Ashraf Haddad1, Ahmad Bashir2, Mathias Fobi3, Kelvin Higa4, Miguel F Herrera5, Antonio J Torres6, Jacques Himpens7,8, Scott Shikora9, Almino Cardoso Ramos10, Lilian Kow11, Abdelrahman Ali Nimeri12. 1. Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC) -Jordan Hospital, Queen Noor St., 4th Circle, P.O BOX 3073, Amman, 11181, Jordan. drajhaddad@gmail.com. 2. Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC) -Jordan Hospital, Queen Noor St., 4th Circle, P.O BOX 3073, Amman, 11181, Jordan. 3. Clinical Affairs and Research, Mohak Bariatric and Robotics, Indore, India. 4. Advanced Laparoscopic Surgery Associates, University of California San Francisco-Fresno, Fresno Heart and Surgical Hospital, Fresno, CA, USA. 5. Endocrine and Bariatric Surgery, UNAM at INCMNSZ, Mexico City, México. 6. General and Bariatric Surgery, Complutense University of Madrid, Hospital Clinico "San Carlos", Madrid, Spain. 7. Metabolic-Bariatric Surgery, CHIREC Delta Hospital, Brussels, Belgium. 8. St Pierre University Hospital, Brussels, Belgium. 9. Harvard Medical School, Center for Metabolic and Bariatric Surgery, Brigham and Women's Hospital, Boston, MA, USA. 10. Gastro-Obeso-Center Institute of Metabolic Optimization, Bela Vista, São Paulo, SP, Brazil. 11. Adelaide Bariatric Centre, 12 The Parade, Norwood, SA, 5067, Australia. 12. Atrium Health Weight Management, Carolinas Medical Center, Charlotte, NC, USA.
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.
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.
Entities:
Keywords:
Bile reflux; Biliopancreatic limb length; Gastric bypass; Liver failure; Malnutrition; Mini gastric bypass; One anastomosis gastric bypass; Postoperative complications; Postoperative leak; Revision of one anastomosis gastric bypass
Authors: Mario Musella; Antonio Susa; Emilio Manno; Maurizio De Luca; Francesco Greco; Marco Raffaelli; Stefano Cristiano; Marco Milone; Paolo Bianco; Antonio Vilardi; Ivana Damiano; Gianni Segato; Laura Pedretti; Piero Giustacchini; Domenico Fico; Gastone Veroux; Luigi Piazza Journal: Obes Surg Date: 2017-11 Impact factor: 4.129
Authors: Luigi Angrisani; A Santonicola; P Iovino; A Vitiello; K Higa; J Himpens; H Buchwald; N Scopinaro Journal: Obes Surg Date: 2018-12 Impact factor: 4.129
Authors: Miguel A Carbajo; Enrique Luque-de-León; José M Jiménez; Javier Ortiz-de-Solórzano; Manuel Pérez-Miranda; María J Castro-Alija Journal: Obes Surg Date: 2017-05 Impact factor: 4.129