Revisional One Anastomosis Gastric Bypass with a 150-cm Biliopancreatic Limb After Failure of Adjustable Gastric Banding: Mid-Term Outcomes and Comparison Between One- and Two-Stage Approaches

Abstract

Purpose Laparoscopic adjustable gastric banding (LAGB) was a common procedure worldwide but associated with a high rate of long-term failure. This study aims to evaluate the safety and effectiveness of conversion to one anastomosis gastric bypass (OAGB) after failed LAGB. Materials and Methods We undertook a retrospective analysis of a prospectively maintained database in a tertiary referral center for bariatric surgery. All cases of revisional OAGB with a biliopancreatic limb (BPL) of 150 cm after failed LAGB performed between 2010 and 2016 were analyzed. Results Overall, 215 patients underwent conversion from LAGB to OAGB. Indication for surgery was primary weight loss (WL) failure in 30.7% of cases and long-term complications in the remaining patients, with or without associated weight regain. At the time of OAGB, the mean age was 43.2 ± 10.5 years and the mean BMI was 42 ± 6.9. Overall postoperative morbidity was 13.5%. The postoperative abscess ± leak rate was 5.9% in the overall population. Two years after OAGB, 9.7% of patients were lost to follow-up, % excess weight loss (EWL) was 88.2 ± 23.9, and % total weight loss (TWL) was 38.7 ± 9.3. At 5 years, 16.6% of patients were lost to follow-up, %EWL was 82.4 ± 25, and %TWL was 36.1 ± 10. There was no statistical difference in complication rates or WL results between the one-stage and two-stage approaches. Conclusion OAGB with a 150-cm BPL represents a safe and effective option after failed LAGB. Both synchronous OAGB and two-step revisional OAGB guarantee satisfying results in terms of postoperative morbidity and WL outcomes. Graphical abstract (PLEASE CORRECT THE GRAPHICAL ABSTRACT !!! 215 PATIENTS INSTEAD OF 250

One anastomosis gastric bypass vs sleeve gastrectomy as a revisional bariatric surgery for weight loss failure after primary restrictive procedure

“…As for re-OAGB, we found an EWL of 86.7% 2 years after revisional surgery. This percentage was comparable to the EWL of 88.2% and 84.1% at 2-years follow-up in two studies by Petrucciani et al 44 and Debs et al, 45 and to the EWL of 79% in a study by Gerges et al 46 evaluating re-OAGB after failure of restrictive procedure. The remarkable difference we found in weight loss outcome (EWL: 86.7% vs 54%) between re-OAGB and re-LSG 2 years after revisional surgery underlines the inferior efficacy of re-adopting a revisional restrictive surgery after an initial failure of primary restrictive surgery, which comes in accordance with two other studies 29,47 that showed a superiority of gastric bypass conversion compared with re-LSG after failure of restrictive surgery.…”

GERD after Roux-en-Y Gastric Bypass: Prevalence and Risk Factors Analysis

“…Previous studies have demonstrated increased prevalence of GERD in bariatric surgery candidates, which was in a range from 40.8% to 62.4% [6][7][8]. Similarly, 41.1% of bariatric surgery patients presenting in our center had GERD preoperatively.…”

“…However, the possible mechanisms of GERD persistence or the new onset after RYGB are poorly understood. Petrucciani N., et al [8] have found that preoperative GERD (OR=2.65, p<0.0001), glycemic imbalances defined as post-prandial symptoms, which has impact on quality of life and occurs at least more than 2 times per month (OR=0.32, p=0.006), anastomotic ulcer (OR=0.35, p<0.0001) and %TWL at 10 years ≥25 (OR=0.524, p= 0.021) were significant risk factors related to GERD 10 years after RYGB [8]. We were unable to confirm the finding that preoperative GERD has influence on the GERD 12 years after surgery because more patients in our study had de novo GERD as compared to those who had persistent GERD.…”

“…Currently, bariatric surgery is the most effective long-term treatment for obesity. The prevalence of GERD symptoms among the patients considered for bariatric surgery is in a range from 40.8% to 62.4% [6][7][8]. Given high prevalence rate, bariatric surgeons must take into consideration GERD symptoms when choosing relevant surgical procedure.…”