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

Wilczyński, Maciej; Spychalski, Piotr; Proczko-Stepaniak, Monika; Bigda, Jacek; Szymański, Michał; Dobrzycka, Małgorzata; Rostkowska, Olga; Kaska, Łukasz

doi:10.1007/s11605-022-05395-w

Cited by 11 publications

(9 citation statements)

References 30 publications

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“…The experts agreed that in case of non-improvement of obesity-related comorbidities, RYGB, OAGB, BPD/DS, and SADI-S are acceptable options as revisional surgeries (89.1%, 80.4%, 80.4%, and 89.1%, respectively). This is in agreement with the current available literature which shows that these operations give good results for obesity-related comorbidities [27,28,[39][40][41].…”

Section: Non-improvement Of Obesity-associated Medical Problemssupporting

confidence: 92%

“…There is lot of debate about tailoring of biliopancreatic limb (BPL) in case of revisional cases compared to primary operation [26][27][28]. The consensus group of experts agreed with 84.7% consensus that the BPL should be increased in RYGB and OAGB when they are used in revisional cases.…”

Section: Operative Considerations In Conversion/revisionmentioning

confidence: 99%

“…Conversion to RYGB in symptomatic GERD and inadequate weight loss and weight regain was, for this group, the only acceptable surgical option with a consensus of 97.7%. Even though OAGB provides further weight loss after failed primary restrictive surgery [26,27], it seems that OAGB comparing to RYGB is less optimal in reflux control [28] and that particularly in the long-term bile reflux might be a critical issue [29]. Finally, in a recent expert consensus on patient selection for OAGB, there was no consensus reached on OAGB as conversional surgery in patients with GERD after restrictive procedures [8].…”

Section: Symptomatic Gerd After Sg and Inadequate Weight Loss/weight ...mentioning

confidence: 99%

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Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Kermansaravi

Parmar

Chiappetta³

et al. 2023

Surg Endosc

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Background Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgical (MBS) procedure worldwide. Despite the desired effect of SG on weight loss and remission of obesity-associated medical problems, there are some concerns regarding the need to do revisional/conversional surgeries after SG. This study aims to make an algorithmic clinical approach based on an expert-modified Delphi consensus regarding redo-surgeries after SG, to give bariatric and metabolic surgeons a guideline that might help for the best clinical decision. Methods Forty-six recognized bariatric and metabolic surgeons from 25 different countries participated in this Delphi consensus study in two rounds to develop a consensus on redo-surgeries after SG. An agreement/disagreement ≥ 70.0% on statements was considered to indicate a consensus. Results Consensus was reached for 62 of 72 statements and experts did not achieve consensus on 10 statements after two rounds of online voting. Most of the experts believed that multi-disciplinary team evaluation should be done in all redoprocedures after SG and there should be at least 12 months of medical and supportive management before performing redo-surgeries after SG for insufficient weight loss, weight regain, and gastroesophageal reflux disease (GERD). Also, experts agreed that in case of symptomatic GERD in the presence of adequate weight loss, medical treatment for at least 1 to 2 years is an acceptable option and agreed that Roux-en Y gastric bypass is an appropriate option in this situation. There was disagreement consensus on efficacy of omentopexy in rotation and efficacy of fundoplication in the presence of a dilated fundus and GERD. Conclusion Redo-surgeries after SG is still an important issue among bariatric and metabolic surgeons. The proper time and procedure selection for redo-surgery need careful considerations. Although multi-disciplinary team evaluation plays a key role to evaluate best options in these situations, an algorithmic clinical approach based on the expert's consensus as a guideline can help for the best clinical decision-making.

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Section: Non-improvement Of Obesity-associated Medical Problemssupporting

confidence: 92%

Section: Operative Considerations In Conversion/revisionmentioning

confidence: 99%

Section: Symptomatic Gerd After Sg and Inadequate Weight Loss/weight ...mentioning

confidence: 99%

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Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Kermansaravi

Parmar

Chiappetta³

et al. 2023

Surg Endosc

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“…In our institution, pOAGB is offered for patients with T2DM, based on our previous study, which proves a better resolution of T2DM after OAGB than after RYGB [ 15 ]. Revisional OAGB is offered as a revisional procedure mostly because of WR or poor weight loss [ 5 , 22 ].…”

Section: Methodsmentioning

confidence: 99%

“…Currently, one of the main options is Roux-en-Y gastric bypass (RYGB) interestingly [ 4 ]. The second surgical conversion option is often one anastomosis gastric bypass (OAGB) [ 5 ]. There is a higher rate of complications after revisional BS than in the primary operation [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Primary Versus Revisional One Anastomosis Gastric Bypass (OAGB) on Fatty Acid Profile

Szymanski,

Wilczynski,

Pakiet

et al. 2023

OBES SURG

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Introduction One anastomosis gastric bypass (OAGB) is one option of a revisional procedure for failed sleeve gastrectomy. Moreover, it can be used as a primary bariatric procedure, and is an effective surgery resulting in significant weight loss and the resolution or improvement of obesity-associated medical problems, accompanied by low perioperative complications. However, as with any therapy, OAGB has its limitations, including micronutrient deficiency or malnutrition. In our study, we compared the fatty acid (FA) profile in serum of patients after both primary OAGB (pOAGB) and revisional OAGB (rOAGB) to identify potential postsurgical FA alterations. Methods This is a retrospective study on patients with obesity who underwent OAGB procedures (pOAGB n=68; rOAGB n=17), conducted from 2016 to 2018. In blood, we analyzed a series of biochemical parameters, and in the serum, the FA profile was determined using gas chromatography-mass spectrometry. Results The percentage of excess BMI loss (% EBMIL) after pOAGB was 73.5 ± 2.47% in comparison to 45.9 ± 4.15% in the rOAGB group (p<0.001). In contrast to the lack of effect of rOAGB on most polyunsaturated FAs, in the pOAGB group, there was a decrease in eicosapentaenoic acid, and eicosatetraenoic and docosahexaenoic acid levels (p<0.001). We also found a decrease in very long-chain FAs (VLCFAs) and an increase in branched-chain FAs (BCFAs) after both types of OAGB procedure. Conclusions Both OAGB procedures improved the profile of most FAs, leading to a decrease in VLCFAs, which are considered harmful, and an improvement in BCFAs, which are considered to be beneficial. There is a need to further investigate the possibility of n-3 polyunsaturated FA supplementation after pOAGB, due to the large decrease in these FAs after pOAGB. Graphical Abstract

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One-anastomosis gastric bypass (OAGB) versus Roux-en-Y gastric bypass (RYGB) as revisional procedures after failed laparoscopic sleeve gastrectomy (LSG): systematic review and meta-analysis of comparative studies

Vitiello,

Berardi,

Peltrini

et al. 2023

Langenbecks Arch Surg

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Introduction The aim of this study was to compare weight loss and gastroesophageal reflux disease (GERD) remission after one-anastomosis gastric bypass (OAGB) versus Roux-en-Y gastric bypass (RYGB) as revisional procedures after laparoscopic sleeve gastrectomy (LSG). Methods In PubMed, Embase, and Cochrane Library, a search was performed using the terms “Roux-en-Y gastric bypass versus one anastomosis gastric bypass,” “revisional surgery,” and “sleeve gastrectomy.” Only original articles in English language comparing OAGB and RYGB were included. No temporal interval was set. The primary outcome measure was weight loss (%TWL). The secondary endpoints were leak, bleeding, marginal ulcer, and GERD. PRISMA flowchart was used. Differences in continuous and dichotomous outcome variables were expressed as mean difference (MD) and risk difference (RD) with 95% CI, respectively. Heterogeneity was assessed by using I2 statistic. Results Six retrospective comparative articles were included in the present meta-analysis. Weight loss analysis showed a MD = 5.70 (95% CI 4.84–6.57) in favor of the OAGB procedure with a statistical significance (p = 0.00001) and no significant statistical heterogeneity (I2 = 0.00%). There was no significant RD for leak, bleeding, or marginal ulcer after the two revisional procedures. After conversion to OAGB, remission from GERD was 68.6% (81/118), and it was 80.6% (150/186) after conversion to RYGB with a RD = 0.10 (95% CI −0.04, 0.24), no statistical significance (p = 0.19), and high heterogeneity (I2 = 96%). De novo GERD was 6.3% (16/255) after conversional OAGB, and it was 0.5% (1/180) after conversion to RYGB with a RD = −0.23 (95% CI −0.57, 0.11), no statistical significance (p = 0.16), and high heterogeneity (I2 = 92%).

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

Cited by 11 publications

References 30 publications

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Best practice approach for redo-surgeries after sleeve gastrectomy, an expert's modified Delphi consensus

Effect of Primary Versus Revisional One Anastomosis Gastric Bypass (OAGB) on Fatty Acid Profile

One-anastomosis gastric bypass (OAGB) versus Roux-en-Y gastric bypass (RYGB) as revisional procedures after failed laparoscopic sleeve gastrectomy (LSG): systematic review and meta-analysis of comparative studies

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