Alireza Khalaj1, Pouria Mousapour2, Mohammad Ali Kalantar Motamedi3, Maryam Mahdavi2, Majid Valizadeh2, Farhad Hosseinpanah2, Maryam Barzin4. 1. Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran. 2. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 3. Department of Surgery at St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada. 4. Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. m.barzin7@gmail.com.
Abstract
PURPOSE: One-anastomosis gastric bypass (OAGB) has raised concerns about nutritional complications possibly attributed to the biliopancreatic limb (BPL) length. We aimed to assess the results of a conservative approach of OAGB compared with the original OAGB and Roux-en-Y gastric bypass (RYGB) in a 1-year follow-up study. MATERIALS AND METHODS: This retrospective study was conducted based on prospectively maintained data in a cohort of patients who underwent either RYGB with a Roux limb of a 150 cm and a BPL of 50 cm (n = 145), OAGB with a 200-cm BPL (n = 272), or OAGB with a 160-cm BPL (n = 383), from March 2013 to 2017 at three university hospitals by a single surgical team. RESULTS: Groups were comparable regarding age and sex. Mean preoperative body mass indexes of the RYGB, OAGB-160, and OAGB-200 groups were 44.5 ± 5.8, 45.6 ± 6.3, and 46.7 ± 6.4 kg/m2, respectively. One-year follow-up rates were 83.4%, 85.3%, and 82.5% for the RYGB, OAGB-200, and OAGB-160 groups, respectively. One-year percent total weight loss values were 33.8 ± 6.7 after OAGB-160 and 35.3 ± 6.9 after OAGB-200 (P = 0.056), which were significantly greater compared with 30.9 ± 8.9 after RYGB (P < 0.001). All groups were comparable regarding remission of type 2 diabetes mellitus, hypertension, dyslipidemia, and fatty liver. Mean operative time was longer with RYGB than with either OAGB techniques. Groups were comparable for postoperative complications except for the incidence of protein-calorie malnutrition (PCM), occurring in 11 patients (4.7%) after OAGB-200, 7 of whom required revisional surgery, in one patient (0.3%) after OAGB-160 who responded to parenteral alimentation, but in no patients after RYGB. CONCLUSION: After 1 year, OAGB with a 160-cm BPL was as effective as OAGB with a 200-cm BPL and RYGB, but safer than OAGB-200. This approach also avoided the need for revisional surgery following postoperative malnutrition.
PURPOSE: One-anastomosis gastric bypass (OAGB) has raised concerns about nutritional complications possibly attributed to the biliopancreatic limb (BPL) length. We aimed to assess the results of a conservative approach of OAGB compared with the original OAGB and Roux-en-Y gastric bypass (RYGB) in a 1-year follow-up study. MATERIALS AND METHODS: This retrospective study was conducted based on prospectively maintained data in a cohort of patients who underwent either RYGB with a Roux limb of a 150 cm and a BPL of 50 cm (n = 145), OAGB with a 200-cm BPL (n = 272), or OAGB with a 160-cm BPL (n = 383), from March 2013 to 2017 at three university hospitals by a single surgical team. RESULTS: Groups were comparable regarding age and sex. Mean preoperative body mass indexes of the RYGB, OAGB-160, and OAGB-200 groups were 44.5 ± 5.8, 45.6 ± 6.3, and 46.7 ± 6.4 kg/m2, respectively. One-year follow-up rates were 83.4%, 85.3%, and 82.5% for the RYGB, OAGB-200, and OAGB-160 groups, respectively. One-year percent total weight loss values were 33.8 ± 6.7 after OAGB-160 and 35.3 ± 6.9 after OAGB-200 (P = 0.056), which were significantly greater compared with 30.9 ± 8.9 after RYGB (P < 0.001). All groups were comparable regarding remission of type 2 diabetes mellitus, hypertension, dyslipidemia, and fatty liver. Mean operative time was longer with RYGB than with either OAGB techniques. Groups were comparable for postoperative complications except for the incidence of protein-calorie malnutrition (PCM), occurring in 11 patients (4.7%) after OAGB-200, 7 of whom required revisional surgery, in one patient (0.3%) after OAGB-160 who responded to parenteral alimentation, but in no patients after RYGB. CONCLUSION: After 1 year, OAGB with a 160-cm BPL was as effective as OAGB with a 200-cm BPL and RYGB, but safer than OAGB-200. This approach also avoided the need for revisional surgery following postoperative malnutrition.
Authors: Mario Musella; Antonio Vitiello; Antonio Susa; Francesco Greco; Maurizio De Luca; Emilio Manno; Stefano Olmi; Marco Raffaelli; Marcello Lucchese; Sergio Carandina; Mirto Foletto; Francesco Pizza; Ugo Bardi; Giuseppe Navarra; Angelo Michele Schettino; Paolo Gentileschi; Giuliano Sarro; Sonja Chiappetta; Andrea Tirone; Giovanna Berardi; Nunzio Velotti; Diego Foschi; Marco Zappa; Luigi Piazza Journal: Obes Surg Date: 2022-01-01 Impact factor: 4.129