Primary restrictive bariatric procedures, including laparoscopic adjustable gastric banding, vertical banded gastroplasty, and laparoscopic sleeve gastrectomy, have shown safety and efficiency as bariatric methods. However, these procedures pose the risk of failure in terms of inadequate weight loss or weight regain. Following failed restrictive surgeries, Roux-en-Y gastric bypass (RYGB) is the most often used revision technique. One-anastomosis gastric bypass (OAGB) has gained popularity during the past 10 years. This study aimed to compare OAGB to RYGB as revisional procedures in terms of perioperative events and weight loss throughout a 1-year follow-up period.
Patients and Methods:
This is a prospective nonrandomized study that included patients who had failed restrictive surgeries and were scheduled for revisional surgery (OAGB or RYGB). Data concerning the patients’ demographics, comorbidities, and surgery events were recorded and analyzed. Propensity score matching was performed.
Results:
A significantly lower mean operative time was shown in the OAGB (105.5 ± 4.3 min vs. 130.7 ± 4.25, t = 27.64, p < 0.001). The OAGB group showed a lower number of patients with leaks (0% vs. 4.5%). The rates of early postoperative complications were comparable in the two groups (6.8% and 9.1%, respectively, p = 0.667) at the 1-year follow-up; remission of esophagitis occurred in one patient of the OAGB group (2.27%) compared with seven patients (15.9%) in the RYGB group (p = 0.014). No statistically significant differences were found between the two groups in the body mass index or the excess weight loss.
Conclusion:
This study supports the efficacy and safety of OAGB for revision of failed restrictive procedures. There remains concern regarding post-OAGB gastroesophageal reflux disease (GERD), and RYGB should be preferred in cases of preoperative GERD.
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References
1.
GBD 2015 Obesity Collaborators; AfshinA, ForouzanfarMH, ReitsmaMB, et al.Health effects of overweight and obesity in 195 countries over 25 Years. N Engl J Med, 2017; 377(1):13–27.
2.
WolfeBM, KvachE, EckelRH. Treatment of obesity: Weight loss and bariatric surgery. Circ Res, 2016; 118(11):1844–1855.
3.
CathelineJM, FysekidisM, BachnerI, et al.Five-year results of sleeve gastrectomy. J Visc Surg, 2013; 150(5):307–312.
4.
TrastulliS, DesiderioJ, GuarinoS, et al.Laparoscopic sleeve gastrectomy compared with other bariatric surgical procedures: A systematic review of randomized trials. Surg Obes Relat Dis, 2013; 9(5):816–829.
5.
van RuttePW, SmuldersJF, de ZoeteJP, et al.Outcome of sleeve gastrectomy as a primary bariatric procedure. Br J Surg, 2014; 101(6):661–668.
6.
FrancoJV, RuizPA, PalermoM, et al.A review of studies comparing three laparoscopic procedures in bariatric surgery: Sleeve gastrectomy, Roux-en-Y gastric bypass and adjustable gastric banding. Obes Surg, 2011; 21(9):1458–1468.
7.
BraghettoI, CsendesA. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg, 2016; 26(4):710–714.
8.
FelsenreichDM, KefurtR, SchermannM, et al.Reflux, sleeve dilation, and barrett’s esophagus after laparoscopic sleeve gastrectomy: Long-term follow-up. Obes Surg, 2017; 27(12):3092–3101.
9.
GencoA, SoricelliE, CasellaG, et al.Gastroesophageal reflux disease and barrett’s esophagus after laparoscopic sleeve gastrectomy: A possible, underestimated long-term complication. Surg Obesity Related Diseases, 2017; 13(4):568–574.
10.
StillCD, WoodGC, ChuX, et al.Clinical factors associated with weight loss outcomes after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring), 2014; 22(3):888–894.
11.
PuzziferriN, RoshekTB3rd, MayoHG, et al.Long-term follow-up after bariatric surgery: A systematic review. JAMA, 2014; 312(9):934–942.
12.
YorkeE, SheppardC, SwitzerNJ, et al.Revision of sleeve gastrectomy to Roux-en-Y Gastric Bypass: A Canadian experience. Am J Surg, 2017; 213(5):970–974.
13.
PędziwiatrM, MałczakP, WierdakM, et al.Revisional gastric bypass is inferior to primary gastric bypass in terms of short- and long-term outcomes-systematic review and meta-analysis. Obes Surg, 2018; 28(7):2083–2091.
14.
AngrisaniL, SantonicolaA, IovinoP, et al.Bariatric surgery survey 2018: Similarities and disparities among the 5 IFSO chapters. Obes Surg, 2021; 31(5):1937–1948.
15.
WuC, BaiR, YanW, et al.Clinical outcomes of one anastomosis gastric bypass versus sleeve gastrectomy for morbid obesity. Obes Surg, 2020; 30(3):1021–1031.
16.
PoublonN, ChidiI, BethlehemM, et al.One anastomosis gastric bypass vs. Roux-en-Y gastric bypass, remedy for insufficient weight loss and weight regain after failed restrictive bariatric surgery. Obes Surg, 2020; 30(9):3287–3294.
17.
Consensus Development Conference Panel. NIH conference. Gastrointestinal surgery for severe obesity. Ann Intern Med, 1991; 115(12):956–961.
18.
FriedM, HainerV, BasdevantA, et al.Interdisciplinary European guidelines on surgery of severe obesity. Obes Facts, 2008; 1(1):52–59.
19.
EisenbergD, ShikoraSA, AartsE, et al.2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for metabolic and bariatric surgery. Surg Obes Relat Dis, 2022; 18(12):1345–1356.
20.
Di LorenzoN, AntoniouSA, BatterhamRL, et al.Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: Update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg Endosc, 2020; 34(6):2332–2358.
21.
MannJP, JakesAD, HaydenJD, et al.Systematic review of definitions of failure in revisional bariatric surgery. Obes Surg, 2015; 25(3):571–574.
22.
LazouraO, ZacharoulisD, TriantafyllidisG, et al.Symptoms of gastroesophageal reflux following laparoscopic sleeve gastrectomy are related to the final shape of the sleeve as depicted by radiology. Obes Surg, 2011; 21(3):295–299.
23.
LundellLR, DentJ, BennettJR, et al.Endoscopic assessment of oesophagitis: Clinical and functional correlates and further validation of the Los Angeles classification. Gut, 1999; 45(2):172–180.
24.
van de LaarAWJM, AchermanYIZ. Weight loss percentile charts of large representative series: A benchmark defining sufficient weight loss challenging current criteria for success of bariatric surgery. Obes Surg, 2014; 24(5):727–734.
25.
BrethauerSA, KimJ, el ChaarM, et al.Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis, 2015; 11:489–506.
26.
AngrisaniL, SantonicolaA, IovinoP, et al.IFSO worldwide survey 2016: Primary, endoluminal, and revisional procedures. Obes Surg, 2018; 28(12):3783–3794.
27.
AltieriMS, YangJ, NieL, et al.Rate of revisions or conversion after bariatric surgery over 10 years in the state of New York. Surg Obes Relat Dis, 2018; 14(4):500–507.
28.
van GemertWG, van WerschMM, GreveJW, et al.Revisional surgery after failed vertical banded gastroplasty: Restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg., 1998; 8(1):21–28.
29.
ParmarCD, GanJ, StierC, et al.One Anastomosis/Mini Gastric Bypass (OAGB-MGB) as revisional bariatric surgery after failed primary adjustable gastric band (LAGB) and Sleeve Gastrectomy (SG): A systematic review of 1075 patients. Int J Surg, 2020; 81:32–38.
30.
LiX, HuX, FuC, et al.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(2):611–622; doi: 10.1007/s11695-022-06401-5
31.
HanyM, ZidanA, ElmonguiE, et al.Revisional Roux-en-Y gastric bypass versus revisional one-anastomosis gastric bypass after failed sleeve gastrectomy: A randomized controlled trial. Obes Surg, 2022; 32(11):3491–3503.
32.
SaadA, HassanM, SayedE. M. Evaluation of laparoscopic one-anastomosis gastric bypass as a revisional procedure for failed vertical-banded gastroplasty and adjustable gastric banding compared with laparoscopic Roux-en-Y gastric bypass. Egyp J Surg, 2021; 40(4):1137–1144.
33.
AlmalkiOM, LeeWJ, ChenJC, et al.Revisional gastric bypass for failed restrictive procedures: Comparison of single-anastomosis (Mini-) and Roux-en-Y gastric bypass. Obes Surg, 2018; 28(4):970–975.
34.
RobertM, EspalieuP, PelasciniE, et al.Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): A multicentre, randomised, open-label, non-inferiority trial. Lancet, 2019; 393(10178):1299–1309.
35.
PoghosyanT, CailleC, MoszkowiczD, et al.Roux-en-Y gastric bypass for the treatment of severe complications after omega-loop gastric bypass. Surg Obes Relat Dis, 2017; 13(6):988–994.
36.
NuzzoA, CzernichowS, HertigA, et al.Prevention and treatment of nutritional complications after bariatric surgery. Lancet Gastroenterol Hepatol, 2021; 6(3):238–251.
37.
PoghosyanT, KrivanS, BaratteC. Bile or acid reflux post one-anastomosis gastric bypass: What must we do? Still an unsolved enigma. J Clin Med, 2022; 11(12):3346.
38.
MusellaM, VitielloA. The eternal dilemma of the bile into the gastric pouch after OAGB: Do we need to worry? Obes Surg, 2021; 31(1):426–427.
39.
ToloneS, CristianoS, SavarinoE, et al.Effects of omega-loop bypass on esophagogastric junction function. Surg Obes Relat Dis, 2016; 12(1):62–69.
40.
TarhiniA, Rives-LangeC, JannotAS, et al.One-anastomosis gastric bypass revision for gastroesophageal reflux disease: Long versus short biliopancreatic limb Roux-en-Y gastric bypass. Obes Surg, 2022; 32(4):970–978.
41.
NehmehWA, BaratteC, Rives-LangeC, et al.Acid reflux is common in patients with gastroesophageal reflux disease after one-anastomosis gastric bypass. Obes Surg, 2021; 31(11):4717–4723.
SaarinenT, RäsänenJ, SaloJ, et al.Bile reflux scintigraphy after mini-gastric bypass. Obes Surg, 2017; 27(8):2083–2089.
44.
FelsenreichDM, SteinlechnerK, LangerFB, et al.Outcome of sleeve gastrectomy converted to Roux-en-Y gastric bypass and one-anastomosis gastric bypass. Obes Surg, 2022; 32(3):643–651.
45.
RaymanS, AssafD, AzranC, et al.Sleeve gastrectomy failure-revision to laparoscopic one-anastomosis gastric bypass or Roux-n-Y gastric bypass: A multicenter Study. Obes Surg, 2021; 31(7):2927–2934.
46.
DayanD, KananiF, BendayanA, et al.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(7):2125–2131.
47.
CheungD, SwitzerNJ, GillRS, et al.Revisional bariatric surgery following failed primary laparoscopic sleeve gastrectomy: A systematic review. Obes Surg, 2014; 24(10):1757–1763.
48.
ParmarCD, MahawarKK, BoyleM, et al.Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is effective for gastro-oesophageal reflux disease but not for further weight loss. Obes Surg, 2017; 27(7):1651–1658.
