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Mostafapour E, Shahsavan M, Shahmiri SS, Jawhar N, Ghanem OM, Kermansaravi M. Prevention of malnutrition after one anastomosis gastric bypass: value of the common channel limb length. BMC Surg 2024; 24:156. [PMID: 38755612 PMCID: PMC11097460 DOI: 10.1186/s12893-024-02438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE Hypoalbuminemia and anemia are commonly observed indications for one anastomosis gastric bypass (OAGB) reversal and remain significant concerns following the procedure. Sufficient common channel limb length (CCLL) is crucial to minimize nutritional complications. However, limited literature exists regarding the impact of CCLL on OAGB outcomes. This study aimed to assess the effect of CCLL on weight loss and nutritional status in patients who underwent OAGB. METHODS A prospective cohort study was conducted from August 2021 to July 2022, involving 64 patients with a body mass index of 40-50 kg/m2. The standardized length of the biliopancreatic limb (BPLL) for all patients in this study was set at 175 cm. Additionally, the measurement of the common channel limb length (CCLL) was performed consistently by the same surgeon for all included patients. RESULTS The mean age and BMI of the patients were 39.91 ± 10.03 years and 43.13 ± 2.43 kg/m2, respectively, at the time of surgery. There was a statistically significant negative correlation between CCLL and percent total weight loss (%TWL) at the 12-month mark after OAGB (P = 0.02). Hypoalbuminemia was observed in one patient (1.6%), while anemia was present in 17 patients (26.6%) at the one-year follow-up. Statistical analysis revealed no significant difference in the incidence of anemia and hypoalbuminemia between patients with CCLL < 4 m and those with CCLL ≥ 4 m. CONCLUSION A CCLL of 4 m does not appear to completely prevent nutritional complications following OAGB. However, maintaining a CCLL of at least 4 m may be associated with a reduced risk of postoperative nutritional deficiencies.
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Affiliation(s)
- Elyas Mostafapour
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Shahsavan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahab Shahabi Shahmiri
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat-E Fatemeh Hospital, School of Medicine, 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.
| | - Noura Jawhar
- Department of Surgery, Mayo Clinic, Rochester, MN, 55902, USA
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, MN, 55902, USA
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Hazrat-E Fatemeh Hospital, School of Medicine, 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.
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Jaliliyan A, Madankan A, Mosavari H, Khalili P, Pouraskari B, Lotfi S, Honarfar A, Fakhri E, Eghbali F. The Impact of Metabolic and Bariatric Surgery on Apo B100 Levels in Individuals with high BMI: A Multi-Centric Prospective Cohort Study. Obes Surg 2024:10.1007/s11695-024-07258-6. [PMID: 38744799 DOI: 10.1007/s11695-024-07258-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Metabolic and Bariatric surgery (MBS) leads to significant weight loss and improvements in obesity-related comorbidities. However, the impact of MBS on Apolipoprotein B100 (Apo-B100) regulation is unclear. Apo-B100 is essential for the assembly and secretion of serum lipoprotein particles. Elevated levels of these factors can accelerate the development of atherosclerotic plaques in blood vessels. This study aimed to evaluate changes in Apo-B100 levels following MBS. METHODS 121 participants from the Iranian National Obesity and Metabolic Surgery Database (INOSD) underwent Laparoscopic Sleeve Gastrectomy (LSG) (n = 43), One-Anastomosis Gastric Bypass (OAGB) (n = 70) or Roux-en-Y Gastric Bypass (RYGB) (n = 8). Serum Apo-B100, lipid profiles, liver enzymes, and fasting glucose were measured preoperatively and six months postoperatively. RESULTS Apo-B100 levels significantly decreased from 94.63 ± 14.35 mg/dL preoperatively to 62.97 ± 19.97 mg/dL after six months (p < 0.01), alongside reductions in total cholesterol, triglycerides, LDL, VLDL, AST, and ALT (p < 0.05). Greater Apo-B100 reductions occurred in non-diabetics versus people with diabetes (p = 0.012) and strongly correlated with baseline Apo-B100 (r = 0.455, p < 0.01) and LDL levels (r = 0.413, p < 0.01). However, surgery type did not impact Apo-B100 changes in multivariate analysis (p > 0.05). CONCLUSION Bariatric surgery leads to a significant reduction in Apo-B100 levels and improvements in lipid profiles and liver enzymes, indicating a positive impact on dyslipidemia and cardiovascular risk in individuals with high BMI.
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Affiliation(s)
- Ali Jaliliyan
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Madankan
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Mosavari
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Pantea Khalili
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Bahador Pouraskari
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Lotfi
- Department of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Andia Honarfar
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Fakhri
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Foolad Eghbali
- Department of Surgery, Surgery Research Center, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, School of Medicine, Rasool-E Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Kitaghenda FK, Hidig SM. Improvement in Pulmonary Hypertension Following Metabolic and Bariatric Surgery: a Brief Review and Meta-analysis. Obes Surg 2024; 34:1866-1873. [PMID: 38478193 DOI: 10.1007/s11695-024-07162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
We reviewed the available evidence on the outcome of metabolic and bariatric surgery (MBS) in patients with pulmonary hypertension (PH). Five studies examining 174 patients were included; the mean age was 54.5 ± 9.27 years; the mean BMI before surgery and at the end of follow-up were 47.2 ± 5.95 kg/m2 and 37.4 ± 2.51 kg/m2, respectively. Furthermore, the results showed a significant decrease in the right ventricle systolic pressure (RVSP) after MBS with a mean difference of 10.11% (CI 95%: 3.52, 16.70, I2 = 85.37%, p = < 0.001), at 16.5 ± 3.8 month follow-up with a morbidity rate of 26% and 0 mortality. Thirty-day postoperative complications included respiratory failure, pulmonary embolism, pulmonary edema, and anastomotic leak. There appears to be a significant improvement in PH with a decrease in medication requirements after MBS.
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Affiliation(s)
- Fidele Kakule Kitaghenda
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221002, People's Republic of China.
| | - Sakarie Mustafe Hidig
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang Province, 322000, People's Republic of China
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Hany M, Zidan A, Aboelsoud MR, Torensma B. Laparoscopic sleeve gastrectomy vs one-anastomosis gastric bypass 5-year follow-up: a single-blinded randomized controlled trial. J Gastrointest Surg 2024; 28:621-633. [PMID: 38704199 DOI: 10.1016/j.gassur.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/15/2024] [Accepted: 01/27/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most performed bariatric procedure worldwide, whereas one-anastomosis gastric bypass (OAGB) is the third most performed procedure. Both procedures have reported good weight loss (WL) and low complications. However, should both have differences in the durability of WL and malnutrition? METHODS A single-blinded, randomized controlled trial of 300 patients was conducted to compare the outcomes of LSG and OAGB over a 5-year follow-up. The primary endpoint was WL in percentages of total WL (%TWL) and excess WL (%EWL). The secondary endpoints were complications, gastroesophageal reflux disease (GERD), associated medical problems, bariatric analysis and reporting outcome system (BAROS) assessment, and weight recurrence (WR). RESULTS Overall, 201 patients (96 in the LSG group and 105 in the OAGB group) completed 5 years of follow-up. OAGB had significantly higher %TWL and %EWL than those of LSG throughout the follow-up. LSG had significantly higher WR and GERD. Both procedures had significant improvement in associated medical problems and BAROS scores compared with baseline, with no significant difference. WR was associated with higher relapse of associated medical conditions after initial remission and with lower BAROS scores regarding WL scores. CONCLUSION OAGB had significantly higher WL, less WR, and less GERD. However, it had a higher incidence of bile reflux. Both procedures had comparable complication rates, excellent remissions in associated medical problems, and improved quality of life. WR was associated with significantly more relapse of associated medical problems and significantly lower BAROS scores.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt; Madina Women Hospital, Alexandria, Egypt.
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Moustafa R Aboelsoud
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Bart Torensma
- Clinical Epidemioloigist, Leiden University Medical Center, Leiden, the Netherlands
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Abu-Abeid A, Yuval JB, Keidar A, Nizri E, Lahat G, Eldar SM. Technical Considerations in One Anastomosis Gastric Bypass-the Israeli Society of Metabolic and Bariatric Surgery Experience. Obes Surg 2024:10.1007/s11695-024-07223-3. [PMID: 38649670 DOI: 10.1007/s11695-024-07223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/30/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is gaining popularity worldwide due to its safety and effectiveness. OAGB is the most commonly performed metabolic bariatric surgery (MBS) in Israel. Israel is the only country where OAGB is the most prevalent MBS. Our aim is to address OAGB technical aspects using a national survey completed by members of the Israeli Society of Metabolic and Bariatric Surgery (ISMBS). MATERIALS AND METHODS An online-survey composed of a 17-item-based questionnaire was sent to ISMBS members. All responses were collected and analyzed. RESULTS A total of 47/64 (73.4%) ISMBS members participated in the survey. Most surgeons (74.5%) had > 10 years of MBS experience, and most (61.7%) performed > 100 MBS/year. The majority (78.7%) perform OAGB as their most common procedure. Most surgeons fashion a 10-15-cm pouch and use a 36-Fr bougie, (57.4% and 38.3%). Regarding bowel length measurement, 70% use visual estimation and 10.6% routinely measure total small bowel length (TSBL). The most common reasons for creating a longer biliopancreatic limb (BPL) were high body mass index (BMI) and revisional surgery (83.3% and 66%, respectively). In a primary procedure of a patient with a BMI = 40, most (76.6%) would create a 150-200-cm BPL. In patients with a BMI > 50 or revisional cases, most (70.2% and 68.0%) would create a 175-225-cm BPL. CONCLUSION OAGB is the most prevalent MBS performed in Israel. This survey showed common preferences and variations among ISMBS members. Further studies are needed in order to standardize and build a consensus on OAGB technique.
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Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.
| | - Jonathan Benjamin Yuval
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Andrei Keidar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Eran Nizri
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Shai Meron Eldar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
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Hailstone L, Tovmassian D, Nguyen CL, Wong P, Le Page PA, Martin D, Taylor C. Medium-Term Outcomes from a Series of 1000 One Anastomosis Gastric Bypass in Australia: A Case Series. Obes Surg 2024:10.1007/s11695-024-07213-5. [PMID: 38609707 DOI: 10.1007/s11695-024-07213-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE This study presents the short- (less than 6 months) and medium-term (6 months to 2 years) outcomes for weight loss and type 2 diabetes mellitus (T2DM) for all patients undergoing one anastomosis gastric bypass (OAGB) across multiple institutions between 2015 and 2021. MATERIALS AND METHODS A retrospective analysis of prospectively collected databases was performed including 1022 participants who underwent OAGB at multiple institutions by multiple surgeons between 2015 and 2021. Primary outcome was percentage total weight loss (TWL) and secondary outcomes were achieving resolution of T2DM; OAGB specific short- and medium-term complications including bile reflux, marginal ulceration and internal herniation. RESULTS One thousand and twenty-two patients underwent OAGB (81% primary surgery). A percentage of 34.1% (n = 349) had a preoperative diagnosis of type 2 diabetes mellitus (T2DM). Mean TWL was 33.6 ± 9% with a T2DM remission rate of 74% at 1-year post-op. Rates of bile reflux and marginal ulceration was 1.1% (n = 11) and 1.1% (n = 11). There were no cases of internal herniation during the follow-up period. CONCLUSION OAGB results has echoed previously published work as being efficacious and safe in a short-medium term. The prevalence of complications, especially bile reflux is overall low in our population and no current evidence exists to support an increased risk of metaplasia or malignancy related to bile within the stomach.
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Affiliation(s)
- Laura Hailstone
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - David Tovmassian
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia.
- University of Sydney, Sydney, NSW, Australia.
| | - Chu Luan Nguyen
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Pearl Wong
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | | | - David Martin
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Craig Taylor
- Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia
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Kabir A, Izadi S, Mashayekhi F, Shokraee K, Rimaz S, Ansar H, Farsi F, Pazouki A. Effect of different bariatric surgery methods on metabolic syndrome in patients with severe obesity. Updates Surg 2024; 76:547-554. [PMID: 38051454 DOI: 10.1007/s13304-023-01699-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
Bariatric surgery (BS) has been as a currently developed treatment of choice for metabolic syndrome (MetS). Which, in turn, is well-known as serious public health concern. Therefore, this study assessed the outcomes of different procedures of BS and possible predictors for improving MetS. This single-center retrospective cohort analysis included bariatric candidates between 2009 and 2017. The operational approach was chosen based on the patient's condition, as well as the patient's metabolic profile and the surgeon's experience. All desired information was evaluated at baseline and 6, 12, and 24 months after the operation. Of the 1111 patients included, 918 (82.6%) were female. There was no considerable trend in the improvement of MetS over the follow-up period of each surgery group. After 6 to 24 months of follow-up, waist circumference reduction was significant in all three types of surgery, and sleeve gastrectomy resulted in the best (but not significant) improvement rates after 24 months (P = 0.079). One anastomosis gastric bypass had highest decrease in percentage of excess weight loss than other procedures (P < 0.001). Each year increase in age was associated with a 4% decrease in MetS remission. In addition, the male gender, was correlated with MetS improvement positively (P = 0.049). Each one-unit increase in hemoglobin A1c (HbA1c) reduced the MetS remission rate by 40%. All three methods of BS were similarly effective in MetS. Consider the predictive value of age, gender, and HbA1c before determining the optimum procedure for each patient is recommended.
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Affiliation(s)
- Ali Kabir
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran.
| | - Simin Izadi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Mashayekhi
- Rasoul Akram Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Kamyar Shokraee
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran
| | - Shahnaz Rimaz
- Department of Epidemiology, School of Public Health, Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hastimansooreh Ansar
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnaz Farsi
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Center, Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Masouri St. Niyayesh St. Satarkhan Ave, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-E Rasool Hospital, Tehran, Iran
- Iran National Center of Excellence for Minimally Invasive Surgery Education, Iran University of Medical Sciences, Tehran, Iran
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Kermansaravi M, Shahsavan M, Ebrahimi R, Mousavimaleki A, Gholizadeh B, Valizadeh R, ShahabiShahmiri S, Carbajo MA. Effect of anti-reflux suture on gastroesophageal reflux symptoms after one anastomosis gastric bypass: a randomized controlled trial. Surg Endosc 2024:10.1007/s00464-024-10792-0. [PMID: 38499781 DOI: 10.1007/s00464-024-10792-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Gastroesophageal reflux disease (GERD) is an issue after one anastomosis gastric bypass (OAGB) and modification of OAGB with adding an anti-reflux system may decrease the incidence of postoperative GERD. This study aimed to compare the efficacy of the anti-reflux mechanism to treat preoperative GERD and prevent de novo GERD. METHODS A prospective randomized clinical trial study was conducted on patients with a body mass index of 40 and more from August 2020 to February 2022. Patients undergoing one anastomosis gastric bypass with and without anti-reflux sutures (groups A and B, respectively). These patients had follow-ups for one year after the surgery. GERD symptoms were assessed in all the patients using the GERD symptom questionnaire. RESULTS The mean age was 39.5 ± 9.8 years and 40.7 ± 10.2 years in groups A and B respectively. GERD symptoms remission occurred in 76.5% and 68.4% of patients in groups A and B, respectively. The incidence of de novo GERD symptoms was lower in group A, compared to group B (6.2% and 16.1% in groups A and B respectively), without any statistically significant difference (p-value: 0.239). CONCLUSION GERD symptoms and de novo GERD after OAGB seems to be under-reported after OAGB. This study suggests that applying an anti-reflux suture can decrease de novo GERD symptoms.
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Affiliation(s)
- Mohammad Kermansaravi
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Surgery Research Center, School of Medicine, Hazrat-E Fatemeh 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.
| | - Masoumeh Shahsavan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Ebrahimi
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Surgery Research Center, School of Medicine, Hazrat-E Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Mousavimaleki
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Surgery Research Center, School of Medicine, Hazrat-E Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Barmak Gholizadeh
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Surgery Research Center, School of Medicine, Hazrat-E Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Shahab ShahabiShahmiri
- Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Surgery Research Center, School of Medicine, Hazrat-E Fatemeh 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
| | - Miguel A Carbajo
- Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain
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9
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Qin X, Lee WJ, Mao Z, Zhang M, Wu G, Zhu T. Transumbilical Stapling Technic of OAGB. Obes Surg 2024; 34:1049-1051. [PMID: 38285302 DOI: 10.1007/s11695-023-06901-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 01/30/2024]
Abstract
Single-port or single-incision laparoscopic surgery (SILS) is esteemed for its efficacy in achieving superior postoperative cosmetic outcomes compared to the conventional laparoscopic approach (Behnia-Willison et al. in Aust N Z J Obstet Gynaecol 52:366-370, 2012; Rogula et al. in Obes Surg 24:1102-1108, 2014; Pitot et al. in Surg Endosc 28:3007-3011, 2014). The introduction of SILS for bariatric procedures can be attributed to the pioneering work of Saber in 2008, who initially applied this technique to laparoscopic sleeve gastrectomy (SG), followed by its utilization in laparoscopic adjustable gastric banding (AGB) (Saber et al. in Obes Surg 18:1338-1342, 2008;Nguyen et al. in Obes Surg 18:1628-1631, 2008). The inaugural application of SILS in Roux-en-Y gastric bypass (RYGB) was documented in 2009, employing a plastic reconstruction methodology. Acknowledging the intricate nature of complex bariatric interventions, we previously detailed a modified SILS approach termed the transumbilical two-site (TUTS) technique for RYGB, which was established as a standard procedure in 2010 (Lee et al. in Surg Obes Relat Dis. 8:208-13, 2012). At that juncture, a solitary article surfaced in 2010 elucidating the dimensions of the small gastric pouch as a mere 8-9 cm, falling short of contemporary surgical requisites for optimal outcomes in one anastomosis gastric bypass (OAGB) (Tacchino et al. in Obes Surg 20:1154-1160, 2010). Notably, the TUTS technique, which was successfully implemented for RYGB, had hitherto not been extended to OAGB due to the complexities associated with creating a slender gastric tube spanning 25 cm. In a pioneering development this year, we have devised a novel strategy to surmount this challenge. The present study is designed to expound upon the transumbilical stapling technique tailored to the unique demands of OAGB.
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Affiliation(s)
- Xiaoguang Qin
- Department of Metabolic/Bariatric Medical Center, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei-Jei Lee
- Department of Metabolic/Bariatric Medical Center, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China.
- Medical Weight Loss Center, China Medical University Hsinchu Hospital, Taiwan, China.
| | - Zhongqi Mao
- Department of Metabolic/Bariatric Medical Center, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Min Zhang
- Department of Metabolic/Bariatric Medical Center, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guoqiang Wu
- Department of Metabolic/Bariatric Medical Center, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China
- Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tian Zhu
- Department of Metabolic/Bariatric Medical Center, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu Province, China
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10
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Liagre A, Martini F, Debs T, Barone SC, Petrucciani N. Roux en Y gastric bypass and iterative intussusception at the jejuno-jejunal anastomosis: Conversion into one anastomosis gastric bypass (with video) - A case report. Int J Surg Case Rep 2024; 115:109244. [PMID: 38215577 PMCID: PMC10821620 DOI: 10.1016/j.ijscr.2024.109244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION The aim of this article is to describe a rare complication of Roux en Y gastric bypass (RYGB): recurrent intestinal intussusception of the biliary limb, and an original treatment: the removal of the jejuno-jejunal anastomosis with conversion into "short limb" one anastomosis gastric bypass (OAGB). PRESENTATION OF CASE A 25-year-old patient underwent RYGB fashioned with a 50 cm-length biliary loop and a 150 cm-length alimentary loop. She was hospitalized other 3 times in the following months for episodes of acute abdominal pain and excessive weight loss, with CT scans showing intussusception at the jejuno-jejunal anastomosis. Conversion from RYGB to OAGB with "short biliary limb" was performed. The patient at 60-month follow-up has no bile reflux and regained weight. DISCUSSION Small bowel intussusception is a rare complication that can occur following Roux-en-Y gastric bypass (RYGB) surgery, leading to symptoms like acute or chronic abdominal pain. Treatment options reported in medical literature include resection and re-fashioning of the jejuno-jejunal anastomosis, simple reduction (with a risk of recurrence), and imbrication/plication of the jejuno-jejunal anastomosis. Given the rarity of this complication, there are no standardized recommendations, and the best treatment should be determined on a case-by-case basis, taking into consideration the patient's unique circumstances and the medical team's expertise. CONCLUSION Intestinal intussusception at the jejuno-jejunal anastomosis responsible for chronic abdominal pain is a rare complication after RYGB. One of the possible treatments is conversion into OAGB.
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Affiliation(s)
- Arnaud Liagre
- Clinique Des Cedres, Bariatric Surgery Unit, Ramsay Générale de Santé, Cornebarrieu, France
| | - Francesco Martini
- Clinique Des Cedres, Bariatric Surgery Unit, Ramsay Générale de Santé, Cornebarrieu, France
| | - Tarek Debs
- Institut Arnault Tzanck, 116 Rue du Commandant Gaston Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Sara Claudia Barone
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - 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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11
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Madani S, Shahsavan M, Pazouki A, Setarehdan SA, Yarigholi F, Eghbali F, Shahmiri SS, Kermansaravi M. Five-Year BAROS Score Outcomes for Roux-en-Y Gastric Bypass, One Anastomosis Gastric Bypass, and Sleeve Gastrectomy: a Comparative Study. Obes Surg 2024; 34:487-493. [PMID: 38147191 DOI: 10.1007/s11695-023-07015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
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.
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Affiliation(s)
- Saeed Madani
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Surgery, Qom University of Medical Sciences, Qom, Iran
| | - Masoumeh Shahsavan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Abdolreza Pazouki
- 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, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran
| | - Seyed Amin Setarehdan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Yarigholi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Foolad Eghbali
- 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, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran
| | - Shahab Shahabi Shahmiri
- 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, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran
| | - 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, Tehran, Iran.
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat-e Rasool Hospital, Tehran, Iran.
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12
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Dayan D, Abu-Abeid A. Huge Diaphragmatic Hernia Following Revisional One Anastomosis Gastric Bypass. Obes Surg 2024; 34:704-705. [PMID: 38151556 DOI: 10.1007/s11695-023-07029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Danit Dayan
- Division of General Surgery, Bariatric Unit, Tel Aviv Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St, 6423906, Tel Aviv, Israel.
| | - Adam Abu-Abeid
- Division of General Surgery, Bariatric Unit, Tel Aviv Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St, 6423906, Tel Aviv, Israel
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13
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Cornejo J, Evans LA, Castillo-Larios R, Celik NB, Elli EF. One anastomosis gastric bypass as a primary bariatric surgery: MBSAQIP database analysis of short-term safety and outcomes. Surg Endosc 2024; 38:270-279. [PMID: 37989890 DOI: 10.1007/s00464-023-10535-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) is described as a simpler, potentially safe, and effective bariatric-metabolic procedure that has been recently endorsed by the American Society of Metabolic and Bariatric Surgery. OBJECTIVES First, we aim to compare the 30-day outcomes between OAGB and other bypass procedures: Roux-en-Y gastric bypass (RYGB) and single anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S). Second, identify the odds between postoperative complications and each surgical procedure. METHODS Patients who underwent primary OAGB, RYGB, and SADI-S were identified using the MBSAQIP database of 2020 and 2021. An analysis of patient demographics and 30-day outcomes were compared between these three bypass procedures. In addition, a multilogistic regression for overall complications, blood transfusions, unplanned ICU admissions, readmission, reoperation, and anastomotic leak stratified by surgical procedure was performed. RESULTS 1607 primary OAGBs were reported between 2020 and 2021. In terms of patient demographics, patients who underwent RYGB and SADI-S showed a higher incidence of comorbidities. On the other hand, OAGB had shorter length of stay (1.39 ± 1.10 days vs 1.62 ± 1.42 days and 1.90 ± 2.04 days) and operative times (98.79 ± 52.76 min vs 125.91 ± 57.76 min and 139.85 ± 59.20 min) than RYGB and SADI-S. Similarly, OAGB showed lower rates of overall complications (1.9% vs 4.5% and 6.4%), blood transfusions (0.4% vs 1.1% and 1.8%), unplanned ICU admission (0.3% vs 0.8% and 1.4%), readmission (2.4% vs 4.9% and 5.0%), and reoperation (1.2% vs 1.9% and 3.1%). A multilogistic regression analysis was performed, RYGB and SADI-S demonstrated higher odds of 30-day complications. CONCLUSION The incidence of primary OAGB has increased since its approval by ASMBS, from 0.05% reported between 2015 and 2019 to 0.78% between 2020 and 2021. OAGB had better 30-day outcomes and shorter operative times than RYGB and SADI-S and therefore, could be considered a viable alternative.
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Affiliation(s)
- Jorge Cornejo
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Lorna A Evans
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Rocio Castillo-Larios
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Nafiye Busra Celik
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Enrique F Elli
- Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Abu-Zeid EED, Atias S, Netz U, Golani G, Avital I, Perry ZH. Gender Comparisons of Surgical Outcomes in Patients Undergoing One Anastomosis Gastric Bypass (OAGB): a Historical Cohort Study. Obes Surg 2024; 34:98-105. [PMID: 38010452 DOI: 10.1007/s11695-023-06954-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION AND PURPOSE Clinical trials in the field of bariatrics have frequently been gender imbalanced, with males representing only 20% of examinees. Long-term gender-oriented results in one anastomosis gastric bypass (OAGB), and specifically quality of life (QOL) parameters, have not been addressed sufficiently. A better understanding of gender's effect on OAGB outcomes can play an important role in selecting the appropriate bariatric surgery for patients. Our study was aimed at examining mid-term gender-associated outcome of OAGB, including the effect on QOL. MATERIALS AND METHODS A retrospective cohort study of patients who underwent OAGB at surgical ward A, SUMC, Israel, between 2015 and 2020. Demographics, body mass index (BMI), and comorbidities were extracted from the national medical records system. Follow-up quality of life (QOL) and weight parameters were supplemented via telephone questionnaires, using the Bariatric Analysis and Reporting Outcome System (BAROS). RESULTS A total of 152 patients were included; of these, 51 (33.6%) were males, with an average follow-up period of 4.1 (± 1.3) years post-surgery. Basic demographics showed no significant pre- or post-surgery differences between males and females, except for pre-op weight (which as expected was higher for males). Males had a higher overall BAROS score than females (3.8 ± 2.1 vs. 2.6 ± 2.1, p < 0.001). CONCLUSIONS OAGB surgery results in better outcomes for male than for female patients as measured by the BAROS, despite a similar BMI reduction, and with no difference in complications. Gender-specific outcomes are one of the variables that one should be aware of in optimizing patient selection and pre-operative patient counseling.
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Affiliation(s)
- Ez El Din Abu-Zeid
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shahar Atias
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Uri Netz
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Guy Golani
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itzhak Avital
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Norton Cancer Institute, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zvi H Perry
- Department of Surgery A, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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15
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Rossoni C, Bragança R, Santos Z, Viveiros O, Ribeiro R. OAGB Bowel Function in Patients With up to 5 Years Follow-Up: Updated Outcomes. Obes Surg 2024; 34:141-149. [PMID: 37946012 PMCID: PMC10781852 DOI: 10.1007/s11695-023-06917-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023]
Abstract
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.
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Affiliation(s)
- Carina Rossoni
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas, 2724-022, Amadora, Portugal.
- Institute of Environmental Health (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-026, Lisbon, Portugal.
- School of Sciences and Health Technologies, Nutrition Sciences, Universidade Lusófona de Humanidades e Tecnologias, 1749-024, Lisbon, Portugal.
| | - Rossela Bragança
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas, 2724-022, Amadora, Portugal
- Nutrition Service of the Centro Hospitalar Univesitário Lisboa Central, 1150-199, Lisbon, Portugal
| | - Zélia Santos
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas, 2724-022, Amadora, Portugal
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096, Lisbon, Portugal
| | - Octávio Viveiros
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas, 2724-022, Amadora, Portugal
- General Surgery Department at Hospital Lusíadas Amadora, 2724-022, Amadora, Portugal
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas Lisboa, 1500-458, Lisbon, Portugal
| | - Rui Ribeiro
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas, 2724-022, Amadora, Portugal
- General Surgery Department at Hospital Lusíadas Amadora, 2724-022, Amadora, Portugal
- Multidisciplinary Center for Obesity Treatment at Hospital Lusíadas Lisboa, 1500-458, Lisbon, Portugal
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Mokhber S, Sheidaei A, Ahmadkaraji S, Setarehdan SA, Abdolhosseini MR, Kabir A, Solaymani-Dodaran M, Pazoukia A. Weight Reduction Percentile Charts: 2-Year Follow-up Results of OAGB and RYGB Post Bariatric Surgery. Obes Surg 2023; 33:3944-3950. [PMID: 37917390 DOI: 10.1007/s11695-023-06899-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Using a single percentile chart provides us with high standards for the evaluation and accurate investigation of sufficient weight loss after bariatric surgery, counseling, and treating patients in an evidence-based way. Creating percentile charts of weight loss for gastric bypass is the aim of this study. MATERIALS AND METHODS This retrospective study was based on data from patients who underwent RYGB or OAGB from February 2008 to February 2020. The lambda-mu-sigma (LMS) method was used to estimate the reduction in body mass index (BMI) and six other metrics measured throughout post-operative follow-up. Percentile charts for various metrics have been presented for the first 2 years' post-surgery. We applied a bootstrap sampling method to evaluate percentile validity. RESULTS We recruited 2579 and 1943 patients who underwent OAGB (75% female) and RYGB (84% female) and were between the ages of 18 and 70 years. The preoperative BMI of patients in the OAGB group was higher than in the RYGB group. Concerning RYGB weight reduction results, the maximum percentage of excess weight loss (%EWL) occurs 18 months after surgery and is steady at 24 months. Far above 50%, EWL is achieved after 6 months. OAGB weight loss follows the same trend as RYGB; at 6 months, the %EWL values are slightly higher than RYGB. CONCLUSIONS We present the first bariatric weight loss percentile chart for OAGB. It allows evaluation of sufficient and insufficient weight loss at any post-operative point in a visual aspect. Furthermore, it predicts prospective outcomes and guides patient monitoring.
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Affiliation(s)
- Somayeh Mokhber
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri St., Niyayesh Ave., Sattarkhan St., Tehran, 1445613113, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina St., Ghods Ave., Keshavarz Bld., Tehran, 1417653761, Iran
| | - Shahrzad Ahmadkaraji
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri St., Niyayesh Ave., Sattarkhan St., Tehran, 1445613113, Iran
| | - Seyed Amin Setarehdan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri St., Niyayesh Ave., Sattarkhan St., Tehran, 1445613113, Iran
| | - Mohammad Reza Abdolhosseini
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri St., Niyayesh Ave., Sattarkhan St., Tehran, 1445613113, Iran
| | - Ali Kabir
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri St., Niyayesh Ave., Sattarkhan St., Tehran, 1445613113, Iran
| | - Masoud Solaymani-Dodaran
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri St., Niyayesh Ave., Sattarkhan St., Tehran, 1445613113, Iran.
| | - Abdolreza Pazoukia
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Rasoule-Akram Hospital, Mansouri St., Niyayesh Ave., Sattarkhan St., Tehran, 1445613113, Iran
- Center of Excellence for Minimally Invasive Surgery Training, Iran University of Medical Sciences, Tehran, Iran
- Center of Excellence of European Branch of International Federation for Surgery of Obesity, Tehran, Iran
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Demirel T. Mid-term Results of Laparoscopic Conversion of Gastric Bypass to Duodenal Switch for Weight Regain: the Review of the Literature and Single-Center Experience. Obes Surg 2023; 33:3889-3898. [PMID: 37864736 DOI: 10.1007/s11695-023-06885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Weight regain after Roux-en-Y gastric bypass (RYGB) is a nightmare for the patients and the surgeons and is mostly regarded as "irreversible." However, conversions to duodenal switch (DS) have been done previously with promising success. The current paper reports a single center's mid-to-long-term follow-up outcomes. METHODS The data from all patients undergoing a conversion of RYGB (and one anastomosis gastric bypass (OAGB)) to DS were reviewed retrospectively. The demographic, operative, and weight loss parameters were analyzed, including age, duration of surgery, weight loss, body mass index (BMI), and morbidity/mortality. RESULTS Seventeen patients were operated on between January 2013 and December 2021. The mean BMI was 45 kg/m2 (33-70) before conversion. The overall average %EWL was 74.4%, the least was 52% at 6 months, and the most was 91% at 24 and 36 months. All comorbidities resolved after conversion. One patient had a gastro-gastrostomy leak needing prompt surgical repair on the same day of diagnosis. Three patients had other complications: a duodenal stump leak, an intrabdominal abscess, and an ileus. All resolved without surgery. One sudden death happened on the 5th postoperative day. CONCLUSION Laparoscopic conversion of gastric bypass operations to DS is a complicated procedure that may have severe complications despite excessive patience and expertise but can be performed in a single step. The mid-to-long-term outcomes are promising for weight loss and control of associated co-morbidities.
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Affiliation(s)
- Tugrul Demirel
- Department of General Surgery, Trakya University School of Medicine, Edirne, 22030, Turkey.
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18
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Ding Z, Jin L, Song Y, Feng C, Shen P, Li H. Comparison of single-anastomosis gastric bypass and sleeve gastrectomy on type 2 diabetes mellitus remission for obese patients: A meta-analysis of randomized controlled trials. Asian J Surg 2023; 46:4152-4160. [PMID: 37002039 DOI: 10.1016/j.asjsur.2023.03.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
Currently, the increasing numbers of one anastomosis gastric bypass (OAGB) brought this technique in the third position in order of frequency, behind sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). However, OAGB is still considered lack of evidence in reducing obesity- related comorbidities. Our study aimed to compare the efficacy for SG and OAGB improving type 2 diabetes mellitus (T2DM) remission and weight loss in obese patients. PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized controlled trials (RCTs) comparing OAGB and SG. Review Manager 5.4.1 was used to analyze the data, and the right effect model was chosen based on heterogeneity. Five randomized controlled trials were included in the study. The remission of T2DM in the OAGB group was more efficient at 1 year and 5 years. Meanwhile, the OAGB group has a greater improvement than the SG group in terms of hypertension (HTN) and fasting plasma glucose (FPG). Although the percentage of excess BMI loss (%EBMIL) between the OAGB and SG groups was not significant at 6 months, the OAGB group had a conspicuous %EBMIL at 1 year. And 5 years after surgery, a higher percentage of excess weight loss (%EWL) was found in the OAGB group. Besides, the OAGB group showed a lower body mass index (BMI) at 5 years than the SG group, but the BMI at 6 months and 1 year were not significant. Finally, at 6 months, the OAGB group exhibited a more remarkable percentage of total weight loss (%TWL) than the SG group. In general, OAGB exhibited a better therapeutic effect in T2DM, HTN, and weight loss than SG in the medium-term follow-up period. To assess the long-term efficacy, clinics should be encouraged to continue longer-term follow-up studies and possibly RCTs.
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Affiliation(s)
- Zujun Ding
- Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Ling Jin
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China
| | - Yu Song
- Department of Translational Medicine Platform, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Chenglei Feng
- Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Pengfei Shen
- Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Hang Li
- Department of General Surgery, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
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19
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Salama AF, Baazaoui J, Shahid F, Singh R, Torres AJ, Bashah MM. Comparative analysis of 5-year efficacy and outcomes of single anastomosis procedures as revisional surgery for weight regain following sleeve gastrectomy. Surg Endosc 2023; 37:7548-7555. [PMID: 37432485 PMCID: PMC10520093 DOI: 10.1007/s00464-023-10234-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/18/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND It is imperative to assess the results of revisional procedures following Sleeve Gastrectomy (SG), given the substantially growing population of patients who experience weight regain within a few years after undergoing this procedure. OBJECTIVE Examine the comparative effectiveness of the Single Anastomosis Duodeno-Ileal Bypass (SADI-S) and the One Anastomosis Gastric Bypass (OAGB-MGB) as revisional procedures, with respect to their impact on weight loss, resolution of comorbidities, incidence of complications, and rates of reoperation in patients who had weight regain after SG with up to or more than 5 years of follow-up. SETTING Hamad General Hospital, Academic tertiary referral center, Qatar. METHODS This study retrospectively analyzed a database of patients who underwent the Single Anastomosis Duodeno-Ileal Switch (SADI-S) or the One Anastomosis Gastric Bypass - Mini Gastric Bypass- (OAGB-MGB) as revisional procedures for weight recidivism after a primary Laparoscopic Sleeve Gastrectomy (LSG). The follow-up period was at least 5 years, during which the impact of both procedures on weight loss, comorbidities, nutritional deficiencies, complications, and outcomes were compared. RESULTS The study comprised 91 patients, with 42 and 49 in the SADI-S and OAGB-MGB groups, respectively. Significant weight loss (measured by total weight loss percentage, TWL%) was observed at the 5-year follow-up for the SADI-S group compared to the OAGB-MGB group (30.0 ± 18.4 vs. 19.4 ± 16.3, p = 0.008). Remission of comorbidities, specifically diabetes mellitus and hypertension, was more prevalent in the SADI-S group. Notably, the OAGB-MGB group had a higher incidence of complications (28.6% vs. 21.42%) and reoperations (5 patients vs. 1 in the SADI-S group). No mortality events were reported in either group. CONCLUSION While both the OAGB-MGB and SADI-S have demonstrated efficacy as revisional procedures for weight regain following SG, the SADI-S exhibits superior outcomes compared to the OAGB-MGB with regard to weight loss, resolution of comorbidities, complication rates, and reoperation rates.
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Affiliation(s)
- Asaad F Salama
- Bariatric and Metabolic Surgery Department, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar.
| | - Jawher Baazaoui
- Bariatric and Metabolic Surgery Department, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Fakhar Shahid
- Bariatric and Metabolic Surgery Department, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Rajvir Singh
- Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Antonio J Torres
- Department of Surgery, Complutense University of Madrid, Hospital Clinico "San Carlos", Madrid, Spain
| | - Moataz M Bashah
- Bariatric and Metabolic Surgery Department, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar
- Department of Surgery, Weill Cornell Medical College, Doha, Qatar
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20
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Vitiello A, Iacovazzo C, Berardi G, Vargas M, Marra A, Buonanno P, Velotti N, Musella M. Propensity score matched analysis of postoperative nausea and pain after one anastomosis gastric bypass (MGB/OAGB) versus sleeve gastrectomy (SG). Updates Surg 2023; 75:1881-1886. [PMID: 37193850 PMCID: PMC10543143 DOI: 10.1007/s13304-023-01536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/10/2023] [Indexed: 05/18/2023]
Abstract
The aim of our study was to assess and compare postoperative nausea and pain after one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (LSG). Patients undergoing OAGB and LSG at our institution between November 2018 and November 2021 have been prospectively asked to report postoperative nausea and pain on a numeric analogic scale. Medical records were retrospectively reviewed to collect scores of these symptoms at the 6th and 12th postoperative hour. One-way analysis of variance (ANOVA) was used to evaluate effect of type of surgery on postoperative nausea and pain scores. To adjust for baseline differences between cohorts, a propensity score algorithm was used to match LSG patients to MGB/OAGB patients in a 1:1 ratio with a 0.1 tolerance. A total number of 228 (119 SGs and 109 OAGBs) subjects were included in our study. Nausea after OAGB was significantly less severe than after LSG both at the 6th and 12th hour assessment; pain was less strong after OAGB at the 6th hour but not after 12 h. Fifty-three individuals had a rescue administration of metoclopramide after LSG and 34 after OAGB (44.5% vs 31.2%, p = 0.04); additional painkillers were required by 41 patients after LSG and 23 after OAGB (34.5% vs 21.1%, p = 0.04). Early postoperative nausea was significantly less severe after OAGB, while pain was comparable especially at the 12th hour.
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Affiliation(s)
- Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Maria Vargas
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Annachiara Marra
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Pasquale Buonanno
- Department of Neurological, Reproductive and Odontostomatological Sciences, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
| | - Mario Musella
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”-Via S. Pansini 5, 80131 Naples, Italy
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21
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Dolores Frutos Bernal M. Bile reflux after bariatric surgery. Cir Esp 2023; 101 Suppl 4:S63-S68. [PMID: 37979939 DOI: 10.1016/j.cireng.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/12/2023] [Indexed: 11/20/2023]
Abstract
The growing epidemic of obesity and the increase in weight loss surgery has led to a resurgence of interest in biliary reflux because anatomical alterations may be refluxogenic. HIDA scan is the least invasive scan with good patient tolerability, sensitivity and reproducibility for the diagnosis of biliary reflux. Patients with more advanced oesophageal lesions have a higher degree of duodenal reflux. It has been shown in animal models and in vitro that there is more Barrett's and dysplasia with duodenal reflux. There are two cases of post-OAGB malignancy reported in 20 years, both without correlation with a biliary aetiology, so the carcinogenic risk probably remains theoretical. Prospective trials on OAGB should include endoscopy preoperatively and at 5-year intervals, to have data on the real effects of bile exposure on the gastric reservoir and oesophagus.
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Affiliation(s)
- M Dolores Frutos Bernal
- Cirugía Bariátrica y Laparoscópica, Departamento de Cirugía General, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
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22
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Yu J, Zhang H, Liu Q, Li H, Wu L, Qi T, Song Z, Huang H, He J, Ding Y. New Mouse Models of Roux-en Y Gastric Bypass and One Anastomosis Gastric Bypass for Type 2 Diabetes. Obes Surg 2023; 33:3163-3176. [PMID: 37635165 DOI: 10.1007/s11695-023-06768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Current bariatric surgery models primarily utilize mice with obesity, overlooking those with type 2 diabetes (T2DM). These models have limitations in replicating clinical procedures accurately and achieving broad applicability. This study aimed to develop novel mouse models of Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) surgeries specifically designed for T2DM research, utilizing simplified surgical techniques closely resembling clinical procedures. METHODS Eight-week-old C57/Bl6 mice, except for the Blank-Control group, were induced with T2DM by combining a high-fat diet and streptozotocin injection. RYGB involved creating a 10% gastric pouch, a 4-cm biliopancreatic limb (BL), and a 4-cm Roux limb (RL). Similarly, OAGB maintained a 10% gastric pouch and a 4-cm BL. To assess the efficacy of these models, we measured the body weight and fasting blood glucose (FBG) and conducted intraperitoneal glucose tolerance test (IPGTT), insulin tolerance test (ITT), and liver B-ultrasound, as well as a histopathological analysis of multiple organs 12 weeks post-operation. RESULTS The survival rates in the Blank-Control, T2DM-Sham, T2DM-RYGB, and T2DM-OAGB groups were 100% (6/6), 100% (6/6), 85.7% (6/7), and 100% (6/6), respectively. Both RYGB and OAGB surgeries similarly led to sustained weight loss, reduced the FBG levels, improved the IPGTT and ITT results, and alleviated the histopathological manifestations in multiple organs. CONCLUSION The innovative mouse models of RYGB and OAGB surgeries effectively improve T2DM. Both surgeries demonstrate comparable efficacy in ameliorating T2DM, even when utilizing a gastric pouch of the same size and the same length of BL in OAGB.
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Affiliation(s)
- Jinlong Yu
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, 510280, People's Republic of China.
| | - Hongbin Zhang
- Southern Medical University School of Laboratory Medicine and Biotechnology, Guangzhou, Guangdong Province, 510280, People's Republic of China.
- Department of Basic Medical Research, General Hospital of Southern Theater Command of PLA, Guangzhou, Guangdong Province, 510280, People's Republic of China.
| | - Qing Liu
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, 510280, People's Republic of China
| | - Heng Li
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510282, People's Republic of China
| | - Liangping Wu
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510282, People's Republic of China
| | - Tengfei Qi
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510282, People's Republic of China
| | - Zhigao Song
- Department of Cardiovascular Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, 510280, People's Republic of China
| | - Hongyan Huang
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510282, People's Republic of China
| | - Jipei He
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510282, People's Republic of China
| | - Yunfa Ding
- Surgical Center for Obesity and Diabetes, Jinshazhou Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, 510282, People's Republic of China
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23
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El Feghali E, Akel R, Chamaa B, Kazan D, Chakhtoura G. Surgical management of gallstone ileus after one anastomosis gastric bypass: A case report. World J Gastrointest Surg 2023; 15:2083-2088. [PMID: 37901746 PMCID: PMC10600774 DOI: 10.4240/wjgs.v15.i9.2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/27/2023] [Accepted: 07/25/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Gallstone ileus following one anastomosis gastric bypass (OAGB) is an exceptionally rare complication. The presented case report aims to highlight the unique occurrence of this condition and its surgical management. Understanding the clinical presentation, diagnostic challenges and successful surgical intervention in such cases is crucial for healthcare professionals involved in bariatric surgery. CASE SUMMARY We present a case report of gallstone ileus following OAGB and discuss its diagnosis and surgical management. A 66-year-old female with a history of OAGB presented to the emergency room with symptoms of small bowel obstruction. Computed tomography scan revealed a gallstone impacted in the distal ileum, causing obstruction. The patient underwent a laparoscopically assisted enterolithotomy, during which the gallstone was extracted and the enterotomy was closed. The patient had an uneventful recovery and was discharged on postoperative day four. CONCLUSION Gallstone ileus should be considered as a possible complication after OAGB, and prompt surgical intervention is usually required for its management. This case report contributes to the limited existing literature, providing insights into the management of this uncommon complication.
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Affiliation(s)
- Elie El Feghali
- Department of General Surgery, Saint Joseph University, Beirut 1107, Lebanon
| | - Rhea Akel
- Department of Radiology, Saint Joseph University, Beirut 1107, Lebanon
| | - Bilal Chamaa
- Department of General Surgery, Saint Joseph University, Beirut 1107, Lebanon
| | - Daniel Kazan
- Department of General Surgery, Saint Joseph University, Beirut 1107, Lebanon
| | - Ghassan Chakhtoura
- Department of General Surgery, Saint Joseph University, Beirut 1107, Lebanon
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24
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Martel-Vilchis A, Gallardo-Chavez V, León-Cabral P, Paz-Fernández A, Luna-Martinez E, Sierra-Salazar M. Massive enlargement of gastric pouch as a complication of gastrojejunal anastomotic stenosis following one anastomosis laparoscopic gastric bypass: A case report. Int J Surg Case Rep 2023; 110:108557. [PMID: 37633198 PMCID: PMC10509814 DOI: 10.1016/j.ijscr.2023.108557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/28/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE By 2030 it is predicted that 1 in 5 women and 1 in 7 men will be living with obesity. The only long-term effective strategy for achieving significant weight loss over time is surgical treatment. One Anastomosis Gastric Bypass (OAGB) has been proposed as an effective therapeutic option. Stenosis of Gastro-Jejunal Anastomosis (GJA) is one of the most common long-term complications and its cause recognized as multifactorial. CASE PRESENTATION We present the case of a patient with a history of progressive postoperative oral intolerance after OAGB with 60 kg weight loss (BMI 20.7 kg/m2). Severe stenosis of the GJA and massive dilation of the gastric remnant was documented, treated multiple times with endoscopic balloon dilation. He was referred to our unit due to persistent symptoms. Revision surgery to a Gastric Bypass was programmed, ultimately performed via an open approach with resection of 80 % of the gastric remnant. CLINICAL DISCUSSION Endoscopic dilatation and surgical revision are the two primary treatment options for GJA stricture. In refractory cases to pneumatic dilation, laparoscopic revision surgery is indicated, however an open approach is frequently required, as surgeries are technically demanding due to distorted anatomy in this population. CONCLUSION Operations to correct chronic complications are tailored to the patient's anatomy as well as the symptoms or pathologies they are intended to correct. Whilst revision surgeries are associated with an increased risk of conversion, complications and longer hospital stay, they can be performed safely in experienced centers.
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Affiliation(s)
- A Martel-Vilchis
- Bariatric Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Tlalpan, CDMX, Mexico
| | - V Gallardo-Chavez
- Bariatric Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Tlalpan, CDMX, Mexico
| | - P León-Cabral
- Bariatric Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Tlalpan, CDMX, Mexico
| | - A Paz-Fernández
- Bariatric Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Tlalpan, CDMX, Mexico
| | - E Luna-Martinez
- Bariatric Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Tlalpan, CDMX, Mexico
| | - M Sierra-Salazar
- Bariatric Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Tlalpan, CDMX, Mexico.
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25
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Yarigholi F, Shahsavan M, Salman A, Pazouki A, Mazaherinezhad A, Kermansaravi M. Safety and Efficacy of One Anastomosis Gastric Bypass in Children and Adolescents: a 5-Year Cohort Study. Obes Surg 2023; 33:2632-2639. [PMID: 37470954 DOI: 10.1007/s11695-023-06749-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Childhood obesity is an important worldwide issue of serious medical and social concern. One anastomosis gastric bypass (OAGB) is an approved, effective, and long-lasting procedure for weight loss and the remission of obesity-associated medical problems in the adult patients, but its efficacy and safety in children and adolescents are still on debate. This study aimed to evaluate safety and efficacy of OAGB compare to SG and RYGB during a 5-year follow-up. METHODS A retrospective cohort study on children and adolescents with severe obesity who underwent primary OAGB, sleeve gastrectomy (SG), and Roux-e-Y gastric bypass (RYGB) at an academic hospital, between March 2016 and December 2020. RESULTS Two hundred twenty-eight patients with 24 to 60 months of follow-up including 107 SG, 37 RYGB, and 84 OAGB were included in the final analysis. The mean age, preoperative weight, and BMI were 15.71 ± 2.09 years (range, 9-18 years), 126.3 ± 22.0 kg (74.5-215 kg), and 45.1 ± 6.9 kg/ m2 (36.4-79.3 kg/m2), respectively. The mean of follow-up was 30.05 ± 19.98 months. The mean of ∆BMI was 30.2 ± 5.1, 30.0 ± 5.4, and 31.1 ± 6.8 at 12th, 36th, and 60th months postoperative. At the 60-month follow-up, there were statistically significant differences in ΔBMI between SG and OAGB and SG and RYGB. CONCLUSION OAGB is a safe and effective procedure for the treatment of obesity in children and adolescents in 24 to 60 months follow-ups.
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Affiliation(s)
- Fahime Yarigholi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Shahsavan
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Ali Salman
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abdolreza Pazouki
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, School of Medicine, 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
| | - Ali Mazaherinezhad
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kermansaravi
- Department of Surgery, Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Rasool-E Akram Hospital, School of Medicine, 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.
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26
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Dayan D, Kanani F, Bendayan A, Nizri E, Lahat G, Abu-Abeid A. The Effect of Revisional One Anastomosis Gastric Bypass After Sleeve Gastrectomy on Gastroesophageal Reflux Disease, Compared with Revisional Roux-en-Y Gastric Bypass: Symptoms and Quality of Life Outcomes. Obes Surg 2023; 33:2125-2131. [PMID: 37166738 DOI: 10.1007/s11695-023-06636-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is common after sleeve gastrectomy (SG). We aimed to evaluate the effect of revisional one anastomosis gastric bypass (OAGB) on GERD, compared with revisional Roux-en-Y gastric bypass (RYGB) METHODS: A retrospective single-center study of a prospectively maintained patient registry (2018-2022). All patients with GERD undergoing OAGB and RYGB after SG were retrieved and included in the study. RESULTS Seventy-eight SG patients had conversion to OAGB (n=31) and RYGB (n=47). Baseline characteristics were similar except age (43.8±11.5 vs. 50.3±13.4 years; p=0.03), body mass index (39.9±8.8 vs. 30.6±6 kg/m2; p<0.001), time interval (8±2.7 vs. 6.4±3.4 years; p=0.01), and sleep apnea (29% vs 8.5%; p=0.01), respectively. There was no significant difference between groups in number of patients consuming proton pump inhibitors (70.1% vs. 72.3%; p=0.66), GERD-health-related quality of life (HRQL) score (9.6±7.2 vs. 13.1±8; p=0.06), and pathological endoscopic findings (48.4% vs. 46.8%; p=0.89). Major complication rates were 0% vs. 8.5% (p=0.09). At 32.4 months follow-up, total weight loss was 22%±12.9 and 4.4%±14.6 (p<0.001), GERD resolution 77.4% and 91.9% (p=0.03), HRQL scoring improved to 1.7±4.5 and 1.7±2.7; p=0.94 for OAGB and RYGB, respectively. CONCLUSIONS SG conversion to RYGB provides better chances for definitive treatment of GERD. OAGB results in good symptom resolution and improved quality of life and may be considered for post-SG GERD treatment. The most appropriate solution should be individualized to each patient.
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Affiliation(s)
- Danit Dayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fahim Kanani
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Bendayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Nizri
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 64230906, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Balamurugan G, Leo SJ, Sivagnanam ST, Balaji Prasad S, Ravindra C, Rengan V, Arora E, Bindal V. Comparison of Efficacy and Safety Between Roux-en-Y Gastric Bypass (RYGB) vs One Anastomosis Gastric Bypass (OAGB) vs Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): a Systematic Review of Bariatric and Metabolic Surgery. Obes Surg 2023; 33:2194-2209. [PMID: 37140720 DOI: 10.1007/s11695-023-06602-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023]
Abstract
In recent years, combined restrictive and hypo-absorptive procedures have gained widespread acceptance. The rationale of this systematic review is to compare the safety and efficacy between Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB) and single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S). Eighteen eligible studies were finalized for this review. Weight loss outcomes were greater with SADI-S (5 years) and OAGB (10 years). SADI-S offered better resolution of diabetes whereas hypertension and dyslipidaemia resolution were better with OAGB. Although early complications and mortality were higher with SADI-S, late complications were more frequent with RYGB. Both SADI-S and OAGB are as effective as RYGB for weight loss, but OAGB offers lesser complications. However, more data is imperative to determine the next gold standard procedure.
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Affiliation(s)
- G Balamurugan
- Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India, 400008.
| | - Sagaya Joel Leo
- Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
| | | | | | | | | | - Eham Arora
- Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India
| | - Vivek Bindal
- Max Super Speciality Hospital, Vaishali, India, 201012
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28
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Bhatia M, Vijayan S, Azir E, El-Hasanii S. Technical Tips Following 850 Consecutive One Anastomosis Gastric Bypass (OAGB) Patients. JSLS 2023; 27:e2023.00024. [PMID: 37663432 PMCID: PMC10473180 DOI: 10.4293/jsls.2023.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Background The surgical procedure One Anastomosis Gastric Bypass (OAGB) has become widely used worldwide. Since its inception, many modifications have been introduced to improve results. Objectives The primary aim of this study was to share the modifications that we have introduced to our OAGB technique after reflecting on the problems and complications we have faced during the evolution of this procedure in our unit. Method A total of 850 patients who underwent OAGB under the same surgical team at two different hospitals in the United Kingdom were displayed according to demography and comorbidities. All complications were reviewed and analysed to instigate the changes in our technique. Results There were 756 (89%) primary and 94 (11%) revisional procedures. There were 596 females (70.11%) and 254 males (29.89%) in our study group. The body mass index range was 32-84 and the mean was 45. The pre-operative weight range was 89-274 kg and the mean was 126.4 kg. Conclusions With experience and reflecting on our complications we have modified our surgical approach, and these alterations have helped us to adopt OAGB as the mainstream bariatric procedure. We want to share our experience with the bariatric community for the benefit of patient care.
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Affiliation(s)
- Mohit Bhatia
- Department of Upper GI & Bariatric Surgery, Princess Royal University Hospital Orpington, Kent, United Kingdom. (all authors)
| | - Sharmila Vijayan
- Department of Upper GI & Bariatric Surgery, Princess Royal University Hospital Orpington, Kent, United Kingdom. (all authors)
| | - Elia Azir
- Department of Upper GI & Bariatric Surgery, Princess Royal University Hospital Orpington, Kent, United Kingdom. (all authors)
| | - Shamsi El-Hasanii
- Department of Upper GI & Bariatric Surgery, Princess Royal University Hospital Orpington, Kent, United Kingdom. (all authors)
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Pivo S, Jenkins M, Fielding CR, Kim M, Schwack B. One Anastomosis Gastric Bypass for Revisional Bariatric Surgery: Assessment of Short-Term Safety. Obes Surg 2023; 33:2108-2114. [PMID: 37191735 DOI: 10.1007/s11695-023-06608-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
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.
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Affiliation(s)
- Sarah Pivo
- Department of Minimally Invasive Surgery, Cedars Sinai Medical Center, 8635 W 3rd st Suite 601, Los Angeles, CA, 90048, USA.
| | - Megan Jenkins
- Department of Surgery, NYU Langone Health, New York, NY, 10016, USA
| | | | - Mirhee Kim
- Department of Surgery, NYU Langone Health, New York, NY, 10016, USA
| | - Bradley Schwack
- Department of Surgery, NYU Langone Health, New York, NY, 10016, USA
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Dayan D, Bendayan A, Nevo N, Nizri E, Lahat G, Abu-Abeid A. Comparison of One Anastomosis Gastric Bypass and Sleeve Gastrectomy for Revision of Laparoscopic Adjustable Gastric Banding: 5-Year Outcomes. Obes Surg 2023:10.1007/s11695-023-06588-1. [PMID: 37046172 DOI: 10.1007/s11695-023-06588-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Laparoscopic adjustable gastric banding (LAGB) is in continuous decline due to low effectiveness and high reoperation rates. This study aims to evaluate outcomes of converting LAGB to one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) for insufficient weight loss or weight regain. MATERIALS AND METHODS Retrospective comparative study, based on prospective registry database of a tertiary center (2012-2019). RESULTS In all, 276 LAGB patients were converted to OAGB (n = 125) and SG (n = 151). Body mass index (BMI) at revision was 41.3 ± 6.6 and 42.3 ± 9.6 kg/m2 (P = 0.34) in OAGB and SG patients, respectively. Time interval was longer in OAGB patients (p < 0.001). Major early complication rates were comparable (2.4% and 4%; p = 0.46). At 5-years, OAGB patients had lower BMI (31.9 vs. 34.5 kg/m2; p = 0.002), and a higher total weight loss (25.1% vs. 18.8%; p = 0.003), compared with SG patients. Resolution of type 2 diabetes was higher in OAGB patients (93.3% vs. 66.6%; p = 0.047), while resolution of hypertension was not significantly different (84.6% and 80.5%; p = 0.68). Revision due to delayed complications was required in five (4%) OAGB patients and nine (8.6%) SG patients (p = 0.14). CONCLUSION OAGB for revision after LAGB due to insufficient weight loss or weight regain is safe, and has better effectiveness in weight reduction and resolution of type 2 diabetes than SG.
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Affiliation(s)
- Danit Dayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Bendayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Nadav Nevo
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Eran Nizri
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Salman MA, Salman A, Assal MM, Elsherbiney M, Tourky M, Elewa A, Khalaf AM, Gadallah MA, Gebril M, Khalid S, Shaaban H, Mohammed AA, Osman MHA, Hassan H. One Anastomosis Gastric Bypass (OAGB) with a 150-cm Biliopancreatic Limb (BPL) Versus a 200-cm BPL, a Systematic Review and Meta-analysis. Obes Surg 2023:10.1007/s11695-023-06556-9. [PMID: 37022609 DOI: 10.1007/s11695-023-06556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023]
Abstract
This is a systematic review and meta-analysis that assessed the impact of performing OAGB with a 150-cm BPL versus a 200-cm BPL concerning weight loss, comorbidities remission, and adverse nutritional effects. The analysis included studies that compared patients who underwent OAGB with a 150-cm BPL and 200-cm BPL. Eight studies were eligible for this review after searching in the EMBASE, PubMed central database, and Google scholar. The pooled analysis revealed favoring the 200-cm BPL limb length for weight loss, with a highly significant difference in the TWL% (p=0.009). Both groups showed comparable comorbidities remission. Significantly higher ferritin and folate deficiency rates were found in the 200-cm BPL group. Considering a 200-cm BPL when performing OAGB delivers a better weight loss outcome than a 150-cm BPL, which is at the expense of a more severe nutritional deficiency. No significant differences were found regarding the comorbidities' remission.
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Affiliation(s)
| | | | | | | | | | - Ahmed Elewa
- National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | | | | | | | | | - Hossam Shaaban
- North Cumbria Integrated Care NHS Foundation Trust, Cumberland Infirmary Hospital, Carlisle, UK
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Liagre A, Martini F, Petrucciani N. Perforated Ulcer of the Gastrojejunal Anastomosis and Concomitant Internal Hernia After One Anastomosis Gastric Bypass. Obes Surg 2023; 33:1629-1631. [PMID: 36988753 PMCID: PMC10156908 DOI: 10.1007/s11695-023-06562-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE The management of concomitant complications after OAGB is challenging. We aim to show the surgical management of two concomitant complications after one anastomosis gastric bypass: internal hernia and anastomotic ulcer perforation. MATERIALS AND METHODS We present the case of a 32-year-old woman with BMI of 51 kg/m2, who underwent OAGB. Three years later, she presented with intense and brutal epigastric pain. She was a heavy smoker. Her weight and BMI were 75 kg and 26 kg/m2, respectively. Clinical examination showed generalized peritonitis, computed tomography showed pneumoperitoneum, diffuse peritoneal effusion, and rotation of the superior mesenteric vessels indicative of an internal hernia. RESULTS A generalized biliary peritonitis secondary to a perforated ulcer on the gastrojejunal anastomosis and internal hernia of the common loop into a large Petersen orifice were diagnosed. The internal hernia was reduced, and a perforation of the posterior surface of the gastrojejunal anastomosis was identified. Surgical treatment consisted in the placement of a Kehr's drain into the perforation, closure of the Petersen orifice, and lavage-drainage of the peritoneal cavity. The postoperative course was uneventful, and she was discharged on postoperative day 12. The Kehr's drain was removed 1 month after discharge. CONCLUSION The combination of two different complications after OAGB can make the pre- and intra-operative judgment difficult and hamper the therapeutic approach. The initial reduction of the internal hernia made it possible to reduce the pressure in the surgical assembly and facilitated the treatment of the anastomotic perforation.
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Affiliation(s)
- Arnaud Liagre
- Clinique Des Cedres, Bariatric Surgery Unit, Ramsay Générale de Santé, Cornebarrieu, France
| | - Francesco Martini
- Clinique Des Cedres, Bariatric Surgery Unit, Ramsay Générale de Santé, Cornebarrieu, France
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Via Di Grottarossa 1035-9, 00139, Rome, Italy.
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Seidemann L, Moulla Y, Dietrich A. [Current evidence on loop length in intestinal bypass procedures]. Chirurgie (Heidelb) 2023; 94:506-511. [PMID: 36894649 DOI: 10.1007/s00104-023-01842-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Intestinal bypass procedures are well recognized for their long-term weight reduction and control of metabolic comorbidities. The selection of the length of the small bowel loop has a significant influence on the positive and also negative effects of the chosen procedure but national and international standardization are missing. OBJECTIVE The aim of this article is to give an overview of the current evidence on the various intestinal bypass procedures and the influence of the chosen small bowel loop length on the desired and adverse postoperative outcomes. The IFSO 2019 consensus recommendations on the standardization of bariatric surgery and metabolic procedures form the basis of these considerations. MATERIAL AND METHODS The current literature was searched for comparative studies addressing the question of different small bowel loop lengths in a Roux-en‑Y gastric bypass, one anastomosis gastric bypass, single anastomosis duodenoileal bypass with sleeve gastrectomy and biliopancreatic diversion (with duodenal switch). RESULTS Due to the heterogeneity of currently available studies and interindividual differences in total small bowel lengths in humans, it is difficult to give definitive recommendations for the choice of small bowel loop lengths. The longer the biliopancreatic loop (BPL) or the shorter the common channel (CC), the higher is the risk of (severe) malnutrition. To prevent malnutrition, the BPL should not be longer than 200 cm and the CC should have a length of at least 200 cm. CONCLUSION The intestinal bypass procedures recommended in the German S3 guidelines are safe and show good long-term outcomes. As part of the postbariatric follow-up, the nutritional status of patients following an intestinal bypass has to be followed-up on the long term in order to avoid malnutrition preferably prior to a clinical manifestation.
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Affiliation(s)
- Lena Seidemann
- Bereich Adipositas-, metabolische und endokrine Chirurgie, Klinik u. Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Yusef Moulla
- Bereich Adipositas-, metabolische und endokrine Chirurgie, Klinik u. Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Arne Dietrich
- Bereich Adipositas-, metabolische und endokrine Chirurgie, Klinik u. Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
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34
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Liu FG, Chang SW, Hsu KF, Chen YJ, Pan HM, Liao GS, Lin CH, Wang SC. Revisional One Anastomosis Gastric Bypass (OAGB) for Poor Response of Duodenal-Jejunal Bypass with Sleeve Gastrectomy (DJB-SG) (Video Report). Obes Surg 2023; 33:1616-1619. [PMID: 36856990 DOI: 10.1007/s11695-023-06529-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Bariatric surgery has actually focused not only on obesity but also more on the improvements or remission of the metabolic diseases. Therefore, revisional surgery is indicated for patients with poor response to the primary bariatric surgery to control weight and obesity-associated medical conditions. METHOD In this video report, the patient was a 27-year-old Asian female with an initial BMI of 36.5 kg/m2 and poorly controlled type 2 diabetes (HbA1c: 11.9%). She underwent primary bariatric surgery of laparoscopic duodenal-jejunal bypass with sleeve gastrectomy (DJB-SG) in June 2019. She had a nadir BMI of 28.8 kg/m2 (corresponding body weight of 72 kg) in June 2020. However, she regained weight (BMI: 34 kg/m2) and had a relapse of diabetes with an HbA1c of 12.0% at the time of consultation for revisional bariatric surgery (RBS) in September 2022. After a multidisciplinary team evaluation, laparoscopic procedures of one anastomosis gastric bypass (OAGB) with resizing the gastric tube, removal of duodenal-jejunal anastomosis, and lengthening of the biliopancreatic limb were performed. RESULTS The operative time was 186 min and blood loss was 50 ml. There were no intraoperative or postoperative complications. The patient had an uneventful postoperative course and was discharged on postoperative day 5. At the 3-month follow-up after RBS, the patient had lost 13 kg (weight dropped from 85 to 72 kg) and achieve remission of diabetes with HbA1c of 5.7%. CONCLUSION Laparoscopic OAGB is technically feasible and practical as a revisional procedure for poor response of DJB-SG.
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Affiliation(s)
- Fa-Guang Liu
- Division of General Surgery, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan.,Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Shu-Wei Chang
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Kuo-Feng Hsu
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
| | - Yen-Ju Chen
- Research Assistant Center, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Hsin-Mei Pan
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Guo-Shiou Liao
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - Chien-Hua Lin
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.,IRCAD Taiwan, Department of Surgery, Chang-Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Sheng-Chun Wang
- Division of General Surgery, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan
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Hsu KF, Chang SW, Lee WJ, Ser KH, Pan HM, Chen YJ, Hung WT, Lin CH, Liao GS, Lee MH, Soong TC. From Our One Anastomosis Gastric Bypass (OAGB) Experience to Establishing Single Anastomosis Sleeve Ileal (SASI) Bypass Procedure: A Single-Center Report. Obes Surg 2023. [PMID: 36810810 DOI: 10.1007/s11695-023-06523-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Bariatric surgery has been proven to be the most effective treatment for obesity with or without metabolic syndrome. One anastomosis gastric bypass (OAGB) is a well-established bariatric procedure developed over the past 20 years with excellent outcomes. Single anastomosis sleeve ileal (SASI) bypass is introduced as a novel bariatric and metabolic procedure. There is some similarity between these two operations. This study aimed to present our SASI procedure based on the past experience of the OAGB in our center. METHOD Thirty patients with obesity underwent SASI surgery from March 2021 to June 2022. Herein, we demonstrated our techniques step by step and key points of techniques learned from our experience with OAGB (shown in the video) with satisfying surgical outcomes. The clinical characteristics, peri-operative variables, and short-term outcomes were reviewed. RESULTS There was no case of conversion to open surgery. The mean operative time, volume of blood loss, and hospital stay were 135.2 ± 39.2 min, 16.5 ± 6.2 mL, and 3.6 ± 0.8 days, respectively. There is no postoperative leakage, bleeding, or mortality. The percentage of total weight loss and excess weight loss at 6 months were 31.2 ± 6.5 and 75.3 ± 14.9, respectively. Improvement in type 2 diabetes (11/11, 100%), hypertension (14/26, 53.8%), dyslipidemia (16/21, 76.2%), and obstructive sleep apnea (9/11, 81.8%) were observed at 6 months after surgery. CONCLUSION Our experience showed that our proposed SASI technique is feasible and may help surgeons perform this promising bariatric procedure without encountering many obstacles.
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Singh B, Saikaustubh Y, Singla V, Kumar A, Ahuja V, Gupta Y, Kashyap L, Aggarwal S. One Anastomosis Gastric Bypass (OAGB) vs Roux en Y Gastric Bypass (RYGB) for Remission of T2DM in Patients with Morbid Obesity: a Randomized Controlled Trial. Obes Surg 2023. [PMID: 36807043 DOI: 10.1007/s11695-023-06515-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Majority of the studies comparing Roux en Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are non-randomized. Moreover, few randomized studies have focussed on weight loss as the primary outcome rather than the impact on type 2 diabetes mellitus (T2DM). This randomized trial compared OABG over RYGB with the hypothesis that OAGB is not inferior to RYGB in terms of remission of T2DM. METHODS This was an open-labelled, randomized trial in which patients having a BMI greater than 30 kg/m2 with T2DM were included. The primary outcome was the remission of T2DM. RESULTS In the study, 25 and 24 patients were recruited in OAGB and RYGB groups respectively. The remission rates of T2DM were similar at all timelines. The highest rate was achieved at 1 year (86.36% vs 85.71%) for both the groups and a 4-year remission rate of (72.22% vs 71.43%), for OAGB vs RYGB respectively. The % EWL was also comparable with the highest rate achieved again at 1 year (69.23% vs 66.67%) and a 4-year rate of (58.33% vs 53.33%), for OAGB vs RYGB respectively. Remission of other co-morbidities, major and minor complication rate, re-admission rate, and nutritional issues were similar in both groups. CONCLUSION OAGB is non-inferior to RYGB in terms of remission of type 2 diabetes mellitus, weight loss, and early and late complications with a shorter operating time.
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Dayan D, Dvir N, Nizri E, Abu-Abeid S, Lahat G, Abu-Abeid A. Safety of concomitant cholecystectomy during one anastomosis gastric bypass compared with sleeve gastrectomy and Roux-en-Y gastric bypass. Updates Surg 2023; 75:671-678. [PMID: 36790632 DOI: 10.1007/s13304-023-01463-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
Candidates of metabolic and bariatric surgery (MBS) are prone for gallstone formation. Concomitant cholecystectomy (CC) during MBS is controversial. This study is first to examine the safety of CC during one anastomosis gastric bypass (OAGB), compared with sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Single-center retrospective comparative study of CC (2012-2021) during OAGB, to SG and RYGB. CC was performed in 115 patients during OAGB (n = 50), SG (n = 39), and RYGB (n = 26). All procedures were completed laparoscopically. Baseline characteristics were similar except age, body mass index, gastroesophageal reflux disease, obstructive sleep apnea, and previous MBS (p < 0.05). Intraoperative complications occurred in one OAGB patient (2% vs. 0%, 0%; p = 0.52), which was not cholecystectomy related. There were no differences in total (6% vs. 2.6%, 15.4%; p = 0.13) and major (2% vs. 0%, 3.8; p = 0.50) early-complication rates. Of them, cholecystectomy-related complications occurred in one OAGB, compared with none of SG and one RYGB (2% vs. 0%, 3.8%; p = 0.50). The former was major, and the latter was minor complication. None of the OAGB patients needed re-admission (0% vs. 0%, 11.5; p = 0.04). All CC outcome parameters were similar between asymptomatic and symptomatic gallstones. Previous bariatric procedures were found to be a significant risk for major complications and readmissions (OR = 16.87, p = 0.019). CC during OAGB for gallstones seems safe, as in SG and RYGB. No cholecystectomy-related intraoperative complications occurred, and postoperative complication rates were low and acceptable. Outcomes for asymptomatic gallstones were similar to symptomatic ones, and we cautiously support CC in the presence of gallstones.
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Affiliation(s)
- Danit Dayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Dvir
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel
| | - Eran Nizri
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel
| | - Subhi Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Lahat
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman Street, 6423906, Tel Aviv, Israel. .,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Jaworski P, Binda A, Barski K, Wawiernia K, Kudlicka E, Wąsowski M, Jankowski P, Tarnowski W. OAGB with shortened excluded ileal loop as an effective treatment for type 2 diabetes mellitus in the cases of Caucasian men and women with obesity of the first degree (BMI 30-35 kg/m 2). Langenbecks Arch Surg 2023; 408:84. [PMID: 36773074 PMCID: PMC9922227 DOI: 10.1007/s00423-023-02785-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/12/2022] [Indexed: 02/12/2023]
Abstract
INTRODUCTION The aim of the study is to assess the effect of shortening the excluded loop of the small intestine to 150 cm on the effectiveness of one anastomosis gastric bypass (OAGB) in remission of type 2 diabetes with Io obesity. MATERIAL AND METHODS The study included 25 patients with a body mass index (BMI) 30-35 kg/m2, with a diagnosis of diabetes mellitus type 2 (T2DM), and undergoing OAGB with excluded 150 cm of the small intestine. RESULTS There were no deaths in the study group, bleeding during the postoperative period requiring reoperation, anastomotic leakage/leakage throught mechanical stitching. The mean a glycated haemoglobin (HbA1C) level 12 months after surgery was 6.16 ± 0.96%, corresponding to a 2.29 ± 3.3% decrease. In more than 85% of the patients taking insulin before surgery, the insulin was discontinued in the postoperative period. Additionally, the level of glycaemia was assessed in patients on the day of surgery (163 ± 58 mg/dl) and on the day of discharge from the hospital (4.7 ± 1.3 days)-it was lower by over 18% (133 ± 39.2 mg). Over the period of 12 months following OAGB, there was a reduction in the mean BMI value from 33.5 ± 2 to 25.5 ± 2.5 kg/m2 and improvement in lipid parameters and mean values of blood pressure. CONCLUSION OAGB with excluded 150 cm of the small intestine has beneficial effect on the remission of T2DM in patients with a BMI of 30-35kg/m2 and is associated with an acceptable level of complications. The achieved weight loss after surgery is satisfactory.
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Affiliation(s)
- Paweł Jaworski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland.
| | - Artur Binda
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Krzysztof Barski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Karolina Wawiernia
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Emilia Kudlicka
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Michał Wąsowski
- Department of General Medicine and Gerontocardiology, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Piotr Jankowski
- Department of General Medicine and Gerontocardiology, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
| | - Wiesław Tarnowski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland
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Rheinwalt KP, Fobbe A, Plamper A, Alizai PH, Schmitz SMT, Brol MJ, Trebicka J, Neumann UP, Ulmer TF. Health-related quality of life outcomes following Roux-en-Y gastric bypass versus one anastomosis gastric bypass. Langenbecks Arch Surg 2023; 408:74. [PMID: 36729181 DOI: 10.1007/s00423-023-02792-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/23/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) are effective standard bariatric surgeries with comparable weight loss and remission of obesity-related comorbidities. As procedure-specific health-related quality of life (HrQoL) outcomes have not been directly compared thus far, we conducted this questionnaire-based study. METHODS Two hundred forty patients after undergoing either RYGB or OAGB between 2011 and 2016 were contacted and asked to fill out SF36 and BAROS questionnaires. All statistical analysis was performed with Microsoft Excel and GraphPad Prism. Primary objectives were procedure-dependent differences in HrQoL. Secondary objectives were weight loss and remission of comorbidities. RESULTS One hundred nineteen of 240 contacted patients (49.6%) replied, 58 after RYGB (48.7%) and 61 after OAGB (51.3%). Follow-up period was < 24 months in 52 and > 24 months in 64 evaluable patients. The mean age was 46 years (range 23 to 71). Regarding the < 24 months groups, both physical and psychological SF36 sum scales were comparably high. Only the subcategory "general health perception" was significantly better after RYGB. Significantly higher excess weight loss (EWL) after RYGB (88.81%) compared to OAGB (66.25%) caused significantly better global < 24 months BAROS outcomes, whereas remission of comorbidities and HrQoL was similar. Both > 24 months groups showed high SF36-HrQoL sum scales. Global mean BAROS results after > 24 months were "very good" in both procedures. EWL in RYGB (80.81%) and in OAGB (81.36%) were comparably excellent. CONCLUSION Concerning SF36 and BAROS evaluated HrQoL in early and late postoperative phases, both procedures demonstrated comparable and relevant improvements. Further (preferably randomized) studies should include evaluation of preoperative HrQoL.
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Affiliation(s)
- Karl Peter Rheinwalt
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schoensteinstrasse 63, 50825, Cologne, Germany.
| | - Anna Fobbe
- Department of General and Visceral Surgery, and Proctology, Klinikum Westfalen GmbH, Knappschaftskrankenhaus Dortmund, Am Knappschaftskrankenhaus 1, 44309, Dortmund, Germany
| | - Andreas Plamper
- Department of Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Schoensteinstrasse 63, 50825, Cologne, Germany
| | - Patrick Hamid Alizai
- Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH-Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Sophia Marie-Therese Schmitz
- Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH-Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Maximilian Joseph Brol
- Department of Internal Medicine B, Westfälische Wilhelms-Universität, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Jonel Trebicka
- Department of Internal Medicine B, Westfälische Wilhelms-Universität, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Ulf Peter Neumann
- Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH-Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Tom Florian Ulmer
- Department of General, Visceral and Transplantation Surgery, University Hospital of the RWTH-Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
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Nazari M, Jameson C, Ryan B, Brancatisano A. Efficacy and Safety of Sleeve Gastrectomy or One Anastomosis Gastric Bypass Conversion Following Adjustable Gastric Banding. Obes Surg 2023; 33:426-433. [PMID: 36480102 DOI: 10.1007/s11695-022-06374-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Given revision or conversion surgery is required in up to 60% of patients who had adjustable gastric band (LAGB), we compared safety and efficacy of sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB) as conversion surgical procedures in patients with suboptimal response or weight recurrence following LAGB. METHODS Conversion surgery was performed in 335 patients between 2016 and 2020. Weight loss, early and late-stage complications, and comorbidity outcomes were reviewed and analyzed. RESULTS One hundred and sixty-three patients underwent cSG (BMI: 38.3 ± 8.3 kg/m2), and 172 patients underwent cOAGB (BMI: 45.2 ± 9.3 kg/m2). Percent total body weight loss (%TWL) was 28.7 ± 9.9% at 12 months, 30.3 ± 12.8% at 2 years, 31.0 ± 14.5% at 3 years, and 31.1 ± 14.7% at 4 years following OAGB, which was significantly higher than SG; 18.4 ± 8.7%, 18.8 ± 9.8%, 19.3 ± 11.1%, and 16.9 ± 10.9%, respectively (p < 0.0001). Remission of comorbidities, regardless of conversion procedure type, was 20.8% for hypertension (HT), 52% for dyslipidemia (DLD), 60% for type 2 diabetes (DM), 64% for non-alcoholic steatohepatitis (NASH), and 76% for insulin resistance (IR).There were no leaks or deaths following SG or OAGB. A twofold greater frequency of complications was seen in the OAGB group vs SG group (15.1% and 6.7%, respectively). CONCLUSION Significant weight loss, acceptable complication rates, and similar remission of comorbidities were seen regardless of the type of conversion procedure. Prospective randomized clinical trials are recommended for further elucidation of long-term outcomes.
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Affiliation(s)
- Mojgan Nazari
- Sydney Bariatric Clinic, Westmead, New South Wales, 2145, Australia. .,Faculty of Medicine and Health, The University of Sydney, Westmead, New South Wales, 2145, Australia.
| | - Carolyn Jameson
- Sydney Bariatric Clinic, Westmead, New South Wales, 2145, Australia.,School of Medicine, University of Notre Dame, Darlinghurst, New South Wales, 2010, Australia
| | - Brendan Ryan
- Sydney Bariatric Clinic, Westmead, New South Wales, 2145, Australia
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Dayan D, Bendayan A, Nizri E, Abu-Abeid S, Lahat G, Abu-Abeid A. One Anastomosis Gastric Bypass Compared with Sleeve Gastrectomy in Elderly Patients: Safety and Long-term Outcomes. Obes Surg 2023; 33:570-6. [PMID: 36547857 DOI: 10.1007/s11695-022-06421-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND As life expectancy increases, more elderly patients are being considered for metabolic bariatric surgery. We aimed to assess the safety and long-term effectiveness of one anastomosis gastric bypass (OAGB) compared to sleeve gastrectomy (SG). METHODS Single-center retrospective comparative study of OAGB and SG (2012-2019) in patients aged ≥ 65 years. RESULTS In all, 124 patients underwent OAGB (n = 41) and SG (n = 83). Mean age was 67.6 ± 2.8 and 67.6 ± 2.6 years (p = 0.89), respectively. Baseline characteristics were comparable, except lower rates of hypertension (HTN) and non-alcoholic fatty liver disease in OAGB than SG patients (43.9% vs. 74.6%; p < 0.001, and 39.0% vs. 89.1%; p < 0.001, respectively). Body mass index (BMI) of OAGB and SG patients decreased from 41.8 ± 7.8 and 43.3 ± 5.9 kg/m2 (p = 0.25) to 28.6 ± 4.7 and 33.2 ± 5.3 (p < 0.001), at long-term follow-up, respectively. Excess weight loss (EWL) > 50% was achieved in 80.6% and 43.2% of OAGB and SG patients, with a mean EWL of 67.2% ± 22.3 and 45.8% ± 18.0 (p < 0.001) and a mean total weight loss (TWL) of 30.7% ± 10.4 and 21.9% ± 8.1 (p < 0.001), respectively. Resolution rates of obesity-associated medical problems were similar, except type 2 diabetes (T2D) and HTN, which were 86.6% and 73.3% in OAGB, compared with 29.7% and 36.3% in SG patients (p < 0.001 and p = 0.001), respectively. Major early complication rates were comparable (2.4% vs. 3.6%; p = 0.73, respectively). Revision for late complications was required in two OAGB patients. CONCLUSIONS OAGB in the elderly is safe and results in better long-term weight reduction and resolution of T2D and HTN than SG.
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AlSabah S, Al Haddad E, Al-Subaie S, Ekrouf S, Almulla A, Alhaddad M, Aljabal MS, Alenezi K. Long-term outcomes of revisional one anastomosis gastric bypass post laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 2023; 408:43. [PMID: 36656465 DOI: 10.1007/s00423-023-02787-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/27/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Revisional bariatric surgeries following laparoscopic sleeve gastrectomy (LSG) have demonstrated a dramatic increase worldwide. Recently, one-anastomosis gastric bypass (OAGB) has become a contender as an appropriate revisional procedure; however, no long-term data currently exist on the effectiveness of it as a revisional surgery post-LSG. METHODS A retrospective analysis was performed on all patients who underwent LSG at a public hospital in Kuwait from 2008 to 2017. A list was obtained of those who underwent revisional OAGB surgery after initial LSG, after which a phone survey was performed and demographics were analyzed. RESULTS A total of 29 patients underwent revisional OAGB post-initial LSG, of which 89.7% were female. Prior to LSG, the mean weight of the patients was 127.5 kg, and the mean BMI was 49.0 kg/m2. The mean weight loss after initial LSG was 43.8 kg, while the average duration until patients underwent revisional OAGB was 5.3 years. The cause for revision was weight regain (86.2%) or inadequate weight loss (13.8%). Prior to undergoing revisional OAGB, the weight and BMI of the patients was 110.9 kg and 42.4 kg/m2, respectively. Revisional OAGB demonstrated a %excess weight loss of 14.5%, 31.9%, 48.0%, 56.3%, 57.2%, and 54.7% at 2 weeks, 3 months, 6 months, 1 year, 4 years, and 5 years, respectively. Twelve morbidities were reported during the follow-up period. CONCLUSION Revisional bariatric surgery is technically demanding and may be associated with a high complication rate. However, OAGB as a revisional procedure has proven to be safe and effective in the long-term outcomes of revisional OAGB patients post-LSG.
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Hsu KF, Pan HM, Chang PC, Huang CK, Wang W, Lee WJ, Soong TC, Lee MH, Yang PJ, Hsin MC, Lin CH, Liao GS. Bariatric surgery trends and progress in Taiwan: 2010-2021. Obes Res Clin Pract 2023; 17:66-73. [PMID: 36623996 DOI: 10.1016/j.orcp.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/04/2022] [Accepted: 12/18/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Taiwan is a leading country regarding bariatric surgery in Asia-Pacific. Since 2010, the Taiwan Society for Metabolic and Bariatric Surgery (TSMBS) has been accountable for the national evolution of bariatric surgery and inaugurated a national database accordingly. This study aimed to analyze the bariatric surgery trends and progress in Taiwan from 2010 to 2021. MATERIALS AND METHODS The TSMBS database was collected on the basis of structured inquiries filled out by bariatric surgeons in Taiwan. All patients involving bariatric surgery were included. The data were stratified with the following objectives, including the types of bariatric procedures, demographic characteristics, and perioperative variables. A nationwide database was comprehensively analyzed and evaluated to determine the trends in the applications of the procedure. RESULTS Data of 30,026 patients were enrolled. A 2.5-fold increase was observed in bariatric procedures, from 1218 in 2010 to 3005 in 2021. Within 12 years, female accounts for 61.8 %. The revisional rate was 3.40 % during the exploration stage (2010-2013), 2.77 % during the maturity stage (2013-2018), and 5.10 % during the expansion stage (2019-2021). The top five of primary bariatric surgery is sleeve gastrectomy (SG, 63.05 %), gastric clipping surgery (GC, 11.17 %), Roux-en-Y gastric bypass (RYGB, 9.34 %), one anastomosis gastric bypass (OAGB, 8.80 %), and sleeve plus surgery (SG plus, 4.43 %). CONCLUSION The trends and progress of Taiwan's bariatric surgery within recent decades are presented in this article. Taiwan's bariatric surgery case number has increased steadily from 2010 to 2021. Amongst all, SG has become the most dominant procedure since 2011 while OAGB takes up second place in 2020.
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Musella M, Berardi G, Velotti N, Schiavone V, Manetti C, Vitiello A. Safety and efficacy of OAGB/MGB during the learning curve: setting a benchmark in a bariatric center of excellence. Updates Surg 2023; 75:169-174. [PMID: 36169887 PMCID: PMC9834165 DOI: 10.1007/s13304-022-01380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 09/12/2022] [Indexed: 01/16/2023]
Abstract
Very little has been published on the learning curve (LC) of the One Anastomosis /Mini Gastric Bypass (OAGB/MGB). Aim of this study was to compare perioperative outcomes of OABG/MGBs performed during the LC of an experienced laparoscopic surgeon to global benchmark cut-offs. First 200 patients undergoing OAGB/MGB at our university hospital from 2010 to 2016 were retrospectively included in this study. LC of the surgeon was divided in two groups of 100 consecutive patients each and perioperative outcomes were compared to abovementioned global benchmarks for LSG and RYGB. A cumulative sum (CUSUM) analysis was performed for operative time and hospital stay. Uneventful postoperative recovery was recorded in 95% of patients. All benchmark values for RYGB were met in group 2. Comparison with cut-offs for LSG showed longer hospital stay and operative time in both groups but postoperative rate of complications resulted lower even for Group 1. CUSUM graph of the operative time runs randomly above the predetermined limit till the 40th cases but reaches the plateau after the 115th operation. CUSUM curve of the hospital stay reaches the plateau after the 57th case. OAGB/MGB confirms to be a feasible procedure, which can be safely and effectively performed during the learning curve. However, at least 100 hundred cases are required to reduce operative time and hospital stay.
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Affiliation(s)
- Mario Musella
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanna Berardi
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Nunzio Velotti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Vincenzo Schiavone
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Cristina Manetti
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
| | - Antonio Vitiello
- Advanced Biomedical Sciences Department, Naples “Federico II” University, AOU “Federico II”, Via S. Pansini 5, 80131 Naples, Italy
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Li X, Hu X, Fu C, Han L, Xie M, Ouyang S. Efficacy and Safety of One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Obesity: a Meta-analysis and Systematic Review. Obes Surg 2023; 33:611-622. [PMID: 36564618 PMCID: PMC9889439 DOI: 10.1007/s11695-022-06401-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/25/2022]
Abstract
The objective of this review is to systematically review the efficacy and safety outcomes of one anastomosis gastric bypass (OAGB) with Roux-en-Y gastric bypass (RYGB). From inception to July 4, 2022, a systematic literature search was performed using PubMed, Embase, and Cochrane Library for randomized clinical trials comparing OAGB with RYGB in obesity. A meta-analysis performed using the RevMan 5.4.1 software evaluations was completed. We identified 1217 reports; after exclusions, eight trials with a total of 931 patients were eligible for analysis. Compared with RYGB, OAGB had multiple advantageous indexes. Examples include percent of excess weight loss (%EWL) at 12 months (P = 0.009), body mass index (BMI) at 2 years (P < 0.00001), early postoperative complication (P = 0.04), remission of dyslipidemia (P < 0.0001), and operative time (P < 0.00001). No significant statistical difference was observed in BMI at 6 months, %EWL at 6 months, BMI at 12 months, percent of excess body mass index loss (%EBMIL) at 2 years, BMI at 5 years, intraoperative complications, late postoperative complications, remission of type 2 diabetes mellitus, and dyslipidemia or gastroesophageal reflux disease remission between OAGB and RYGB. OAGB is no less effective than RYGB; no significant differences in weight loss efficacy were observed, and more large and long-term randomized controlled trials are needed to verify this. In addition, studies have shown that OAGB has a shorter operation time, fewer early postoperative complications, and a shorter learning curve, making it easier for young surgeons to perform.
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Affiliation(s)
- Xianting Li
- Department of Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China ,Department of General Surgery, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China
| | - Xu Hu
- Department of Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China ,Department of General Surgery, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China
| | - Chendong Fu
- Department of Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China ,Department of General Surgery, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China
| | - Lang Han
- Department of Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China ,Department of General Surgery, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China
| | - Ming Xie
- Department of Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China ,Department of General Surgery, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China
| | - Shurui Ouyang
- Department of Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China ,Department of General Surgery, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi, 563000 Guizhou China
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Plamper A, Lingohr P, Nadal J, Trebicka J, Brol MJ, Woestemeier A, Schmitz SMT, Alizai PH, Neumann UP, Ulmer TF, Rheinwalt KP. A Long-Term Comparative Study Between One Anastomosis Gastric Bypass and Sleeve Gastrectomy. J Gastrointest Surg 2023; 27:47-55. [PMID: 36376721 PMCID: PMC9877051 DOI: 10.1007/s11605-022-05515-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND One anastomosis gastric bypass (OAGB) has become increasingly accepted in bariatric surgery and meanwhile represents the third most common procedure worldwide. While it shows promising weight loss results and comorbidity resolution, questions about issues such as reflux or nutritional deficiencies (ND) persist in the long term. On the other hand, the most frequently performed sleeve gastrectomy (SG) has to accept growing criticism regarding long-term results and reflux issues. There is a particular lack of long-term comparative data for both procedures. This study presents our long-term experience. METHODS We evaluated OAGB and SG patients retrospectively comparing for weight loss and resolution of comorbidities as well as perioperative and long-term complications in a follow-up period of 5 years. RESULTS Nine hundred eleven OAGB and 241 SG were included in the study. OAGB had a shorter operation time and hospital stay. Overall complication rate did not differ in both groups. Ulcers were more frequent in OAGB (7.7% vs. 1.7%, p = 0.001), whereas insufficient weight loss (IWL)/weight regain (WR) proved to be more prevalent in SG (25.7% vs. 6.4%, p < 0.001). The same held true for reflux (17.8% vs. 8.3%, p < .001). On the other hand, ND were more common in OAGB (20.0% vs. 12.0%, p = 0.005). Revisional surgery was more often indicated after SG. Analysis by linear mixed model showed that OAGB achieved a lower BMI/higher loss of BMI. Improvement of T2DM (94.6% vs. 85.2%, p = 0.008) and sleep apnea (88.8% vs. 78.8%, p = 0.01) was superior in OAGB. CONCLUSIONS OAGB had a superior effect on weight loss as well as improvement of T2DM and sleep apnea. Furthermore, long-term problems such as IWL/WR and reflux were more related to SG. On the other hand, a malabsorptive procedure such as OAGB showed a higher risk for ND. Our findings support the available data in the literature.
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Affiliation(s)
- Andreas Plamper
- grid.416655.5Department for Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
| | - Philipp Lingohr
- grid.15090.3d0000 0000 8786 803XDepartment for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Jennifer Nadal
- grid.15090.3d0000 0000 8786 803XInstitute for Medical Biometrics, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Jonel Trebicka
- grid.5949.10000 0001 2172 9288Department of Internal Medicine B, WW University Muenster, Muenster, Germany
| | - Maximilian J. Brol
- grid.5949.10000 0001 2172 9288Department of Internal Medicine B, WW University Muenster, Muenster, Germany
| | - Anna Woestemeier
- grid.15090.3d0000 0000 8786 803XDepartment for General, Visceral, Thoracic and Vascular Surgery, University Hospital of Bonn, Bonn, Germany
| | - Sophia M.-T. Schmitz
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Patrick H. Alizai
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ulf P. Neumann
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Tom F. Ulmer
- grid.412301.50000 0000 8653 1507Clinic for General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Karl P. Rheinwalt
- grid.416655.5Department for Bariatric, Metabolic and Plastic Surgery, St. Franziskus-Hospital, Cologne, Germany
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47
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Bacoeur-Ouzillou O, Perinel J, Pelascini E, Abdallah M, Poncet G, Pasquer A, Robert M. Management strategies of anastomotic ulcer after gastric bypass and risk factors of recurrence. Surg Endosc 2022; 36:9129-9135. [PMID: 35764841 DOI: 10.1007/s00464-022-09393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/06/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Marginal ulcers (MU) after gastric bypass are a challenging problem. The first-line treatment is a medical therapy with eviction of risk factors but is sometimes insufficient. The management strategies of intractable ulcers are still not clearly defined. The aim of our study was to analyse the risk factors for recurrence, the management strategies used and their efficiencies. METHODS Based on a retrospective analysis of all MU managed in our tertiary care centre of bariatric surgery during the last 14 years, a descriptive analysis of the cohort, the management strategies and their efficiency were analysed. A logistic regression was done to identify the independent associated risk factors of intractable ulcer. RESULTS Fifty-six patients matched inclusion criteria: 30 were referred to us (13 Roux-en-Y Gastric Bypass-RYGB and 17 One Anastomosis Gastric Bypass-OAGB), 26 were operated on in our institution (24 RYGB and 2 OAGB). 11 patients had a complicated inaugural MU requiring an interventional procedure in emergency: 7 perforations, 4 haemorrhages. The majority of MU were treated medically as a first-line therapy (n = 45; 80.4%). 32 MU recurred: 20 patients required surgery as a 2nd line therapy, 6 were operated on as a 3rd line therapy and 1 had a surgery as a 5th line therapy. The OAGB was the only risk factor of recurrence (p = 0.018). We found that the Surgical management was significantly more frequent for patients with a OAGB (84% versus 35% for RYGB, p = 0.001); the most performed surgical procedure was a conversion of OAGB to RYGB (n = 11, 37.9%). CONCLUSION Surgery was required for a large number of MU especially in case of recurrence, but recurrence can still occur after the surgery. The OAGB was the only risk factor of recurrence identified and conversion to RYGB seemed to be effective for the healing.
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Affiliation(s)
- Ophélie Bacoeur-Ouzillou
- Chirurgie viscérale et digestive, CHU Clermont-Ferrand, Hôpital Estaing, 1 Place Lucie et Raymond Aubrac, 63000, Clermont Ferrand, France.
- Faculté de Médecine, Université Clermont Auvergne, 28 Place Henri Dunant, 63001, Clermont Ferrand, France.
- Chirurgie viscérale et Bariatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon, France.
| | - Julie Perinel
- Chirurgie viscérale et Bariatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon, France
- Université Lyon 1, 8 Avenue Rockefeller, 69373, Lyon Cedex 08, France
| | - Elise Pelascini
- Chirurgie viscérale et Bariatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon, France
| | - Mourad Abdallah
- Chirurgie viscérale et digestive, CHU Clermont-Ferrand, Hôpital Estaing, 1 Place Lucie et Raymond Aubrac, 63000, Clermont Ferrand, France
- Faculté de Médecine, Université Clermont Auvergne, 28 Place Henri Dunant, 63001, Clermont Ferrand, France
| | - Gilles Poncet
- Chirurgie viscérale et Bariatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon, France
- Université Lyon 1, 8 Avenue Rockefeller, 69373, Lyon Cedex 08, France
| | - Arnaud Pasquer
- Chirurgie viscérale et Bariatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon, France
- Université Lyon 1, 8 Avenue Rockefeller, 69373, Lyon Cedex 08, France
| | - Maud Robert
- Chirurgie viscérale et Bariatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, 5 Place d'Arsonval, 69437, Lyon, France.
- Université Lyon 1, 8 Avenue Rockefeller, 69373, Lyon Cedex 08, France.
- CarMeN Lab, INSERM Unit 1060, Hôpital LYON SUD Secteur 2 Bâtiment Cens-Eli D 165 Chemin du Grand Revoyet, 69310, Pierre Bénite, France.
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48
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Lee RXN, Rizkallah N, Chiappetta S, Stier C, Pouwels S, Sakran N, Singhal R, Mahawar K, Madhok B. Surgical Management of Gastro-oesophageal Reflux Disease After One Anastomosis Gastric Bypass - a Systematic Review. Obes Surg 2022; 32:4057-4065. [PMID: 36255646 DOI: 10.1007/s11695-022-06301-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 10/24/2022]
Abstract
Gastro-oesophageal reflux disease (GORD) after one anastomosis gastric bypass (OAGB) remains a concern. We reviewed the current literature on revisional surgery after OAGB for GORD. MEDLINE, EMBASE, and PubMed databases were searched. We identified 21 studies, appraising 13,658 OAGB patients. A total of 230 (1.6%) patients underwent revisional surgery for GORD. Revision to Roux-en-Y configuration was performed in 211 (91.7%) patients. Six (2.6%) patients had a Braun entero-enterostomy added to the OAGB. Thirteen (5.6%) patients underwent excluded stomach fundoplication (ESF). Reflux symptoms resolved in 112 (48.6%) patients, persisted in 13 (5.6%) patients, and were not reported in 105 (45.6%) patients. Revisional surgery after OAGB for GORD appears to be rare, and when required, conversion to Roux-en-Y configuration is the commonest choice.
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Affiliation(s)
- Rachel Xue Ning Lee
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Nayer Rizkallah
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Christine Stier
- Department of Surgical Endoscopy, Sana Hospitals, Germany and Obesity Center NRW, Huerth, Germany
| | - Sjaak Pouwels
- Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Nasser Sakran
- Department of Surgery, Holy Family Hospital, Nazareth, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Rishi Singhal
- Bariatric and Upper GI Unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kamal Mahawar
- Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK.,Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Brijesh Madhok
- East Midlands Bariatric and Metabolic Institute, University Hospital of Derby and Burton NHS Foundation Trust, Derby, UK.
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49
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Jung JJ, Park AK, Hutter MM. The United States Experience with One Anastomosis Gastric Bypass at MBSAQIP-Accredited Centers. Obes Surg 2022; 32:3239-3247. [PMID: 36008649 DOI: 10.1007/s11695-022-06002-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE One anastomosis gastric bypass (OAGB) has emerged as a potentially safe and effective weight-loss procedure. Worldwide, OAGB is the third most commonly performed primary bariatric procedure, comprising 4% of the annual volume. In the USA, OAGB has yet to be endorsed as a primary bariatric procedure and can only be performed under research protocols or as a revision procedure. MATERIALS AND METHODS We performed an observational cohort study to describe the preoperative, intraoperative, and postoperative characteristics of adult patients who underwent primary or revision OAGB from 2015 to 2019 at MBSAQIP centers. Exclusion criteria included emergent surgery, incomplete 30-day follow-up, and non-laparoscopic- or robotic approach. RESULTS During the study period, 803,906 bariatric procedures were performed and 645 (0.08%) were OAGB. Among these, 436 (67.6%) were primary and 209 (32.4%) were revision OAGB. The mean operation time was 89 min (SD, 59) and 8% were performed using a robotic approach. The overall complication rate was 7.4% and there was one death (0.2%). The post-operative complication rates were generally higher than the early complication rate (3.4%) reported in the YOMEGA trial, an RCT from France. Revision OAGB had a longer mean operation time of 141 min (SD, 85, p < 0.001). CONCLUSION Primary OAGB was a rarely performed bariatric procedure at MBSAQIP-accredited centers comprising only 0.05% compared to 4% worldwide. Future studies should compare safety of OAGB to that of established bariatric procedures like Roux-en-Y gastric bypass and sleeve gastrectomy.
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Affiliation(s)
- James J Jung
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Division of General Surgery, Department of Surgery, University of Toronto, 30 Bond Street, 16CC-043, Toronto, ON, M5B 1W8, Canada.
| | - Albert K Park
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Matthew M Hutter
- Division of Gastrointestinal and Oncologic Surgery, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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50
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Abu-Abeid A, Goren O, Abu-Abeid S, Dayan D. One Anastomosis Gastric Bypass for Revision of Restrictive Procedures: Mid-Term Outcomes and Analysis of Possible Outcome Predictors. Obes Surg 2022; 32:3264-3271. [PMID: 35953635 DOI: 10.1007/s11695-022-06235-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Revisional one anastomosis gastric bypass (OAGB) for insufficient weight reduction following primary restrictive procedures is still investigated. We report mid-term outcomes and possible outcome predictors. MATERIALS AND METHODS Single-center retrospective comparative study of revisional OAGB outcomes (2015-2018) following laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG); silastic ring vertical gastroplasty (SRVG) is separately discussed. RESULTS In all, 203 patients underwent revisional OAGB following LAGB (n = 125), SG (n = 64), and SRVG (n = 14). Comparing LAGB and SG, body mass index (BMI) at revision were 41.3 ± 6.6 and 42 ± 11.2 kg/m2 (p = 0.64), reduced to 31.3 ± 8.3 and 31.9 ± 8.3 (p = 0.64) at mid-term follow-up, respectively. Excess weight loss (EWL) > 50% was achieved in ~ 50%, with EWL of 79.4 ± 20.4% (corresponding total weight loss 38.5 ± 10.4%). SRVG patients had comparable outcomes. Resolution rates of type 2 diabetes (T2D) and hypertension (HTN) were 93.3% and 84.6% in LAGB compared with 100% and 100% in SG patients (p = 0.47 and p = 0.46), respectively. In univariable analysis, EWL > 50% was associated with male gender (p < 0.001), higher weight (p < 0.001), and BMI (p = 0.007) at primary surgery, and higher BMI at revisional OAGB (p < 0.001). In multivariable analysis, independent predictors for EWL > 50% were male gender (OR = 2.8, 95% CI 1.27-6.18; p = 0.01) and higher BMI at revisional OAGB (OR = 1.11, 95% CI 1.03-1.19; p = 0.006). CONCLUSION Revisional OAGB for insufficient restrictive procedures results in excellent weight reduction in nearly 50% of patients, with resolution of T2D and HTN at mid-term follow-up. Male gender and higher BMI at revision were associated with EWL > 50% following revisional OAGB. Identification of more predictors could aid judicious patient selection.
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Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel. .,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Or Goren
- Division of Anesthesiology, Pain and Intensive Care, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel
| | - Subhi Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danit Dayan
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.,Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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