacy further.
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Affiliation(s)
- Elchanan Quint
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Zvi H Perry
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
- Department of General Surgery A, Soroka University Medical Center, Beer Sheba, Israel.
| | - Nur Elkrinawi
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Ivan Kukeev
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - David Czeiger
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Alex Vakhrushev
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
| | - Gilbert Sebbag
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
| | - Oleg Dukhno
- Department of General Surgery B, Soroka University Medical Center, Beer Sheba, Israel
- Bariatric Surgery Unit, Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel
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Lee S, Supparamaniam S, Varghese C, Mahawar K. Marginal Ulcers Following One-Anastomosis Gastric Bypass: a Systematic Review and Meta-analysis. Obes Surg 2023; 33:2884-2897. [PMID: 37526816 DOI: 10.1007/s11695-023-06762-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Marginal ulcer (MU) is an uncommon but significant complication following one-anastomosis gastric bypass (OAGB). Our study aims to understand the incidence rates, risk factors, and management of MU following OAGB. METHODS MEDLINE, Scopus, and Cochrane Library databases were examined to identify all studies on OAGB where authors had reported on MU. Data were collected on basic demographics, incidence rates, risk factors, and management of this condition. RESULTS Thirty-two studies involving 8868 patients were analysed. The mean age and body mass index (BMI) of patients in these studies were 40.9 ± 4.5 years and 47.6 ± 5.6 kg/m2, respectively. Among the patient cohort, approximately 72% were female, and 20.6% had preoperative gastroesophageal reflux disease (GERD). The authors described prescribing proton-pump inhibitors (PPI) prophylaxis to 14.1% of patients after surgery. Two hundred twenty-eight patients were reported to have MU. The incidence of MU was 2.59% (95% CI 1.89-3.52), of which 53 patients presented within 12 months, 24 patients presented after 31 months, and five patients after 6 years. One hundred forty-six patients did not have presentation time documented. Sixty-five patients were described to have MU diagnosed on endoscopy, of which 54 were symptomatic and 11 were asymptomatic. The authors were, however, not specific on the choice of investigation for the remaining 163 patients. Of patients, 89.7% were treated conservatively with PPIs, whilst 10.3% had surgery to treat MU. CONCLUSIONS Marginal ulcer is an uncommon complication following OAGB. The majority of patients are treated conservatively with PPIs. Larger, well-designed studies reporting on risk factors, investigation, and management of MU following OAGB are warranted.
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Affiliation(s)
- Shiela Lee
- Bariatric Unit, Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK.
| | | | - Chris Varghese
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kamal Mahawar
- Bariatric Unit, Sunderland Royal Hospital, Kayll Rd, Sunderland, SR4 7TP, UK
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Ospanov O, Yeleuov G, Buchwald JN, Zharov N, Yelembayev B, Sultanov K. A Randomized Controlled Trial of Acid and Bile Reflux Esophagitis Prevention by Modified Fundoplication of the Excluded Stomach in One-Anastomosis Gastric Bypass: 1-Year Results of the FundoRing Trial. Obes Surg 2023; 33:1974-1983. [PMID: 37099252 DOI: 10.1007/s11695-023-06618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/14/2023] [Accepted: 04/19/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND The advantages and disadvantages of one-anastomosis gastric bypass (OAGB) with primary modified fundoplication using the excluded stomach ("FundoRing") is unclear. We aimed to assess the impact of this operation in a randomized controlled trial (RCT) and answer the next questions: (1) What the impact of wrapping the fundus of the excluded part of the stomach in OAGB on protection in the experimental group against developing de novo reflux esophagitis? (2) If preoperative RE could be improved in the experimental group? (3) Can preoperative acid reflux as measured by PH impedance, be treated by the addition of the "FundoRing"? METHODS The study design was a single-center prospective, interventional, open-label (no masking) RCT (FundoRing Trial) with 1-year follow-up. Endpoints were body mass index (BMI, kg/m2) and acid and bile RE assessed endoscopically by Los Angeles (LA) classification and 24-h pH impedance monitoring. Complications were graded by Clavien-Dindo classification (CDC). RESULTS One hundred patients (n = 50 FundoRingOAGB (f-OAGB) vs n = 50 standard OAGB (s-OAGB)) with complete follow-up data were included in the study. During OAGB procedures, patients with hiatal hernia underwent cruroplasty (29/50 f-OAGB; 24/50 s-OAGB). There were no leaks, bleeding, or deaths in either group. At 1 year, BMI in the f-OAGB group was 25.3 ± 2.77 (19-30) vs 26.48 ± 2.8 (21-34) s-OAGB group (p = 0.03). In f-OAGB vs s-OAGB groups, respectively, acid RE was seen in 1 vs 12 patients (p = 0.001) and bile RE in 0 vs 4 patients (p < 0.05). CONCLUSION Routine use of a modified fundoplication of the OAGB-excluded stomach to treat patients with obesity decreased acid and prevented bile reflux esophagitis significantly more effectively than standard OAGB at 1 year in a randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04834635.
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Affiliation(s)
- Oral Ospanov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Beybitshilik Street 49A, 010000, Astana, Kazakhstan.
- Surgery Center of Professor Oral Ospanov, Astana, Kazakhstan.
| | - Galymzhan Yeleuov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Beybitshilik Street 49A, 010000, Astana, Kazakhstan
| | - J N Buchwald
- Division of Scientific Research Writing, Medwrite Medical Communications, Maiden Rock, WI, USA
| | - Nurlan Zharov
- Department of Surgical Disease and Bariatric Surgery, Astana Medical University, Beybitshilik Street 49A, 010000, Astana, Kazakhstan
| | | | - Kassymkhan Sultanov
- Department of Surgical Disease, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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Braga JGR, Ramos AC, Callejas-Neto F, Chaim EA, Cazzo E. WEIGHT LOSS AND QUALITY OF LIFE AFTER ONE ANASTOMOSIS GASTRIC BYPASS: A 2-YEAR FOLLOW-UP STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:241-246. [PMID: 37585942 DOI: 10.1590/s0004-2803.202302023-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/27/2023] [Indexed: 08/18/2023]
Abstract
•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.
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Affiliation(s)
| | - Almino Cardoso Ramos
- Universidade Estadual de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil
| | | | - Elinton Adami Chaim
- Universidade Estadual de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil
| | - Everton Cazzo
- Universidade Estadual de Campinas, Departamento de Cirurgia, Campinas, SP, Brasil
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Safety and Efficacy of Laparoscopic Vertical Clip Gastroplasty: Early Results of an Italian Multicenter Study. Obes Surg 2023; 33:303-312. [PMID: 36459357 DOI: 10.1007/s11695-022-06364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/28/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Sleeve gastrectomy, the most commonly performed bariatric surgery procedure, carries limitations both short term including postoperative complications such as hemorrhage and gastric fistula and long term such as weight regain and gastroesophageal reflux. A new procedure has been proposed to overcome many of these limitations: laparoscopic vertical clip gastroplasty (LVCG) with BariClip. MATERIALS AND METHODS Fifty patients were offered LVCG and enrolled for a feasibility study in two referral bariatric centers. Indication was given as for sleeve gastrectomy, after a multidisciplinary path evaluating age, gender, BMI, comorbidities, eating behaviors, and gastroesophageal reflux. The primary outcome was major postoperative complications. Secondary outcomes included weight loss, incidence of de-novo GERD, and comorbidity resolution. RESULTS Patients had a mean age of 44 years and mean BMI of 37 kg/m2 ± 6.2. All procedures were performed successfully in laparoscopy, with no conversion or intraoperative adverse events. The overall major postoperative complication rate was 6%. Re-operation was required in three patients for slippage. No mortality occurred. Excess weight loss, excess BMI loss, and total weight loss at 6 months were 36%, 57%, and 22%, respectively. There was no instance of de-novo GERD. Resolution of hypertension occurred in 50% of cases, OSAS in 65% of cases, and DMII in 80% of cases. CONCLUSION The safety of LVCG procedure has been reproduced in a multicentric, multi-surgeon study. Weight loss outcomes appear promising. A randomized trial is needed to fully assess the benefits of LVCG.
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Chidambaram R, Pradhan S. Closed loop small bowel obstruction due to herniation through silastic ring after bariatric surgery. BMJ Case Rep 2022; 15:e250335. [PMID: 35618340 PMCID: PMC9137341 DOI: 10.1136/bcr-2022-250335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/04/2022] Open
Abstract
Bariatric surgery is an effective treatment for obesity and obesity-related complications. Weight regain after surgery plagues all methods of bariatric procedures including the minigastric bypass. The use of a 'silastic ring' around the gastric pouch has been shown to reduce weight regain. We present here a very rare complication of silastic ring use, in which a loop of small bowel had herniated through the ring and produced a closed loop small bowel obstruction. The patient was successfully treated with an emergency laparotomy to resect the silastic ring and release the herniated bowel. This case highlights the hernia risk that silastic rings pose and cautions careful consideration before their use.
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Affiliation(s)
- Rama Chidambaram
- Medical Education Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Department of General Surgery, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
| | - Sharin Pradhan
- Department of General Surgery, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
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Kermansaravi M, Lainas P, Shahmiri SS, Yang W, Jazi AD, Vilallonga R, Antozzi L, Parmar C, Kassir R, Chiappetta S, Zubiaga L, Vitiello A, Mahawar K, Carbajo M, Musella M, Shikora S. The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons. Surg Endosc 2022; 36:6170-6180. [PMID: 35064321 PMCID: PMC9283149 DOI: 10.1007/s00464-021-08979-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/31/2021] [Indexed: 11/27/2022]
Abstract
Background Bariatric surgery in patients with BMI over 50 kg/m2 is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey. Methods An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m2 was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors. Results 789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m2 should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m2, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively. Conclusion This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m2. Careful analysis of these results is useful for identifying several areas for future research and consensus building. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08979-w.
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Affiliation(s)
- Mohammad Kermansaravi
- Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Béclère Hospital, Paris-Saclay University, Clamart, France
- Metropolitan Hospital of Athens, HEAL Academy, Athens, Greece
| | - Shahab Shahabi Shahmiri
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | | | - Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Center of Excellence for the EAC-BC, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- ELSAN, Clinique Saint Michel, Centre Chirurgical de L'Obésité, Toulon, France
| | | | - Chetan Parmar
- Department of Surgery, The Whittington Health NHS Trust, London, UK
- University College London Medical School, London, UK
| | - Radwan Kassir
- Department of Digestive Surgery, Centre Hospitalier Universitaire Félix Guyon, St Denis de la Réunion, France
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Lorea Zubiaga
- Miguel Hernandez of Elche University, Alicante, Spain
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy
| | - Kamal Mahawar
- South Tyneside and Sunderland Foundation NHS Trust, Sunderland, UK
| | - Miguel Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples "Federico II" University, AOU "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
| | - Scott Shikora
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Campanelli M, Bianciardi E, Benavoli D, Bagaglini G, Lisi G, Gentileschi P. Laparoscopic Banded One Anastomosis Gastric Bypass: A Single-Center Series. J Obes 2022; 2022:4942052. [PMID: 35132363 PMCID: PMC8817855 DOI: 10.1155/2022/4942052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Michela Campanelli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and University of Rome “Tor Vergata”, Rome, Italy
| | - Emanuela Bianciardi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Domenico Benavoli
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and University of Rome “Tor Vergata”, Rome, Italy
| | - Giulia Bagaglini
- General Surgery Residency School, University of Rome “Tor Vergata”, Rome, Italy
| | - Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Viale Dell'Umanesimo 10, Rome 00144, Italy
| | - Paolo Gentileschi
- Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital and University of Rome “Tor Vergata”, Rome, Italy
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Liagre A, Martini F, Kassir R, Juglard G, Hamid C, Boudrie H, Van Haverbeke O, Antolino L, Debs T, Petrucciani N. Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50? Obes Surg 2021; 31:3966-3974. [PMID: 34176036 PMCID: PMC8397657 DOI: 10.1007/s11695-021-05499-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 01/23/2023]
Abstract
Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract ![]()
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Affiliation(s)
- Arnaud Liagre
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Francesco Martini
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Gildas Juglard
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Celine Hamid
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Hubert Boudrie
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Olivier Van Haverbeke
- Ramsay Générale de Santé, Clinique des Cedres, Bariatric Surgery Unit, Cornebarrieu, France
| | - Laura Antolino
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Tarek Debs
- Department of Digestive Surgery and Liver Transplantation, Nice University Hospital, Nice, France
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.
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Long-Term Efficacy of Bariatric Surgery for the Treatment of Super-Obesity: Comparison of SG, RYGB, and OAGB. Obes Surg 2021; 31:3391-3399. [PMID: 33993423 DOI: 10.1007/s11695-021-05464-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The most appropriate procedure for the treatment of super obesity (BMI > 50 kg/m2) is unknown. We aimed to evaluate the safety, long-term (> 5 years) weight loss, and adverse events between three commonly performed procedures, sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) in super-obese patients. METHODS Between January 2002 and December 2015, 498 successive patients with super morbid obesity (BMI > 50), who underwent SG or RYGB or OAGB, were recruited. Surgical outcome, weight loss, resolution of co-morbidities, and late complications were followed and compared between the 3 groups. All data derived from a prospective bariatric database and a retrospective analysis was conducted. RESULTS The average patient age was 32.1 ± 10.4 years, with a mean body mass index (BMI) of 56.0 ± 6.7 kg/m2. Of them, 190 (38.9%) underwent SG, 62 (12.4%) RYGB, and 246 (49.4%) OAGB. There was no difference in basic characters between the 3 groups except SG had fewer diabetic patients. RYGB group had higher intraoperative blood loss, longer operating time, and hospital stay than the other 2 groups. RYGB had a higher 30-days post-operative major complication rate (4.8%) than SG (0.5%) and OAGB (0.8%). The follow-up rate at 1 and 5 years was 89.4% and 52.0%. At post-operative 5 years, OAGB had a higher total weight loss (40.8%) than SG (35.1%), but not RYGB (37.2%). SG had a lower remission rate in dyslipidemia comparing to OAGB and RYGB, but T2DM remission rate was no different between the groups. The overall revision rate is 5.4% (27/498) of the whole group, and SG had a lower revision rate (2.6%) than RYGB (8.1%) and OAGB (6.9%). CONCLUSION SG is an effective and durable primary bariatric procedure for the treatment of super obesity and metabolic disorders. OAGB had a similar operation risk to SG but resulted in a better weight loss than SG.
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Borges-Canha M, Neves JS, Mendonça F, Silva MM, Costa C, M. Cabral P, Guerreiro V, Lourenço R, Meira P, Salazar D, Ferreira MJ, Pedro J, Barkoudah E, Sande A, Lau E, B. Souto S, Preto J, Freitas P, Carvalho D. Beta Cell Function as a Baseline Predictor of Weight Loss After Bariatric Surgery. Front Endocrinol (Lausanne) 2021; 12:714173. [PMID: 34456871 PMCID: PMC8387593 DOI: 10.3389/fendo.2021.714173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/22/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Obesity is a multifactorial disease, which is strongly associated to other metabolic disorders. Bariatric surgery is the most effective treatment of morbid obesity. The role of beta cell function in weight loss after bariatric surgery is uncertain. AIM To evaluate the association between beta cell function and percentage of total body weight loss (TBWL%) 1, 2, 3, and 4 years after bariatric surgery in patients with morbid obesity. METHODS Retrospective longitudinal study in patients with morbid obesity followed in our center between January 2010 and July 2018. Patients were excluded if they had diabetes at baseline or missing data on the needed parameters. We evaluated baseline Homeostatic Model Assessment of IR, Homeostatic Model Assessment of β-cell function (HOMA-beta), Quantitative Insulin Sensitivity Check Index, and Matsuda and DeFronzo index, and TBWL% at years 1 to 4. Linear regression models were used to evaluate the association of indexes of insulin resistance with TBWL% (unadjusted and adjusted for age, sex, BMI, and type of surgery). RESULTS There were 1,561 patients included in this analysis. HOMA-beta was negatively associated with TBWL% at second, third, and fourth years post-surgery (β = -1.04 [-1.82 to -0.26], p<0.01; β = -1.16 [-2.13 to -0.19], p=0.02; β = -1.29 [-2.64 to 0.06], p=0.061, respectively). This was not observed in the first year post-surgery nor for the other indexes. Glycemia at baseline was positively associated to EWL% at second and third years post-surgery. CONCLUSION β-cell function at baseline seems to be associated to long-term weight loss, explicitly after the first year post bariatric surgery. This might be a helpful predictor of weight loss in clinical practice.
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Affiliation(s)
- Marta Borges-Canha
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- *Correspondence: Marta Borges-Canha, ; orcid.org/0000-0003-2929-3751
| | - João Sérgio Neves
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Fernando Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria Manuel Silva
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Cláudia Costa
- Serviço de Endocrinologia do Instituto Português de Oncologia do Porto, Francisco Gentil, EPE, Porto, Portugal
| | - Pedro M. Cabral
- Serviço de Patologia Clínica do Centro Hospitalar Universitário Cova da Beira, EPE, Covilhã, Portugal
| | - Vanessa Guerreiro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Rita Lourenço
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Patrícia Meira
- Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Daniela Salazar
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Maria João Ferreira
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Jorge Pedro
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ebrahim Barkoudah
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Ana Sande
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Eva Lau
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Selma B. Souto
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - John Preto
- Serviço de Cirurgia Geral do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo do Centro Hospitalar Universitário de São João, Porto, Portugal
- Investigação e Inovação em Saúde (i3s), Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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