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Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) for Biliary Reflux Resistant to Medical Treatment: Lessons Learned from a Retrospective Series of 2780 Consecutive Patients Undergoing OAGB

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Biliary reflux resistant to medical treatment has an incidence of 0.6–10% after one anastomosis gastric bypass (OAGB) and may be a reason for revisional surgery. The aim of this study is to report the results of a single-institution series of patients who underwent conversion from OAGB to Roux-en-Y gastric bypass (RYGB) for biliary reflux.


Data of OAGB patients converted to RYGB between May 2010 and December 2017 were prospectively collected and retrospectively analyzed. The afferent limb was sectioned proximally to the gastrojejunal anastomosis. A jejuno-jejunal latero-lateral anastomosis was performed between the biliary and alimentary limb. The final RYGB had an alimentary limb of 100 cm and a biliary limb of 150 cm.


During the study period, 2780 patients underwent OAGB. A total of 32 patients (1.2%) underwent conversion from OAGB to RYGB for biliary reflux, at a mean of 30.3 months from OAGB. Mean weight before RYGB was 70.6 kg, and mean body mass index BMI was 26 kg/m2. Four patients experienced postoperative complications (12.5%). Patients’ mean weight was 74.3 kg at 24 months follow-up, with BMI of 27.2 kg/m2. Conversion to RYGB relieved symptoms of biliary reflux in all patients but 2 (93.8%).


Biliary reflux although rare can complicate OAGB. RYGB is a safe and feasible technique of revision in this case. A shorter length of the afferent limb during the initial operation facilitates the revision.

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  1. 1.

    Parmar CD, Mahawar KK. One anastomosis (mini) gastric bypass is now an established bariatric procedure: a systematic review of 12,807 patients. Obes Surg. 2018;28(9):2956–67.

  2. 2.

    De Luca M, Tie T, Ooi G, et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSO position statement. Obes Surg. 2018;28(5):1188–206.

  3. 3.

    Carbajo MA, Luque-de-León E, Jiménez JM, et al. Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 patients. Obes Surg. 2017;27(5):1153–67.

  4. 4.

    Haddad A, Fobi M, Bashir A, et al. Outcomes of one anastomosis gastric bypass in the IFSO Middle East North Africa (MENA) region. Obes Surg. 2019;29(8):2409–14.

  5. 5.

    Musella M, Apers J, Rheinwalt K, et al. Efficacy of bariatric surgery in type 2 diabetes mellitus remission: the role of mini gastric bypass/one anastomosis gastric bypass and sleeve Gastrectomy at 1 year of follow-up. A European survey Obes Surg. 2016;26(5):933–40.

  6. 6.

    Robert M, Espalieu P, Pelascini E, 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):1299–309.

  7. 7.

    Debs T, Petrucciani N, Kassir R, et al. Trends of bariatric surgery in France during the last 10 years: analysis of 267,466 procedures from 2005-2014. Surg Obes Relat Dis. 2016 Oct;12(8):1602–9.

  8. 8.

    Ruiz-Tovar J, Carbajo MA, Jimenez JM, et al. Long-term follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a prospective randomized comparative study of weight loss and remission of comorbidities. Surg Endosc. 2019;33(2):401–10.

  9. 9.

    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.

  10. 10.

    Bruzzi M, Chevallier J-M, Czernichow S. One-anastomosis gastric bypass: why biliary reflux remains controversial? Obes Surg. 2017;27(2):545–7.

  11. 11.

    Chevallier JM, Arman GA, Guenzi M, et al. One thousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy. Obes Surg. 2015 Jun;25(6):951–8.

  12. 12.

    Greene CL, Worrell SG, DeMeester TR. Rat reflux model of esophageal cancer and its implication in human disease. Ann Surg. 2015;262(6):910–24.

  13. 13.

    Brown CS, Lapin B, Wang C, et al. Reflux control is important in the management of Barrett’s esophagus: results from a retrospective 1,830 patient cohort. Surg Endosc. 2015;29(12):3528–34.

  14. 14.

    Musella M, Berardi G, Bocchetti A, et al. Esophagogastric neoplasms following bariatric surgery: an updated systematic review. Obes Surg. 2019;29(8):2660–9.

  15. 15.

    Scozzari G, Trapani R, Toppino M, et al. Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surg Obes Relat Dis. 2013 Feb;9(1):133–42.

  16. 16.

    Guirat A, Addossari HM. One anastomosis gastric bypass and risk of Cancer. Obes Surg. 2018;28(5):1441–4.

  17. 17.

    Keleidari B, Mahmoudieh M, Davarpanah Jazi AH, et al. Comparison of the bile reflux frequency in one anastomosis gastric bypass and Roux-en-Y gastric bypass: a cohort study. Obes Surg. 2019;29(6):1721–5.

  18. 18.

    Amor IB, Petrucciani N, Kassir R, et al. Laparoscopic conversion of one anastomosis gastric bypass to a standard Roux-en-Y gastric bypass. Obes Surg. 2017;27(5):1398.

  19. 19.

    Bolckmans R, Arman G, Himpens J. Efficiency and risks of laparoscopic conversion of omega anastomosis gastric bypass to Roux-en-Y gastric bypass. Surg Endosc. 2019;33(8):2572–82.

  20. 20.

    Godina M, Nagliati C, Menegon P, et al. Emergency laparoscopic conversion from mini/one anastomosis gastric bypass to modified Roux-en-Y-gastric bypass due to acute bleeding from a recurrent marginal ulcer. Updat Surg. 2017;69(3):421–4.

  21. 21.

    Nimeri A, Al Shaban T, Maasher A. Conversion of one anastomosis gastric bypass/mini gastric bypass to Roux-en-Y gastric bypass for bile reflux gastritis after failed Braun jejunojejunostomy. Surg Obes Relat Dis. 2017;13(2):361–3.

  22. 22.

    Facchiano E, Leuratti L, Veltri M, et al. Laparoscopic conversion of one anastomosis gastric bypass to Roux-en-Y gastric bypass for chronic bile reflux. Obes Surg. 2016;26(3):701–3.

  23. 23.

    Kassir R, Alamri T, Lointier P. Laparoscopic conversion of omega loop gastric bypass into Roux-en-Y gastric bypass. Obes Surg. 2017;27(5):1392–3.

  24. 24.

    Poghosyan T, Caille C, Moszkowicz D, 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):988–94.

  25. 25.

    Johnson WH, Fernanadez AZ, Farrell TM, et al. Surgical revision of loop (“mini”) gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(1):37–41.

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Correspondence to Niccolo Petrucciani.

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Kassir, R., Petrucciani, N., Debs, T. et al. Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) for Biliary Reflux Resistant to Medical Treatment: Lessons Learned from a Retrospective Series of 2780 Consecutive Patients Undergoing OAGB. OBES SURG (2020). https://doi.org/10.1007/s11695-020-04460-0

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  • Bariatric surgery
  • One anastomosis gastric bypass
  • Postoperative complications
  • Bile reflux
  • Roux-en-Y gastric bypass
  • Revision
  • Surgical