The IFSO Worldwide One Anastomosis Gastric Bypass Survey: Techniques and Outcomes?

Abstract

Introduction

One anastomosis gastric bypass (OAGB) has become one of the most commonly performed gastric bypass procedures in some countries.

Objectives

To assess how surgeons viewed the OAGB, perceptions, indications, techniques, and outcomes, as well as the incidence of short- and long-term complications and how they were managed worldwide.

Methods

A questionnaire was sent to all IFSO members in all 5 chapters to study the pattern of practice and outcomes of OAGB.

Results

Seven hundred and forty-two surgeons responded. The most commonly performed procedures were sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and OAGB. Preoperatively, 70% of the surgeons performed endoscopy routinely. In regards to weight loss, 83% (570 surgeons) responded that OAGB produces better weight loss than SG, and 49% (342 surgeons) responded that OAGB produces better weight loss than RYGB. The most common length of the biliopancreatic limb (BPL) utilized was 200 cm. Sixty-seven percent of surgeons did not measure the total length of the small bowel. In patients with reflux disease and history of smoking, 53% and 22% of surgeons respectively still offered OAGB as a treatment option. Postoperatively, leak was documented in 963 patients, and it was the leading cause for mortality. Leak management was conservative in 35%. Conversion to RYGB was performed in 31%. In 16% the anastomosis was reinforced, 6% of the patients were reversed, and other procedures were performed in 12%. Revision of OAGB for malnutrition/steatorrhea or severe bile reflux was reported at least once by 37% and 45% of surgeons, respectively (200 cm was the most commonly encountered biliopancreatic limb BPL in those revised for malnutrition). Most common strategy for revision was conversion to RYGB (43%), reversal to normal anatomy (32%), shortening of the BPL (20%), and conversion to SG (5%). Nevertheless, 5 out of 98 mortalities (5%) were due to liver failure/malnutrition.

Conclusion

There are infrequent but potentially severe specific complications including malnutrition, liver failure, and bile reflux that may require surgical correction after OAGB.

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References

  1. 1.

    Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001;11(3):276–80. https://doi.org/10.1381/096089201321336584.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28(12):3783–94. https://doi.org/10.1007/s11695-018-3450-2.

    Article  PubMed  Google Scholar 

  3. 3.

    Musella M, Susa A, Greco F, et al. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc. 2014;28(1):156–63. https://doi.org/10.1007/s00464-013-3141-y.

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Musella M, Susa A, Manno E, et al. Complications following the mini/one anastomosis gastric bypass (MGB/OAGB): a multiinstitutional survey on 2678 patients with a mid-term (5 years) follow-up. Obes Surg. 2017;27(11):2956–67. https://doi.org/10.1007/s11695-017-2726-2.

    Article  PubMed  Google Scholar 

  5. 5.

    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. https://doi.org/10.1016/j.soard.2015.08.521.

    Article  PubMed  Google Scholar 

  6. 6.

    Taha O, Abdelaal M, Abozeid M, et al. Outcomes of omega loop gastric bypass, 6-years experience of 1520 cases. Obes Surg. 2017;27(8):1952–60. https://doi.org/10.1007/s11695-017-2623-8.

    Article  PubMed  Google Scholar 

  7. 7.

    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. https://doi.org/10.1007/s11695-016-2428-1.

    Article  PubMed  Google Scholar 

  8. 8.

    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. https://doi.org/10.1007/s11695-015-2017-8.

    Article  PubMed  Google Scholar 

  9. 9.

    Nimeri A, Al Shaban T, Maasher A. Laparoscopic conversion of one anastomosis gastric bypass/mini gastric bypass to Roux-en-Y gastric bypass for bile reflux gastritis. Surg Obes Relat Dis. 2017;13(1):119–21. https://doi.org/10.1016/j.soard.2016.09.033.

    Article  PubMed  Google Scholar 

  10. 10.

    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. https://doi.org/10.1016/j.soard.2016.10.022.

    Article  PubMed  Google Scholar 

  11. 11.

    Haddad A, Bashir A, Nimeri A. Gastrogastric fistula: an unusual cause for severe bile reflux following conversion of sleeve gastrectomy to one anastomosis gastric bypass. Obes Surg. 2018;28(7):2151–3. https://doi.org/10.1007/s11695-018-3288-7.

    Article  PubMed  Google Scholar 

  12. 12.

    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. https://doi.org/10.1007/s11695-019-03881-w.

    Article  PubMed  Google Scholar 

  13. 13.

    Kular KS, Manchanda N, Rutledge R. Analysis of the five-year outcomes of sleeve gastrectomy and mini gastric bypass: a report from the Indian sub-continent. Obes Surg. 2014;24(10):1724–8. https://doi.org/10.1007/s11695-014-1264-4.

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Magouliotis DE, Tasiopoulou VS, Svokos AA, et al. One-anastomosis gastric bypass versus sleeve gastrectomy for morbid obesity: a systematic review and meta-analysis. Obes Surg. 2017;27(9):2479–87. https://doi.org/10.1007/s11695-017-2807-2.

    Article  PubMed  Google Scholar 

  15. 15.

    Madhok B, Mahawar KK, Boyle M, et al. Management of super-super obese patients: comparison between mini (one anastomosis) gastric bypass and sleeve gastrectomy. Obes Surg. 2016;26(7):1646–9. https://doi.org/10.1007/s11695-016-2181-5.

    Article  PubMed  Google Scholar 

  16. 16.

    Bruzzi M, Rau C, Voron T, et al. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis. 2015;11(2):321–6. https://doi.org/10.1016/j.soard.2014.09.004.

    Article  PubMed  Google Scholar 

  17. 17.

    Liagre A, Debs T, Kassir R, et al. One anastomosis gastric bypass with a biliopancreatic limb of 150 cm: weight loss, nutritional outcomes, endoscopic results, and quality of life at 8-year follow-up. Obes Surg. 2020;30(11):4206–17. https://doi.org/10.1007/s11695-020-04775-y.

    Article  PubMed  Google Scholar 

  18. 18.

    Sheikh L, Pearless LA, Booth MW. Laparoscopic silastic ring mini-gastric bypass (SR-MGBP): up to 11-year results from a single centre. Obes Surg. 2017;27(9):2229–34. https://doi.org/10.1007/s11695-017-2659-9.

    Article  PubMed  Google Scholar 

  19. 19.

    Higa K, Ho T, Tercero F, et al. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25. https://doi.org/10.1016/j.soard.2010.10.019.

    Article  PubMed  Google Scholar 

  20. 20.

    Adams TD, Davidson LE, Litwin SE, et al. Health benefits of gastric bypass surgery after 6 years. JAMA. 2012;308(11):1122–31. https://doi.org/10.1001/2012.jama.11164.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Adams TD, Davidson LE, Litwin SE, et al. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–55. https://doi.org/10.1056/NEJMoa1700459.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    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. https://doi.org/10.1016/S0140-6736(19)30475-1. Erratum in: Lancet. 2019 Mar 30;393(10178):1298.

    Article  PubMed  Google Scholar 

  23. 23.

    Bhandari M, Nautiyal HK, Kosta S, et al. Comparison of one-anastomosis gastric bypass and Roux-en-Y gastric bypass for treatment of obesity: a 5-year study. Surg Obes Relat Dis. 2019;15(12):2038–44. https://doi.org/10.1016/j.soard.2019.05.025.

    Article  PubMed  Google Scholar 

  24. 24.

    O'Brien PE, Hindle A, Brennan L, et al. Long-term outcomes after bariatric surgery: a systematic review and meta-analysis of weight loss at 10 or more years for all bariatric procedures and a single-centre review of 20-year outcomes after adjustable gastric banding. Obes Surg. 2019;29(1):3–14. https://doi.org/10.1007/s11695-018-3525-0.

    Article  PubMed  Google Scholar 

  25. 25.

    Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22(5):697–703. https://doi.org/10.1007/s11695-012-0618-z.

    Article  PubMed  Google Scholar 

  26. 26.

    Wilson JA, Romagnuolo J, Byrne TK, et al. Predictors of endoscopic findings after Roux-en-Y gastric bypass. Am J Gastroenterol. 2006;101(10):2194–9. https://doi.org/10.1111/j.1572-0241.2006.00770.x.

    Article  PubMed  Google Scholar 

  27. 27.

    Coblijn UK, Lagarde SM, de Castro SM, et al. Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg. 2015;25(5):805–11. https://doi.org/10.1007/s11695-014-1482-9.

    Article  PubMed  Google Scholar 

  28. 28.

    Beaupel N, Bruzzi M, Voron T, et al. Management of acute intra-abdominal sepsis caused by leakage after one anastomosis gastric bypass. Surg Obes Relat Dis. 2017;13(8):1297–305. https://doi.org/10.1016/j.soard.2017.04.008.

    Article  PubMed  Google Scholar 

  29. 29.

    Genser L, Carandina S, Tabbara M, et al. Presentation and surgical management of leaks after mini-gastric bypass for morbid obesity. Surg Obes Relat Dis. 2016;12(2):305–12. https://doi.org/10.1016/j.soard.2015.06.010.

    Article  PubMed  Google Scholar 

  30. 30.

    Liagre A, Queralto M, Juglard G, et al. Multidisciplinary management of leaks after one-anastomosis gastric bypass in a single-center series of 2780 consecutive patients. Obes Surg. 2019;29(5):1452–61. https://doi.org/10.1007/s11695-019-03754-2.

    Article  PubMed  Google Scholar 

  31. 31.

    Tacchino RM. Bowel length: measurement, predictors, and impact on bariatric and metabolic surgery. Surg Obes Relat Dis. 2015;11(2):328–34. https://doi.org/10.1016/j.soard.2014.09.016.

    Article  PubMed  Google Scholar 

  32. 32.

    Nabil TM, Khalil AH, Mikhail S, et al. Conventional versus distal laparoscopic one-anastomosis gastric bypass: a randomized controlled trial with 1-year follow-up. Obes Surg. 2019;29(10):3103–10. https://doi.org/10.1007/s11695-019-03991-5.

    Article  PubMed  Google Scholar 

  33. 33.

    Pizza F, Lucido FS, D'Antonio D, et al. Biliopancreatic limb length in one anastomosis gastric bypass: which is the best? Obes Surg. 2020;30(10):3685–94. https://doi.org/10.1007/s11695-020-04687-x.

    Article  PubMed  Google Scholar 

  34. 34.

    Khalaj A, Kalantar Motamedi MA, Mousapour P, et al. Protein-calorie malnutrition requiring revisional surgery after one-anastomosis-mini-gastric bypass (OAGB-MGB): case series from the Tehran Obesity Treatment Study (TOTS). Obes Surg. 2019;29(6):1714–20. https://doi.org/10.1007/s11695-019-03741-7.

    Article  PubMed  Google Scholar 

  35. 35.

    Motamedi MAK, Barzin M, Ebrahimi M, et al. Severe fatal protein malnutrition and liver failure in a morbidly obese patient after mini-gastric bypass surgery: case report. Int J Surg Case Rep. 2017;33:71–4. https://doi.org/10.1016/j.ijscr.2017.02.033.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Eilenberg M, Langer FB, Beer A, et al. Significant liver-related morbidity after bariatric surgery and its reversal-a case series. Obes Surg. 2018;28(3):812–9. https://doi.org/10.1007/s11695-017-2925-x.

    Article  PubMed  Google Scholar 

  37. 37.

    Addeo P, Cesaretti M, Anty R, et al. Liver transplantation for bariatric surgery-related liver failure: a systematic review of a rare condition. Surg Obes Relat Dis. 2019;15(8):1394–401. https://doi.org/10.1016/j.soard.2019.06.002.

    Article  PubMed  Google Scholar 

  38. 38.

    Saarinen T, Pietiläinen KH, Loimaala A, et al. Bile reflux is a common finding in the gastric pouch after one anastomosis gastric bypass. Obes Surg. 2020;30(3):875–81. https://doi.org/10.1007/s11695-019-04353-x.

    Article  PubMed  Google Scholar 

  39. 39.

    Bruzzi M, Duboc H, Gronnier C, et al. Long-term evaluation of biliary reflux after experimental one-anastomosis gastric bypass in rats. Obes Surg. 2017;27(4):1119–22. https://doi.org/10.1007/s11695-017-2577-x.

    Article  PubMed  Google Scholar 

  40. 40.

    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;30(6):2093–8. https://doi.org/10.1007/s11695-020-04460-0.

    Article  PubMed  Google Scholar 

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Correspondence to Ashraf Haddad.

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Conflict of Interest

Ashraf Haddad, Ahmad Bashir, Kelvin Higa, Miguel Herrera, Almino Ramos, Antonio Torres, and Lilian Kow do not have any conflict of interests.

Mathias Fobi is the founding President of Bariatric Corporation, Maker of Rings for Bariatric operations.

Jacques Himpens reports personal fees from J&J and Medtronic, outside the submitted work.

Scott Shikora is the Editor-in-Chief of Obesity Surgery Journal.

Abdelrahman Nimeri reports personal fees from Medtronic, outside the submitted work.

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Haddad, A., Bashir, A., Fobi, M. et al. The IFSO Worldwide One Anastomosis Gastric Bypass Survey: Techniques and Outcomes?. OBES SURG (2021). https://doi.org/10.1007/s11695-021-05249-5

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Keywords

  • One anastomosis gastric bypass
  • Gastric bypass
  • Mini gastric bypass
  • Biliopancreatic limb length
  • Postoperative leak
  • Bile reflux
  • Malnutrition
  • Liver failure
  • Postoperative complications
  • Revision of one anastomosis gastric bypass