One Anastomosis Gastric Bypass Versus Roux-en-y Gastric Bypass Surgery as Revisional Surgery after Restrictive Bariatric Operations

Abstract

Background: Restrictive bariatric procedures, such as gastric banding and sleeve gastrectomy are technically simple, and effective in achieving weight loss and managing obesity-related comorbidities in the short term. A subset of patients who underwent restrictive bariatric procedures needs revisional surgery for unsuccessful weight loss, gastroesophageal reflux disease, or anatomic complications after primary surgery. Aims:To compare revisional one anastomosis gastric bypass (r-OAGB) against revisional Roux-en-Y gastric bypass (r-RYGB) after failed or complicated restrictive procedures. Patients and methods:This prospective study was conducted on 40 patients who met the inclusion criteria with minimal follow-up of 1 year. Twenty patients were converted to OAGB/MGB and 20 patients were converted to RYGB as a revisional procedure. Both groups were compared for operative time, hospital stay, intraoperative and postoperative complications and short-term outcome. Results:The operative time was significantly longer for r-RYGB with a mean time of 258.25±75.21 mins compared to 216.75±47.30 mins for r-OAGB. Hiatus hernia was found and repaired in 3 patients of the r-OAGB group and 10 patients of r-RYGB. Postoperative complications occurred in 10% of r-OAGB group and 25% of r-RYGB. The mean postoperative weight and BMI were significantly lower than preoperative weight and BMI in both groups with no significant difference between both groups. The mean %EWL was 75.06 ± 24.28 for r-OAGB compared to 64.54 ± 30.40 for r-RYGB therefore EWL% was statistically significant higher after r-OAGB. Overall comorbidities improved in both groups postoperatively while anemia was recorded in 6 patients after r-RYGB compared to 3 patients after r-OAGB. Conclusion:One anastomosis gastric bypass is a simple and effective revisional procedure with less complications, shorter operative time and satisfactory weight loss.