Kamal K Mahawar1,2, Chetan Parmar3, Yitka Graham4,5. 1. Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK - kmahawar@gmail.com. 2. Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK - kmahawar@gmail.com. 3. Whittington Hospital NHS Trust, London, UK. 4. Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK. 5. Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.
Abstract
INTRODUCTION: One anastomosis gastric bypass (OAGB) is now a recognized mainstream bariatric procedure being adopted by an increasing number of surgeons. The purpose of this review was to present an evidence-based summary of its key technical aspects and prevention and management of its specific complications. EVIDENCE ACQUISITION: We examined PubMed for all published articles on OAGB, including the ones published under one of its various other names. EVIDENCE SYNTHESIS: An ideal OAGB procedure has a long, narrow pouch constructed carefully to avoid going too close to the greater curvature of the stomach especially at the bottom of the pouch and maintains a safe distance from the angle of His. A bilio-pancreatic limb length of 150 cm appears to be safest and a limb length of >200 cm is associated with a significantly increased incidence of protein-calorie malnutrition. We recommend routine closure of Petersen's space to prevent Petersen's hernia and suggest a protocol for micronutrient supplementation. This review also presents evidence-based algorithms for prevention and management of marginal ulcers, protein-calorie malnutrition, and gastroesophageal reflux disease after OAGB. We suggest lifelong supplementation with two multivitamin/mineral supplements (each containing at least 1.0 mg copper and 15 mg zinc) daily, 1.5 mg vitamin B12 orally daily or 3-monthly injection with 1 mg vitamin B12, 120 mg elemental iron daily, 1500 mg elemental calcium daily, and 3000 international units of vitamin D daily. CONCLUSIONS: This review examines key technical steps of OAGB. We also discuss how to prevent and manage its specific complications.
INTRODUCTION: One anastomosis gastric bypass (OAGB) is now a recognized mainstream bariatric procedure being adopted by an increasing number of surgeons. The purpose of this review was to present an evidence-based summary of its key technical aspects and prevention and management of its specific complications. EVIDENCE ACQUISITION: We examined PubMed for all published articles on OAGB, including the ones published under one of its various other names. EVIDENCE SYNTHESIS: An ideal OAGB procedure has a long, narrow pouch constructed carefully to avoid going too close to the greater curvature of the stomach especially at the bottom of the pouch and maintains a safe distance from the angle of His. A bilio-pancreatic limb length of 150 cm appears to be safest and a limb length of >200 cm is associated with a significantly increased incidence of protein-calorie malnutrition. We recommend routine closure of Petersen's space to prevent Petersen's hernia and suggest a protocol for micronutrient supplementation. This review also presents evidence-based algorithms for prevention and management of marginal ulcers, protein-calorie malnutrition, and gastroesophageal reflux disease after OAGB. We suggest lifelong supplementation with two multivitamin/mineral supplements (each containing at least 1.0 mg copper and 15 mg zinc) daily, 1.5 mg vitamin B12 orally daily or 3-monthly injection with 1 mg vitamin B12, 120 mg elemental iron daily, 1500 mg elemental calcium daily, and 3000 international units of vitamin D daily. CONCLUSIONS: This review examines key technical steps of OAGB. We also discuss how to prevent and manage its specific complications.
Authors: Mohammad Kermansaravi; Amir Hossein DavarpanahJazi; Shahab ShahabiShahmiri; Miguel Carbajo; Antonio Vitiello; Chetan D Parmar; Mario Musella Journal: Obes Surg Date: 2021-02-17 Impact factor: 4.129
Authors: Mary O'Kane; Helen M Parretti; Jonathan Pinkney; Richard Welbourn; Carly A Hughes; Jessica Mok; Nerissa Walker; Denise Thomas; Jennifer Devin; Karen D Coulman; Gail Pinnock; Rachel L Batterham; Kamal K Mahawar; Manisha Sharma; Alex I Blakemore; Iris McMillan; Julian H Barth Journal: Obes Rev Date: 2020-08-02 Impact factor: 9.213