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Shahabi Shahmiri S, Sheikhbahaei E, Davarpanah Jazi A, Zefreh H, Yang W, Valizadeh R, Ribeiro R, Kermansaravi M. Remnant Gastrectomy and Gastric Bypass: A Systematic Review of Indications and Outcomes of Resectional Gastric Bypass. Obes Surg 2024; 34:2634-2649. [PMID: 38735966 DOI: 10.1007/s11695-024-07240-2] [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: 03/13/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND In this systematic review, we aim to evaluate the reasons and outcomes behind remnant gastrectomy with or after gastric bypass procedures. RESULTS A total of 66 studies examining 1918 patients were included in this study with 70% of female predominance. Twenty studies reported RGB on 1751 patients and 46 studies reported remnant gastrectomy after gastric bypass in 167 patients. The most common etiology of RGB was related to the in situ remnant stomach neoplasia in 10 studies on 981 patients; mostly for preventive intentions in high prevalence areas. Remnant gastrectomy after gastric bypass was performed to treat a complication such as GGF, retrograde bile reflux gastritis, cancer mostly adenocarcinoma. Studies revealed that RGB has similar weight loss in comparison to standard Roux-en-Y gastric bypass.
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Affiliation(s)
- Shahab Shahabi Shahmiri
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-e Akram University Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool University Hospital, Tehran, Iran
| | - Erfan Sheikhbahaei
- Minimally Invasive and Bariatric Surgery Research Center of Rasool-e Akram University Hospital, Iran University of Medical Sciences, Manaouri St., Niyayesh St., Sattar Khan St., Tehran, Iran
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirhossein Davarpanah Jazi
- Minimally Invasive and Bariatric Surgery Research Center of Rasool-e Akram University Hospital, Iran University of Medical Sciences, Manaouri St., Niyayesh St., Sattar Khan St., Tehran, Iran.
| | - Hamidreza Zefreh
- Minimally Invasive Surgery and Obesity Research Center, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Wah Yang
- Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
- The State Key Laboratory of Pharmaceutical Biotechnology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Rui Ribeiro
- Hospital Lusiadas Amadora Metabolic Surgery Unit and General Surgery Department Coordinator, Amadora, Portugal
| | - Mohammad Kermansaravi
- Department of Surgery, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-e Akram University Hospital, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool University Hospital, Tehran, Iran
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Ghiassi S, Nimeri A, Aleassa EM, Grover BT, Eisenberg D, Carter J. American Society for Metabolic and Bariatric Surgery position statement on one-anastomosis gastric bypass. Surg Obes Relat Dis 2024; 20:319-335. [PMID: 38272786 DOI: 10.1016/j.soard.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 01/27/2024]
Abstract
The following position statement is issued by the American Society for Metabolic and Bariatric Surgery in response to inquiries made to the society by patients, physicians, society members, hospitals, health insurance payors, and others regarding one-anastomosis gastric bypass as a treatment for obesity and metabolic disease. This statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time. The statement may be revised in the future as more information becomes available.
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Affiliation(s)
- Saber Ghiassi
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
| | - Abdelrahman Nimeri
- Department of Surgery, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Essa M Aleassa
- Digestive Disease Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Brandon T Grover
- Department of Surgery, Gundersen Health System, La Crosse, Wisconsin
| | - Dan Eisenberg
- Department of Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Jonathan Carter
- Department of Surgery, University of California, San Francisco, California
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Mouawad C, Dahboul H, Chamaa B, Osseis M, Noun R, Chakhtoura G. One anastomosis gastric bypass vs sleeve gastrectomy as a revisional bariatric surgery for weight loss failure after primary restrictive procedure. Asian J Endosc Surg 2024; 17:e13248. [PMID: 37750456 DOI: 10.1111/ases.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/15/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Weight loss failure after restrictive bariatric procedures initiated the debate about the choice of an adequate revisional intervention, a question still unanswered. While many surgeons went for a conversion to gastric bypass, others opted for re-trying a revisional restrictive procedure to avoid the side effects of gastric bypass. The objective of our study was to compare weight loss outcome between revisional laparoscopic sleeve gastrectomy (re-LSG) and revisional one anastomosis gastric bypass (re-OAGB) for insufficient weight loss or weight regain following primary restrictive bariatric surgery. MATERIALS AND METHODS We included 20 obese patients, with a history of weight regain or insufficient weight loss after primary restrictive surgery, who underwent re-LSG (eight patients) or re-OAGB (12 patients) between January 2018 and January 2021. Patients were followed up 2 years after their revisional intervention. Statistics were performed using IBM® SPSS® software for Windows version 21. RESULTS In the re-LSG group, the average body mass index (BMI) before primary restrictive procedure was 43.7 kg/m2 . The average period between the primary and revisional surgery was 12.6 years. Patients had a nadir BMI of 33.2 kg/m2 during that period and reached a mean BMI of 40.6 kg/m2 before re-LSG. Two years after re-LSG, the average BMI was 31.5 kg/m2 with a percent of excess weight loss (%EWL) of 54% and percent of excess BMI loss (%EBMIL) of 66.6%. In the re-OAGB group, the average BMI before primary restrictive procedure was 39 kg/m2 . The average period between the primary and revisional surgery was 10.7 years. Patients had a nadir BMI of 30.5 kg/m2 during that period and reached a mean BMI of 36.5 kg/m2 before re-OAGB. Two years after re-OAGB, the average BMI was 27 kg/m2 with a %EWL of 86.7% and %EBMIL of 92.6%. CONCLUSION For patients with insufficient weight loss or weight regain following primary restrictive bariatric surgery, re-OAGB has a better effectiveness in weight reduction compared with re-LSG after a 2-year follow up.
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Affiliation(s)
- Christian Mouawad
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Houssam Dahboul
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Bilal Chamaa
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Michael Osseis
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
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Kermansaravi M, Kassir R, Valizadeh R, Parmar C, Davarpanah Jazi AH, Shahmiri SS, Benois M. Management of leaks following one-anastomosis gastric bypass: an updated systematic review and meta-analysis of 44 318 patients. Int J Surg 2023; 109:1497-1508. [PMID: 37026835 PMCID: PMC10389517 DOI: 10.1097/js9.0000000000000346] [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: 07/24/2022] [Accepted: 03/05/2023] [Indexed: 04/08/2023]
Abstract
INTRODUCTION One-anastomosis gastric bypass (OAGB) complication, such as leakage, can be dangerous and should be managed properly, yet little data exist in the literature regarding the management of leaks after OAGB, and there are no guidelines to date. METHODS The authors performed a systematic review and meta-analysis of the literature and 46 studies, examining 44 318 patients were included. RESULTS There were 410 leaks reported in 44 318 patients of OAGB published in the literature, which represents a prevalence of 1% of leaks after OAGB. The surgical strategy was very variable among all the different studies; 62.1% of patients with leaks had to undergo another surgery due to the leak. The most commonly performed procedure was peritoneal washout and drainage (with or without T-tube placement) in 30.8% of patients, followed by conversion to Roux-en-Y gastric bypass in 9.6% of patients. Medical treatment with antibiotics, with or without total parenteral nutrition alone, was conducted in 13.6% of patients. Among the patients with the leak, the mortality rate related to the leak was 1.95%, and the mortality due to the leak in the population of OAGB was 0.02%. CONCLUSION The management of leaks following OAGB requires a multidisciplinary approach. OAGB is a safe operation with a low leak risk rate, and the leaks can be managed successfully if detected in a timely fashion.
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Affiliation(s)
- Mohammad Kermansaravi
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Surgery Research Center, Rasool-E Akram Hospital, School of Medicine, Iran University of Medical Sciences
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-E Rasool Hospital
| | - Radwan Kassir
- Diabete Athérothrombose Thérapies Réunion Océan Indien, INSERM, UMR 1188, Université de La Réunion
- Department of Digestive Surgery Unit, University Hospital of la Réunion – Félix Guyon Hospital, Saint-Denis, La Réunion, France
| | - Rohollah Valizadeh
- Division of Minimally Invasive and Bariatric Surgery, Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran
- Urmia University of Medical Sciences, Urmia, Iran
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, UK
| | | | - Shahab Shahabi Shahmiri
- Division of Minimally Invasive and Bariatric Surgery, Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran
| | - Marine Benois
- Department of Digestive Surgery Unit, University Hospital of la Réunion – Félix Guyon Hospital, Saint-Denis, La Réunion, France
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IFSO Update Position Statement on One Anastomosis Gastric Bypass (OAGB). Obes Surg 2021; 31:3251-3278. [PMID: 33939059 DOI: 10.1007/s11695-021-05413-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022]
Abstract
The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) issued a position statement on the role of one anastomosis gastric bypass (OAGB) in the field of bariatric/metabolic surgery in 2018 De Luca et al. (Obes Surg. 28(5):1188-206, 2018). This position statement was issued by the IFSO OAGB task force and approved by the IFSO Scientific Committee and IFSO Executive Board. In 2018, the OAGB task force recognized the necessity to update the position statement in the following 2 years since additional high-quality data could emerge. The updated IFSO position statement on OAGB was issued also in response to inquiries to the IFSO by society members, universities, hospitals, physicians, insurances, patients, policy makers, and media. The IFSO position statement on OAGB has been reviewed within 2 years according to the availability of additional scientific evidence. The recommendation of the statement is derived from peer-reviewed scientific literature and available knowledge. The IFSO update position statement on OAGB will again be reviewed in 2 years provided additional high-quality studies emerge.
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Gupta N, Agrawal H, Yelamanchi R, Ahuja A. Mini-gastric Bypass—One Anastomosis Gastric Bypass in the Armamentarium of Bariatric Surgeon: a Narrative Review of Complications. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02774-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Revisional One-Anastomosis Gastric Bypass After Restrictive Index Surgery-a Metaanalysis and Comparison with Revisional Roux-en-Y Gastric Bypass. Obes Surg 2020; 31:949-964. [PMID: 33159293 DOI: 10.1007/s11695-020-05094-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND One-anastomosis gastric bypass (OAGB) was established as a recognized bariatric procedure in the 2018 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) position statement. This study evaluates the outcomes of revisional OAGB (rOAGB) after a restrictive index procedure, and to compare it to revisional RYGB (rRYGB). METHODS A literature search was performed according to the PRISMA guidelines on papers published from inception till February 2020. Original studies involving patients who underwent rOAGB after a primary failed restrictive procedure were included. The primary outcome measured was postrOAGB weight loss. Secondary outcome measures include comorbidity resolution, operative duration, length of stay, morbidity, and mortality. RESULTS A total of 21 studies with 1377 patients were included. Five studies compared rOAGB versus rRYGB. Majority of the patients (76%) were female, with mean age of 43.5 years old. Mean body mass index (BMI) before revisional surgery was 41.6 kg/m2. The most common biliopancreatic limb length was 200 cm. Percentage of excess weight loss after rOAGB increases to a maximum of 76.0% at 48 months postsurgery. rOAGB resulted in a pooled prevalence of diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea resolution of 74.9%, 48.4%, 63.2%, and 75.7% respectively. When compared to rRYGB, rOAGB demonstrated greater weight loss, comparable metabolic syndrome resolution, but with a shorter operating time. Morbidity and mortality rates were low across all studies. CONCLUSIONS rOAGB has potential as an alternative revisional surgery, with weight loss profiles and rates of metabolic syndrome resolution that are comparable to rRYGB.
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One Anastomosis/Mini-Gastric Bypass (OAGB/MGB) as Revisional Surgery Following Primary Restrictive Bariatric Procedures: a Systematic Review and Meta-Analysis. Obes Surg 2020; 31:370-383. [PMID: 33118133 PMCID: PMC7809003 DOI: 10.1007/s11695-020-05079-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 10/31/2022]
Abstract
One anastomosis gastric bypass (OAGB/MGB) has gained popularity in the past decade. International databases were searched for articles published by September 10, 2020, on OAGB/MGB as a revisional procedure after restrictive procedures. Twenty-six studies examining a total of 1771 patients were included. The mean initial BMI was 45.70 kg/m2, which decreased to 31.52, 31.40, and 30.54 kg/m2 at 1, 3, and 5-year follow-ups, respectively. Remission of type-2 diabetes mellitus (T2DM) following OAGB/MGB at 1-, 3-, and 5-year follow-up was 65.16 ± 24.43, 65.37 ± 36.07, and 78.10 ± 14.19%, respectively. Remission/improvement rate from gastroesophageal reflux disease (GERD). Also, 7.4% of the patients developed de novo GERD following OAGB/MGB. Leakage was the most common major complication. OAGB/MGB appears to be feasible and effective as a revisional procedure after failed restrictive bariatric procedures.
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Parmar CD, Gan J, Stier C, Dong Z, Chiappetta S, El-Kadre L, Bashah MM, Wang C, Sakran N. One Anastomosis/Mini Gastric Bypass (OAGB-MGB) as revisional bariatric surgery after failed primary adjustable gastric band (LAGB) and sleeve gastrectomy (SG): A systematic review of 1075 patients. Int J Surg 2020; 81:32-38. [PMID: 32738545 DOI: 10.1016/j.ijsu.2020.07.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
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Conversion from laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) to one anastomosis gastric bypass (OAGB): preliminary data from a multicenter retrospective study. Surg Obes Relat Dis 2019; 15:1332-1339. [PMID: 31272866 DOI: 10.1016/j.soard.2019.05.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/19/2019] [Accepted: 05/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure, while laparoscopic adjustable gastric banding (LAGB) has been for a decade one of the most popular interventions for weight loss. After LSG and LAGB, some patients may require a second surgery due to weight regain or late complications. One anastomosis gastric bypass (OAGB) is a promising bariatric procedure, which provides effective long-term weight loss and has a favorable effect on type 2 diabetes. OBJECTIVES To retrospectively analyze data from 10 Italian centers on conversion from LAGB and LSG to OAGB. SETTING High-volume centers for bariatric surgery. METHODS Prospectively collected data from 10 high-volume centers were retrospectively reviewed. Body mass index (BMI), percentage of excess BMI loss, reasons for redo, remission from co-morbidities (hypertension, diabetes, gastroesophageal reflux, and dyslipidemia), and major complications were recorded. RESULTS Three hundred patients were included in the study; 196 patients underwent conversion from LAGB to OAGB and 104 were converted from LSG. BMI was 45.1 ± 7 kg/m2 at the time of first intervention, 41.8 ± 6.3 kg/m2 at redo time, and 30.5 ± 5.5 kg/m2 at last follow-up appointment. Mean percentage of excess BMI loss was 13.2 ± 28.2 at conversion and 73.4 ± 27.5 after OAGB. Remission rates from hypertension, diabetes, gastroesophageal reflux, and dyslipidemia were 40%, 62.5%, 58.7% and 52%, respectively. Mean follow-up was 20.8 (range, 6-156) months and overall complications rate was 8.6%. CONCLUSION Our data show that OAGB is a safe and effective revisional procedure after failed restrictive bariatric surgery.
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