Applying an Anti-reflux Suture in the One Anastomosis Gastric Bypass to Prevent Biliary Reflux: a Long-Term Observational Study

Slagter, Nienke; Hopman, Jonne; Altenburg, Anna G; Heide, Loek J M de; Jutte, Ewoud H.; Kaijser, Mirjam A.; Damen, S.L.; Beek, André P van; Emous, Marloes

doi:10.1007/s11695-021-05238-8

Cited by 18 publications

(4 citation statements)

References 56 publications

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“…Nevertheless, OAGBc also presents an anti-reflux effect against acid reflux, specifically when improved with one of the anti-reflux mechanisms. 28 An independent comparison of the treatment of this complication of LSG would require a randomized controlled, blinded trial that could reliably answer the question regarding the superiority of either method. Furthermore, the low number of diabetes cases may bias the achieved outcome.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Long-term Outcomes of RYGB and OAGB as Conversion Procedures After Failed LSG — a Case–Control Study

Wilczyński

Spychalski

Proczko-Stepaniak

et al. 2022

Journal of Gastrointestinal Surgery

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Objective To compare the effect of RYGB and OAGB on patients after failed treatment of obesity by laparoscopic sleeve gastrectomy (LSG). Study Design A case–control study based on a prospectively maintained database of reoperated patients after failed LSG, which included 33 patients who underwent RYGB conversion and 47 patients who underwent OAGB conversion. Result The mean %EBWL after a 5-year follow-up for RYGBc vs OAGBc was 84.04% vs 72.95% (p = 0.2176), respectively. Complete long-term diabetes remission was observed significantly more frequently in the OAGBc than in the RYGBc group (97.3% vs 33%; p = 0.035). There were no other statistically significant differences in the remission rate of comorbidities between RYGBc and OAGBc: hypertension 30% vs 27.3% (p = 0.261), dyslipidemia 83.3% vs 59.1% (p = 0.277), OSAS 100% vs 60% (p = 0.639), and GERD 40% vs 71.4% (p > 0.99), respectively. 7 patients were newly diagnosed with GERD after OAGBc and none after RYGBc. There were no statistically significant differences in the number of complications between the OAGBc and RYGB groups. The Comprehensive Complication Index was 17.85 (± IQR 29.6) in the OAGBc group and 14.92 (± IQR 21.75) in the RYGBc group (p = 0.375). Conclusion The authors recognized complete long-term type 2 diabetes remission after conversion surgery as the most relevant difference, where the OAGB variety was found superior for its better efficacy. Any other statistically significant differences in the consequences after both conversion procedures used after the failure of LSG have not been stated. Both methods therefore can be considered to complete the initial treatment, considering the preferences and individual burdens of the patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Long-term Outcomes of RYGB and OAGB as Conversion Procedures After Failed LSG — a Case–Control Study

Wilczyński

Spychalski

Proczko-Stepaniak

et al. 2022

Journal of Gastrointestinal Surgery

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“…The anti-reflux sutures that were performed in all patients in this study were described first by Carbajo M. [ 25 ] as mechanism to prevent biliary reflux. A current observational study by Slagter N. et al of 703 patients showed that applying these sutures leads to much lower conversion rates to RYGB [ 26 ]. Nevertheless, further objective studies dealing with this issue have to be awaited.…”

Section: Discussionmentioning

confidence: 99%

Esophageal function and non-acid reflux evaluated by impedance-24 h-pH-metry, high-resolution manometry, and gastroscopy after one-anastomosis gastric bypass—outcomes of a prospective mid-term study

et al. 2023

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Background One-Anastomosis Gastric Bypass (OAGB) is the third most common bariatric operation for patients with obesity worldwide. One concern about OAGB is the presence of acid and non-acid reflux in a mid- and long-term follow-up. The aim of this study was to objectively evaluate reflux and esophagus motility by comparing preoperative and postoperative mid-term outcomes. Setting Cross-sectional study; University-hospital based. Methods This study includes primary OAGB patients (preoperative gastroscopy, high-resolution manometry (HRM), and impedance-24 h-pH-metry) operated at Medical University of Vienna before 31st December 2017. After a mean follow-up of 5.1 ± 2.3 years, these examinations were repeated. In addition, history of weight, remission of associated medical problems (AMP), and quality of life (QOL) were evaluated. Results A total of 21 patients were included in this study and went through all examinations. Preoperative weight was 124.4 ± 17.3 kg with a BMI of 44.7 ± 5.6 kg/m2, total weight loss after 5.1 ± 2.3 years was 34.4 ± 8.3%. In addition, remission of AMP and QOL outcomes were very satisfactory in this study. In gastroscopy, anastomositis, esophagitis, Barrett´s esophagus, and bile in the pouch were found in: 38.1%, 28.3%, 9.5%, and 42.9%. Results of HRM of the lower esophageal sphincter pressure were 28.0 ± 15.6 mmHg, which are unchanged compared to preoperative values. Nevertheless, in the impedance-24 h-pH-metry, acid exposure time and DeMeester score decreased significantly to 1.2 ± 1.2% (p = 0.004) and 7.5 ± 8.9 (p = 0.017). Further, the total number of refluxes were equal to preoperative; however, the decreased acid refluxes were replaced by non-acid refluxes. Conclusion This study has shown decreased rates of acid reflux and increased non-acid reflux after a mid-term outcome of primary OAGB patients. Gastroscopy showed signs of chronic irritation of the gastrojejunostomy, pouch, and distal esophagus, even in asymptomatic patients. Follow-up gastroscopies in OAGB patients after 5 years may be considered. Graphical Abstract

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“…The gastrojejunostomy was closed manually using an absorbable suture. Application of an anti-reflux suture, attaching the proximal jejunum at the left lateral side of the gastric pouch using one suture, was based on surgeon’s preference [ 14 ]. A BP-limb length of 150, 180, or 200 cm was used.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of the One Anastomosis Gastric Bypass with Various Biliopancreatic Limb Lengths: a Retrospective Single-Center Cohort Study

et al. 2021

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Introduction One anastomosis gastric bypass (OAGB) is an effective and safe treatment for morbidly obese patients. Longer biliopancreatic (BP) limb length is suggested to result in better weight loss outcomes, but to date, no data are available for the OAGB to substantiate this. We hypothesized that applying a longer BP-limb length in the higher BMI classes would result in more weight reduction so that the attained BMI would be comparable to patients with a lower BMI, thereby compensating for differences in baseline BMI. Method A retrospective cohort study in patients who underwent a primary OAGB at a teaching hospital in the Netherlands between January 2015 and December 2016. BP-limb length was tailored based on preoperative BMI. Patients were divided into three different groups depending on the length of the BP-limb: 150, 180, and 200 cm. Weight loss outcomes after 1 and 3 years and resolution of comorbidities were compared between these groups. Results Of the 632 included patients, a BP-limb length of 150 cm was used in 172 (27.2%), 180 cm in 388 (61.4%), and 200 cm in 72 (11.4%) patients. Despite more BMI loss, %EWL was lower and attained BMI remained higher in the groups with longer BP-limb lengths. After adjustment for the confounder preoperative BMI, longer BP-limb lengths were not associated with higher BMI loss. There was no difference in remission rates of comorbidities. Conclusion Attained BMI remained higher in spite of tailoring BP-limb length according to baseline BMI with no differences in remission rates of comorbidities. Graphical Abstract

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Applying an Anti-reflux Suture in the One Anastomosis Gastric Bypass to Prevent Biliary Reflux: a Long-Term Observational Study

Cited by 18 publications

References 56 publications

Comparison of the Long-term Outcomes of RYGB and OAGB as Conversion Procedures After Failed LSG — a Case–Control Study

Comparison of the Long-term Outcomes of RYGB and OAGB as Conversion Procedures After Failed LSG — a Case–Control Study

Esophageal function and non-acid reflux evaluated by impedance-24 h-pH-metry, high-resolution manometry, and gastroscopy after one-anastomosis gastric bypass—outcomes of a prospective mid-term study

Outcomes of the One Anastomosis Gastric Bypass with Various Biliopancreatic Limb Lengths: a Retrospective Single-Center Cohort Study

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