Advertisement

Mini/One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass as a Second Step Procedure After Sleeve Gastrectomy—a Retrospective Cohort Study

  • Sonja ChiappettaEmail author
  • Christine Stier
  • Oliver Scheffel
  • Simone Squillante
  • Rudolf A. Weiner
Original Contribution
  • 68 Downloads

Abstract

Background

Whether one anastomosis gastric bypass (OAGB) or Roux-en-Y gastric bypass (RYGB) is a better revisional bariatric surgery (RBS) after sleeve gastrectomy (SG) is still under debate. The aim is to compare short-term outcomes of RYGB and OAGB as a RBS after SG, pertaining to their effects on weight loss, resolution of comorbidities, and complications.

Methods

We performed a single-center analysis of 55 patients (n = 34 OAGB, n = 21 RYGB). Indications for revisional surgery included weight regain/loss failure (67%) and intractable gastroesophageal reflux disease (33%). Data were collected up to 1-year follow-up (FU) and included time of revisional surgery, operation time, weight, body mass index, excess weight loss, and total weight loss (TWL), both in percent, complications and resolution of comorbidities.

Results

Operation time was 79 ± 36 (OAGB-MGB) and 98 ± 24 min (RYGB) (p = 0.03). In the first 30 postoperative days, three patients in the RYGB group, and no patient in the OAGB group, had postoperative complications. FU was 100%. Minor complication rates at 12 months were 33.3% (RYGB) and 35.3% (OAGB). At 12 months, mean % TWL was 10.3 ± 7.6% (RYGB) and 15.8 ± 7.8% (OAGB) (p = 0.0132).

Conclusions

OAGB after failed SG was found to be a quicker procedure with less perioperative complications. At 1-year FU, no significant differences were seen between RYGB and OAGB regarding readmission and minor complications. Still long-term FU including the risk of malnutrition is needed to have a complete evaluation of OAGB as a RBS for the future.

Keywords

OAGB-MGB RYGB SG Revisional surgery 

Abbreviations

SG

Sleeve gastrectomy

OAGB-MGB

One anastomosis gastric bypass-mini gastric bypass

RYGB

Roux-en-Y gastric bypass

GERD

Gastroesophageal reflux disease

FU

Follow-up

BPD/DS

Biliopancreatic diversion with duodenal switch

SD

Standard deviation

BMI

Body mass index

EWL

Excess weight loss

TWL

Total weight loss

PPI

Proton pump inhibitor

GERD-HRQL

GERD–Health-Related Quality of Life Questionnaire

BPL

Biliopancreatic limb

RSI

Reflux symptom index

RBS

Revisional bariatric surgery

Notes

Compliance with Ethical Standards

Conflict of Interest

All authors declare that they have no conflicts of interest.

Informed Consent

Informed consent was obtained from all the individual participants included in the study.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

References

  1. 1.
    Gadiot RP et al. Long-term results of laparoscopic sleeve gastrectomy for morbid obesity: 5 to 8-year results. Obes Surg. 2017;27(1):59–63.CrossRefGoogle Scholar
  2. 2.
    Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252(2):319–24.CrossRefGoogle Scholar
  3. 3.
    Arman GA, Himpens J, Dhaenens J, et al. Long-term (11+years) outcomes in weight, patient satisfaction, comorbidities, and gastroesophageal reflux treatment after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(10):1778–86.CrossRefGoogle Scholar
  4. 4.
    Felsenreich DM, Langer FB, Kefurt R, et al. Weight loss, weight regain, and conversions to Roux-en-Y gastric bypass: 10-year results of laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2016;12(9):1655–62.CrossRefGoogle Scholar
  5. 5.
    Braghetto I, Csendes A. Prevalence of Barrett’s esophagus in bariatric patients undergoing sleeve gastrectomy. Obes Surg. 2016;26(4):710–4.CrossRefGoogle Scholar
  6. 6.
    Weiner RA, Theodoridou S, Weiner S. Failure of laparoscopic sleeve gastrectomy—further procedure? Obes Facts. 2011;4(Suppl 1):42–6.Google Scholar
  7. 7.
    El Chaar M et al. Indications for revisions following 630 consecutive laparoscopic sleeve gastrectomy cases: experience in a single accredited center. J Gastrointest Surg. 2017;21(1):12–6.CrossRefGoogle Scholar
  8. 8.
    Homan J, Betzel B, Aarts EO, et al. Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2015;11(4):771–7.CrossRefGoogle Scholar
  9. 9.
    Casillas RA, Um SS, Zelada Getty JL, et al. Revision of primary sleeve gastrectomy to Roux-en-Y gastric bypass: indications and outcomes from a high-volume center. Surg Obes Relat Dis. 2016;12(10):1817–25.CrossRefGoogle Scholar
  10. 10.
    Sarela AI, Dexter SPL, O’Kane M, et al. Long-term follow-up after laparoscopic sleeve gastrectomy: 8–9-year results. Surg Obes Relat Dis. 2012;8(6):679–84.CrossRefGoogle Scholar
  11. 11.
    Diamantis T, Apostolou KG, Alexandrou A, et al. Review of long-term weight loss results after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2014;10(1):177–83.CrossRefGoogle Scholar
  12. 12.
    Bohdjalian A, Langer FB, Shakeri-Leidenmühler S, et al. Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg. 2010;20(5):535–40.CrossRefGoogle Scholar
  13. 13.
    Lauti M, Kularatna M, Hill AG, et al. Weight regain following sleeve gastrectomy—a systematic review. Obes Surg. 2016;26(6):1326–34.CrossRefGoogle Scholar
  14. 14.
    Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis. 2017;13(4):568–74.CrossRefGoogle Scholar
  15. 15.
    De Luca M et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSO position statement. Obes Surg. 2018;28(5):1188–206.CrossRefGoogle Scholar
  16. 16.
    Jammu GS, Sharma R. A 7-year clinical audit of 1107 cases comparing sleeve gastrectomy, Roux-en-Y gastric bypass, and mini-gastric bypass, to determine an effective and safe bariatric and metabolic procedure. Obes Surg. 2016;26(5):926–32.CrossRefGoogle Scholar
  17. 17.
    Disse E, Pasquer A, Espalieu P, et al. Greater weight loss with the omega loop bypass compared to the Roux-en-Y gastric bypass: a comparative study. Obes Surg. 2014;24(6):841–6.CrossRefGoogle Scholar
  18. 18.
    Cavin JB, Voitellier E, Cluzeaud F, et al. Malabsorption and intestinal adaptation after one anastomosis gastric bypass compared with Roux-en-Y gastric bypass in rats. Am J Physiol Gastrointest Liver Physiol. 2016;311(3):G492–500.CrossRefGoogle Scholar
  19. 19.
    Musella M, Susa A, Manno E, et al. Complications following the mini/one anastomosis gastric bypass (MGB/OAGB): a multi-institutional survey on 2678 patients with a mid-term (5 years) follow-up. Obes Surg. 2017;27(11):2956–67.CrossRefGoogle Scholar
  20. 20.
    Bruzzi M, Voron T, Zinzindohoue F, et al. Revisional single-anastomosis gastric bypass for a failed restrictive procedure: 5-year results. Surg Obes Relat Dis. 2016;12(2):240–5.CrossRefGoogle Scholar
  21. 21.
    Moszkowicz D, Rau C, Guenzi M, et al. Laparoscopic omega-loop gastric bypass for the conversion of failed sleeve gastrectomy: early experience. J Visc Surg. 2013;150(6):373–8.CrossRefGoogle Scholar
  22. 22.
    Chiappetta S, Stier C, Squillante S, et al. The importance of the Edmonton Obesity Staging System in predicting postoperative outcome and 30-day mortality after metabolic surgery. Surg Obes Relat Dis. 2016;12(10):1847–55.CrossRefGoogle Scholar
  23. 23.
    Agha RA, Borrelli MR, Vella-Baldacchino M, et al. The STROCSS statement: strengthening the reporting of cohort studies in surgery. Int J Surg. 2017;46:198–202.CrossRefGoogle Scholar
  24. 24.
    Velanovich V. The development of the GERD-HRQL symptom severity instrument. Dis Esophagus. 2007;20(2):130–4.CrossRefGoogle Scholar
  25. 25.
    Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002;16(2):274–7.CrossRefGoogle Scholar
  26. 26.
    Shantavasinkul PC, Omotosho P, Corsino L, et al. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2016;12(9):1640–5.CrossRefGoogle Scholar
  27. 27.
    Brethauer SA, Kim J, el Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506.CrossRefGoogle Scholar
  28. 28.
    Lee WJ, Ser KH, Lee YC, et al. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22(12):1827–34.CrossRefGoogle Scholar
  29. 29.
    Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242(1):20–8.CrossRefGoogle Scholar
  30. 30.
    Tolone S, Cristiano S, Savarino E, et al. Effects of omega-loop bypass on esophagogastric junction function. Surg Obes Relat Dis. 2016;12(1):62–9.CrossRefGoogle Scholar
  31. 31.
    Dolan K, Hatzifotis M, Newbury L, et al. A clinical and nutritional comparison of biliopancreatic diversion with and without duodenal switch. Ann Surg. 2004;240(1):51–6.CrossRefGoogle Scholar
  32. 32.
    Slater GH et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8(1):48–55. discussion 54-5CrossRefGoogle Scholar
  33. 33.
    Cheung D, Switzer NJ, Gill RS, et al. Revisional bariatric surgery following failed primary laparoscopic sleeve gastrectomy: a systematic review. Obes Surg. 2014;24(10):1757–63.CrossRefGoogle Scholar
  34. 34.
    Noun R, Zeidan S, Riachi E, et al. Mini-gastric bypass for revision of failed primary restrictive procedures: a valuable option. Obes Surg. 2007;17(5):684–8.CrossRefGoogle Scholar
  35. 35.
    Quezada N, Hernández J, Pérez G, et al. Laparoscopic sleeve gastrectomy conversion to Roux-en-Y gastric bypass: experience in 50 patients after 1 to 3 years of follow-up. Surg Obes Relat Dis. 2016;12(8):1611–5.CrossRefGoogle Scholar
  36. 36.
    Poghosyan T, Lazzati A, Moszkowicz D, et al. Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: an audit of 34 patients. Surg Obes Relat Dis. 2016;12(9):1646–51.CrossRefGoogle Scholar
  37. 37.
    Carmeli I, Golomb I, Sadot E, et al. Laparoscopic conversion of sleeve gastrectomy to a biliopancreatic diversion with duodenal switch or a Roux-en-Y gastric bypass due to weight loss failure: our algorithm. Surg Obes Relat Dis. 2015;11(1):79–85.CrossRefGoogle Scholar
  38. 38.
    Parmar CD, Mahawar KK, Boyle M, 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):1651–8.CrossRefGoogle Scholar
  39. 39.
    Mahawar KK, Kumar P, Parmar C, et al. Small bowel limb lengths and Roux-en-Y gastric bypass: a systematic review. Obes Surg. 2016;26(3):660–71.CrossRefGoogle Scholar
  40. 40.
    Luis F, Zorrilla-Nunez, AC, Giambartolomei G, et al. The importance of the biliopancreatic limb length in gastric bypass: a systematic review. SOARD, 2018.Google Scholar
  41. 41.
    Disse E, Pasquer A, Pelascini E, et al. Dilatation of sleeve gastrectomy: myth or reality? Obes Surg. 2017;27(1):30–7.CrossRefGoogle Scholar
  42. 42.
    Muller-Stich BP et al. Laparoscopic mesh-augmented hiatoplasty with cardiophrenicopexy versus laparoscopic Nissen fundoplication for the treatment of gastroesophageal reflux disease: a double-center randomized controlled trial. Ann Surg. 2015;262(5):721–5. discussion 725-7CrossRefGoogle Scholar
  43. 43.
    Stefanidis D, Malireddy K, Kuwada T, et al. Revisional bariatric surgery: perioperative morbidity is determined by type of procedure. Surg Endosc. 2013;27(12):4504–10.CrossRefGoogle Scholar
  44. 44.
    Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16(9):1138–44.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obesity and Metabolic SurgerySana Klinikum OffenbachOffenbach am MainGermany
  2. 2.AdipositaszentrumUniversity Hospital of WürzburgWürzburgGermany
  3. 3.Department of General SurgeryOspedale del MareNaplesItaly

Personalised recommendations