Short-term outcomes of the conversion of one anastomosis gastric bypass to Roux-en-Y gastric bypass in symptomatic reflux patients without revising the size of the gastric pouch

Abstract

Background: Revising the size of the gastric pouch during the conversion of one anastomosis gastric bypass (OAGB)/mini-gastric bypass to Roux-en-Y gastric bypass (RYGB) is an important point. Even in patients undergoing RYGB, marginal ulcer is regarded as a known complication. Materials and Methods: In our Centre of Excellence in Bariatric and Metabolic Surgery, 2492 patients underwent OAGB from February 2012 to January 2019. Twelve of 2492 patients were enrolled in this clinical case series because of persistent gastroesophageal reflux-like symptoms which underwent conversional RYGB. All patients regularly received proton-pump inhibitors (PPIs) for 6 months after the surgery. After this period, the cases with symptomatic reflux were invited to be visited in the clinic by a bariatric surgeon and a gastroenterologist and received 6 months of PPI therapy until their symptoms disappeared. Twelve refractory reflux cases underwent conversional RYGB after 1 year. An enteroenterostomy was created in all the patients 75 cm distal to the gastrojejunostomy without resizing the gastric pouch, and the jejunal loop was cut just before the gastrojejunostomy. Results: Before conversional surgery, mean ± standard deviation (SD) body mass index (BMI) and gastroesophageal reflux disease (GERD)-Q score were found to be 26.45 ± 2.34 kg/m 2 and 10.08 ± 0.56, respectively. At 1 year after conversion, mean ± SD BMI in the patients was 28.12 ± 4.71, and GERD-Q score was 5.08 ± 1.5. Conclusion: It seems that resizing the gastric pouch is not necessary during the conversion of OAGB to RYGB.

Single-Anastomosis Procedures in Metabolic Surgery

“…48,61 Postoperative bleeding occurs in less than 3% of the cases, and the management tends to be conservative and rarely require additional surgical interventions. 38,62,63 Similarly, in a retrospective cohort study performed on 653 patients undergoing OAGB, the postoperative bleeding rate was 1.3%. 63 The clinical signs and symptoms correlated with this complication are severe abdominal pain and distension, tachycardia, hypotension, and drop in hemoglobin.…”

“…38,62,63 Similarly, in a retrospective cohort study performed on 653 patients undergoing OAGB, the postoperative bleeding rate was 1.3%. 63 The clinical signs and symptoms correlated with this complication are severe abdominal pain and distension, tachycardia, hypotension, and drop in hemoglobin. 55,64 Small bowel obstructions (SBOs) secondary to internal hernias are unusual and it represents less than 0.5%.…”