Roux-en-Y Versus One Anastomosis Gastric Bypass as Redo-Operations Following Sleeve Gastrectomy: A Retrospective Study

Analysis of intra- and postoperative interventional endoscopic measures in 3000 bariatric surgical procedures over 15 years: a single center study

In addition to preoperative diagnostic gastroscopy, some bariatric surgery patients require one or more differentiated endoscopic interventions as part of postoperative complication management. The aim of this study is to analyze endoscopic interventions regarding indication, type of procedure, material used, and outcome. We prospectively collected and retrospectively analyzed data over a period of 15 years from 2006 to 2021 of all consecutive patients who underwent an interventional upper gastrointestinal endoscopy after bariatric surgery at our center. The primary study objective was the type and frequency of the treatment. Secondary study objectives included clinical outcomes and postinterventional complications. Of 3000 bariatric procedures, 145 (4.8%), among them 11.1% (n = 54) of 485 Roux-en-Y gastric bypasses, 7.1% (n = 20) of 282 redo operations, 5.7% (n = 20) of 351 revisional operations, 3.3% (n = 13) of 398 sleeve gastrectomies, and 1.9% (n = 26) of 1394 one-anastomosis gastric bypasses, received an interventional endoscopy for postoperative complication management. 79.3% (n = 115) were female, mean age was 42.4 (± 10.7) years, mean BMI was 43.5 (± 9.8) kg/m2. Complication after interventional endoscopy happened in 1.6%, revisional surgery was necessary in 0.5% (n = 3). Causes for endoscopic intervention were stenosis (52.4%), leakage/fistula (35.9%), intraluminal bleeding (13.1%), dumping syndrome (9.0%), and gallstones (1.4%). The performed interventions were balloon dilation (48.3%), stent therapy (33.1%), metallic clipping (12.4%), injection therapy (0.09%), bougienage (0.07%), vacuum therapy (0.06%), and pigtail therapy (0.04%). Endoscopic intervention is an effective and safe way of treating adverse events after bariatric surgery. Stenosis and leakage were the most frequent complications, with endoscopic balloon dilatation and stent therapy as the most frequent and successful treatment options. RYGB was the procedure with the most endoscopic interventional involvement. To better learn about outcomes of specific endoscopic techniques further studies preferably with larger multicenter samples are required.

Omentopexy in Sleeve Gastrectomy: The Game Changer for Minimizing Complications and Surgery Time in Revisional Roux-en-Y Gastric Bypass

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric surgery; however, some patients experience inadequate weight loss or weight regain, requiring revisional bariatric surgery such as Roux-en-Y gastric bypass (RYGB). Omentopexy, a technical variation during LSG, may influence long-term outcomes and the complexity of subsequent surgeries. This study aims to evaluate the impact of omentopexy during LSG on perioperative outcomes and surgery duration in patients requiring revisional RYGB.

METHODS

This retrospective cohort study analyzed 62 patients who underwent revisional RYGB following primary LSG between January 2015 and January 2024. Patients were divided into two groups based on whether omentopexy was performed during the initial LSG. The primary outcomes assessed were perioperative complications, intrathoracic gastric migration (IGM), and surgery duration during RYGB. Secondary outcomes included hospital stay length and 30-day readmission rates.

RESULTS

Of the 62 patients, 56 were female and 6 were male, with a mean age of 44.3 years. The mean body mass index (BMI) was 39.5 kg/m2. The omentopexy group (O-LSG) exhibited a significantly lower rate of perioperative complications (7.6%) compared to the non-omentopexy group (NO-LSG) (25%, p < 0.05). Intrathoracic gastric migration was observed in 13.8% of NO-LSG patients, while no cases were found in the O-LSG group. Additionally, surgery duration was significantly shorter in the O-LSG group (p < 0.05). No significant difference was found between the groups regarding hospital stay length or 30-day readmission rates.

CONCLUSIONS

Omentopexy during primary LSG is associated with reduced perioperative complications, shorter surgery durations, and lower rates of intrathoracic gastric migration during revisional RYGB. These findings suggest that performing omentopexy during LSG may simplify revisional procedures and improve patient outcomes.

Laparoscopic One Anastomosis Gastric Bypass as a Revisional Procedure After Failed Vertical Banded Gastroplasty: Our Center Experience

Background: Vertical banded gastroplasty (VBG) was historically a popular restrictive bariatric procedure, but long-term failure rates due to weight regain, stenosis, and gastroesophageal reflux have necessitated revisional interventions. One anastomosis gastric bypass (OAGB), also known as mini-gastric bypass, has emerged as a viable revisional option due to its technical simplicity, lower complication rates, and promising metabolic outcomes. This study evaluates the safety, efficacy, and outcomes of OAGB as a revisional procedure following failed VBG, based on our center's experience and a review of the current literature. Methods: Seventy-one patients who underwent revisional OAGB after failed open VBG between February 2014 and February 2020 were included in this retrospective study. Three years outcomes regarding weight loss (the percentage of excess body weight loss (EBWL %) and change in body mass index (BMI)), co-morbidities resolution, morbidity, and mortality were assessed. Results: The EBWL % after revisional OAGB was 68.2 ± 9.4%, 65.9 ± 2.5%, and 59.6 ± 7.4% after 1, 2, and 3 years, respectively. The mean BMI before revisional surgery was 41.8 ± 3.7 kg/m2,which decreased to 31.9 ± 4.2 kg/m2 3 years after the revisional surgery. After 1 year, there was a remarkable resolution of obesity-related co-morbidities, the remission of type 2 diabetes mellitus was 85.7%, and of hypertension was 80%. Remission of other comorbidities was also observed. Bile reflux was encountered in 6 cases (8.5%), two of them required surgical intervention. Conclusions: OAGB is a feasible and effective revisional procedure after failed open VBG. However, the risk of bile reflux should be considered to justify these findings; further prospective randomized controlled trials are required.

Bariatric surgery and relevant comorbidities: a systematic review and meta-analysis

BACKGROUND

Obesity is a growing epidemic in the United States, and with this, has come an increasing volume of metabolic surgery operations. The ideal management of obesity-associated medical conditions surrounding these operations is yet to be determined. This review sought to investigate the routine use of intraoperative cholangiogram (IOC) with cholecystectomy during or after a bypass-type operation, the ideal management of post-sleeve gastrectomy gastroesophageal reflux disease (GERD), and the optimal bariatric operation in patients with known inflammatory bowel disease (IBD).

METHODS

Using medical literature databases, searches were performed for randomized controlled trials (RCTs) and non-randomized comparative studies from 1990 to 2022. Each study was screened by two independent reviewers from the SAGES Guidelines Committee for eligibility. Data were extracted while assessing the risk of bias using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale for RCTs and cohort studies, respectively. A meta-analysis was performed using random effects.

RESULTS

Routine use of IOC was associated with a significantly decreased rate of common bile duct injury and a trend towards decreased intraoperative complications, perioperative complications, and mortality. The rates of reoperation, postoperative pancreatitis, cholangitis, and choledocholithiasis were low in the routine use of the IOC group, but no non-routine use studies evaluated these outcomes. After sleeve gastrectomy, GERD-specific quality of life was significantly higher in the surgically treated group compared to the medically treated group. Bypass-type operations had worse outcomes of IBD sequelae than sleeve gastrectomy, including pain, patient perception, and fistula formation. Sleeve patients had lower mortality and fewer short- and long-term complications.

CONCLUSIONS

Low-quality data limited the conclusions that were drawn; however, trends were observed favoring the routine use of IOC during cholecystectomy for patients with bypass-type anatomy, surgical treatment of GERD post-sleeve gastrectomy, and sleeve gastrectomy in IBD patients. Future research proposals are suggested to further answer the questions posed.

Revisional bariatric surgery following sleeve gastrectomy: a meta-analysis comparing Roux-en-Y gastric bypass and one anastomosis gastric bypass

INTRODUCTION

The number of bariatric operations is increasing each year. Sleeve gastrectomy is the most popular procedure; however, it often requires revision surgery because of insufficient weight loss, weight regain or gastro-oesophageal reflux disease (GORD). The most popular revisional procedures are Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB). The primary outcome of this meta-analysis was weight loss after revisional surgery following laparoscopic sleeve gastrectomy and the secondary outcomes were gastro-oesophageal reflux, BMI difference, operative time, bleeding and anastomotic leak.

METHODS

A systematic electronic search was undertaken using PubMed, MEDLINE, Ovid, Cochrane Library and Google Scholar following PRISMA guidelines. The initial search identified 2,546 articles. After screening, seven papers met the inclusion criteria: six retrospective studies and one randomised controlled trial.

RESULTS

In total, 802 patients met the inclusion criteria: 390 had an OAGB and a further 412 had an RYBG. All patients previously had a sleeve gastrectomy for weight loss. The length of follow-up was 12 months for our primary outcome. We found no statistically significant difference in excess weight loss (%EWL) between OAGB and RYGB (p = 0.11). The incidence of postoperative reflux was statistically significantly higher in the OAGB group (16% vs 10.1%, p < 0.003). Operative time was statistically significantly lower in the OAGB group (p = 0.04).

CONCLUSIONS

This meta-analysis showed no statistically significant difference between the two revision bariatric surgery procedures for %EWL. RYGB was superior to OAGB in reducing the incidence of symptomatic GORD, whereas OAGB had a significant shorter operative time.

Rheumatic Diseases Following Metabolic and Bariatric Surgery: A Systematic Review and Meta-Analysis

Metabolic and bariatric surgery (MBS) has been associated with weight reduction and obesity complications improvement. However, there is no clear evidence of the extent and consistency of the effects of this procedure on rheumatic diseases. This study aims to conduct a meta-analysis to address the impact of MBS on rheumatic diseases. We searched PubMed, Cochrane, and Embase for studies reporting the prevalence of rheumatic diseases, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the medication use after MBS. We conducted a random-effects meta-analysis using odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). P-values < 0.05 were considered statistically significant. We included 28 studies comprising 43,421 patients, with 13,347 patients with rheumatic diseases. The prevalence of osteoarthritis (OA), rheumatoid arthritis, and psoriatic arthritis was significantly reduced after MBS (OR 0.20; 95% CI 0.12 to 0.33; P = 0.01). The WOMAC index for patients with OA had a statistically significant overall reduction after MBS at 6 months (MD - 20.60 points; 95% CI - 28.73 to - 12.47; P < 0.01) and at 12 months (MD - 15.88 points; 95% CI - 19.09 to - 12.66; P < 0.01). Medication use significantly decreased after MBS, both at the follow-up beyond 2 years (OR 0.49; 95% CI 0.35 to 0.69; P < 0.01) and up to 2 years (OR 0.32; 95% CI 0.15 to 0.69; P < 0.01). In this meta-analysis, we found a significant decrease in the prevalence of rheumatic diseases, improvements in the WOMAC index, and reduced medication use among patients undergoing MBS.

Long-term outcomes of sleeve gastrectomy in a patient group with mainly high BMI: a single-center study

Since long-term results after laparoscopic sleeve gastrectomy (LSG) are rather scarce, this study aims to add LSG results with a minimum of 5 years of follow-up. Prospectively collected data from primary LSG in a tertiary bariatric center from 08/2007 to 12/2018 with follow-up ≥ 5 years were analyzed retrospectively. Primary endpoints included total body weight loss (%TBWL) and excess weight loss (%EWL), insufficient weight loss (IWL), weight regain (WR), remission of associated diseases, development of new-onset gastroesophageal reflux disease (GERD), and nutritional deficiencies. Furthermore, the study focused on incidence, time point, and causes of conversion and revision operations. A total of 207 LSG (132 female, mean age 43 (± 10.7) years) entered this study. 33.3% (52 of 156 without conversion) were lost to follow-up for ≥ 5-year data. Perioperative mortality was 0.5% (n = 1). %TBWL was 27.1% (± 12.4) and %EWL 52.5% (± 24.3). IWL or WR was found in 48.8%, new-onset GERD occurred in 27.5% of cases, leading to conversion in 26.6% and revisions in 2%. Nutritional deficiencies were observed in 23.7%, while resolution of associated diseases was sufficient. This patient group with a mean BMI > 50 kg/m2 at baseline showed fair results regarding weight loss issues and remission of associated diseases at ≥ 5 years postoperatively. Yet, a rate of 48.8% of either IWL and/or WR and 27.5% of new-onset GERD required conversion and revision operations in 28.6%. To better learn about long-term results of LSG, further studies preferably with larger multicenter samples and comparisons with alternative primary procedures, preferably in a prospectively randomized approach, possibly with focus on high BMI patients, are required.

Short-Term Weight Loss Outcomes of 104 Mini-Gastric Bypass or One-Anastomosis Gastric Bypass Operations: Retrospective study

Objectives

This study aimed to examine the short-term effects of mini-gastric bypass (MGB) or one-anastomosis gastric bypass (OAGB) procedures on weight loss in individuals with obesity.

Methods

This retrospective study was conducted in Medicano Hospital, Erbil, Iraq, from January 2019 to May 2020. Preoperative body mass index (BMI), age, height and preoperative weight were recorded as baseline measures. Weight-related changes were evaluated during a follow-up phase of 48 weeks.

Results

A total of 104 patients with obesity underwent MGB or OAGB surgery. The mean baseline parameters of the subjects before surgery included 1.64 m for height, 122.9 kg for weight and 45.6 kg/m2 for BMI. During the 48-week follow-up period, there was a substantial reduction in mean weight, which dropped from 122.9 kg at baseline to 75.5 kg at week 48. The weight change (in percentage) gradually increased from -11.8% at week 12 to -37.9% at week 48, without statistically significant association with demographic factors or chronic diseases. From week 12 to week 48, the percentage of excess weight loss (%EWL) increased substantially from 26.8% to 86.1%. The results of the subgroup analysis indicated that the %EWL was considerably higher among those aged 30 or older at week 36 and singles at week 48.

Conclusion

This study's results illustrate the efficacy of MGB or OAGB procedures in significantly reducing weight in the short term. The %EWL increased with the follow-up time and was significantly associated with age and marital status.

Therapeutic Options for Recurrence of Weight and Obesity Related Complications After Metabolic and Bariatric Surgery: An IFSO Position Statement

Obesity is a chronic disease that may require multiple interventions and escalation of therapy throughout the years. Until recently, no universal definition existed for recurrent weight gain and insufficient weight loss. Standardization of reporting is key so outcomes can be compared and data can be pooled. The recent IFSO consensus provided standard terminology and definitions that will likely resolve this in the future, and publishers will need to enforce for authors to use these definitions. This current IFSO position statement provides guidance for the management of recurrent weight gain after bariatric surgery.

Surgical treatment strategies for gastroesophageal reflux after laparoscopic sleeve gastrectomy

Bariatric surgery has emerged as an effective therapeutic approach for combating obesity. As the most commonly performed bariatric surgery, laparoscopic sleeve gastrectomy (LSG) has a long-term and effective outcome in weight reduction. However, studies have reported an increased incidence of gastroesophageal reflux disease (GERD) among patients after LSG. For those who fail to respond to conventional oral acid-suppressing medication, surgical intervention comes into consideration. The most commonly performed revisional surgery for sleeve gastrectomy is the Roux-en-Y gastric bypass, which can effectively alleviate the symptoms of reflux in patients and also continues to promote weight loss in patients who have not achieved satisfactory results or have experienced weight regain. In addition to this established procedure, innovative techniques such as laparoscopic magnetic sphincter augmentation (MSA) are being explored. MSA is less invasive, has good reflux treatment outcomes, and its safety and efficacy are supported by the literature, making it a promising tool for the future treatment of gastroesophageal reflux. This article also explores the role of endoscopic interventions for GERD treatment of post-sleeve gastrectomy patients. Although these methods have shown some therapeutic effect, their efficacy still requires further study due to a lack of support from more clinical data. For patients with preoperative hiatal hernia or gastroesophageal reflux symptoms, some experts now consider performing LSG combined with hiatal hernia repair or fundoplication to alleviate or prevent postoperative reflux symptoms. Both of these surgical approaches have demonstrated favorable outcomes; however, the addition of fundoplication requires further investigation regarding its long-term effects and potential postoperative complications. This article gathers and examines the current laparoscopic and endoscopic treatments for refractory gastroesophageal reflux following LSG, as well as the concurrent treatment of LSG in patients with preoperative gastroesophageal reflux or hiatal hernia.

Revisional one-anastomosis gastric bypass for failed laparoscopic sleeve gastrectomy

The study aimed to evaluate the mid-term weight loss outcomes and complications of revisional one-anastomosis gastric bypass (OAGB) following failed laparoscopic sleeve gastrectomy (LSG). A total of 586 patients underwent LSG from January 2010 to February 2018. Revisional OAGB (rOAGB) was performed in 22 (3.8%) patients. A retrospective analysis of prospectively collected data from 20 patients with at least 12 months of follow-up after the revisional OAGB was carried out. The indications for revisional surgery were as follows: insufficient weight loss-4 (20%), weight regain-13 (65%), weight regain and symptoms of gastroesophageal reflux disease (GERD)-2 (10%), and dysphagia with gastroesophageal reflux-1 (5%). The mean interval between the LSG and rOAGB was 35.3 ± 15.4 months (range 4-64). The mean follow-up time after rOAGB was 45.5 ± 17.1 months (range 12-54). At the end of the follow-up after rOAGB, %TWL was 26.4 ± 8.9%, and %EWL was 58.5 ± 21.6%, based on pre-LSG body weight. In all three patients with intractable GERD, the clinical symptoms of reflux retreated after revisional OAGB. The overall complication rate was 20%. In conclusion, the main indications for revision after LSG are weight regain, insufficient weight loss, and intractable GERD. Revisional OAGB emerges as a viable surgical alternative for unsuccessful LSG, presenting notable weight loss outcomes; however, it may be linked to an increased incidence of complications.

Revision/Conversion Surgeries After One Anastomosis Gastric Bypass-An Experts' Modified Delphi Consensus

PURPOSE

There is a lack of evidence for treatment of some conditions including complication management, suboptimal initial weight loss, recurrent weight gain, or worsening of a significant obesity complication after one anastomosis gastric bypass (OAGB). This study was designed to respond to the existing lack of agreement and to provide a valuable resource for clinicians by employing an expert-modified Delphi consensus method.

METHODS

Forty-eight recognized bariatric surgeons from 28 countries participated in the modified Delphi consensus to vote on 64 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus.

RESULTS

A consensus was achieved for 46 statements. For recurrent weight gain or worsening of a significant obesity complication after OAGB, more than 85% of experts reached a consensus that elongation of the biliopancreatic limb (BPL) is an acceptable option and the total bowel length measurement is mandatory during BPL elongation to preserve at least 300-400 cm of common channel limb length to avoid nutritional deficiencies. Also, more than 85% of experts reached a consensus on conversion to Roux-en-Y gastric bypass (RYGB) with or without pouch downsizing as an acceptable option for the treatment of persistent bile reflux after OAGB and recommend detecting and repairing any size of hiatal hernia during conversion to RYGB.

CONCLUSION

While the experts reached a consensus on several aspects regarding revision/conversion surgeries after OAGB, there are still lingering areas of disagreement. This highlights the importance of conducting further studies in the future to address these unresolved issues.

Sleeve Migration Following Sleeve Gastrectomy: A Systematic Review of Current Literature

Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure worldwide. The incidence and consequences of sleeve migration (SM) are not clearly understood. There is no clear consensus on appropriate measures to reduce the risk of SM. This study systematically reviewed the literature and identified 405 cases of SM from 21 studies. Age ranged from 18 to 68 years. Thirty-two percent and 11% of patients were females and males respectively, while sex was not reported in 57%. Time to diagnosis ranged from 1 day to 5 years postoperatively. A total of 9.6% and 58.8% of patients had or had no previous hiatal hernia respectively. SM incidence, risk factors, proposed mechanisms, clinical presentation, diagnosis, management, and potential preventive strategies are described in this review.

One Anastomosis Gastric Bypass as Revisional Surgery Following Sleeve Gastrectomy: A Systematic Review and Meta-Analysis

BACKGROUND

Although sleeve gastrectomy (SG) is the most performed metabolic and bariatric surgery (MBS) worldwide, some patients require conversional procedures due to weight recurrence or late complications. Recently, one-anastomosis gastric bypass (OAGB) gained popularity as a viable option to address those problems. The aim of this meta-analysis is to assess the safety and efficacy of conversional OAGB after primary SG in the management of patients with obesity.

METHODS

Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to February 2023 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42023403528).

RESULTS

From 1,117 studies screened, twenty studies met the eligibility criteria, with a total of 1,057 patients with obesity undergoing conversional OAGB after primary SG. The mean age ranged from 28.2 to 49.5 years, and 744 patients (75.2%) were women. At one year after revisional OAGB, the pooled mean percent excess weight loss (%EWL) was 65.2% (95%CI: 56.9, 73.4, I2 = 97%). The pooled mean %EWL after conversional OAGB was 71.1% (95%CI: 62.2, 80.0, I2 = 90%) at two years and 71.6% (95%CI: 61.0, 82.2, I2 = 50%) at five years. Additionally, resolution rates of diabetes and hypertension were 65.4% (95%CI: 0.522, 0.785, I2 = 65%) and 58.9% (95%CI: 0.415, 0.762, I2 = 89%), respectively.

CONCLUSIONS

Our meta-analysis demonstrated OAGB as an effective conversional procedure after primary SG in terms of weight loss and obesity-associated medical problems for selected patients. Despite the promising results, further randomized controlled studies with larger sample sizes and more extended follow-up periods are necessary to determine if the OAGB is the best conversional surgery after SG.

ReSleeve or revisional one anastomosis gastric bypass for failed primary sleeve gastrectomy with dilated gastric tube: a retrospective study

BACKGROUND

Revisional bariatric surgery (RBS) has been increasingly performed due to weight loss failure (WLF). Many revisional procedures have been proposed after primary laparoscopic sleeve gastrectomy (pLSG) failure, including ReSleeve gastrectomy (ReLSG), and laparoscopic one anastomosis gastric bypass (LOAGB). Choosing the RBS post-pLSG failure represents a challenge. WLF without gastric tube (GT) dilation is undoubtedly converted to a malabsorptive procedure, but the presence of GT dilation makes it more difficult to select a RBS. This study aimed to compare two relatively simple revisional procedures after pLSG failure with dilated GT to help decision making on which procedure better done to which patient.

METHODS

Data of 52 patients who completed one year follow-up (FU) after their RBS (ReLSG: 27 or LOAGB: 25) for their failed pLSG were collected, assessed, correlated to weight loss (WL) and compared.

RESULTS

Mean operative time was 97 ± 18.4 min. with revisional LOAGB (RLOAGB) and 62 ± 11 min. with ReLSG. Six patients (11.5%) had seven postoperative procedure-specific complications. Significant hemorrhage occurred in three patients. Two cases of leakage were encountered with each procedure. LOAGB Patients had lower mean final weight (76.2 ± 10.5 vs 85.3 ± 13), lower mean Final BMI (26.4 ± 2.5 vs 29.7 ± 2.9) and higher mean percentage of excess weight loss (EWL%) (83.6 ± 13.5% vs 60.29 ± 14.6%). All RLOAGB patients and 77.8% of ReLSG patients had EWL% > 50%. RLOAGB patients had higher EWL% compared to ReLSG (p < 0.001). Insufficient WL (IWL) patients had higher EWL% compared to weight regain (WR) patients (p = 0.034).

CONCLUSION

Both procedures (RLOAGB and ReLSG) were relatively safe and effective in terms of WL. RLOAGB led to higher WL compared to ReLSG in all types of patients despite higher Caloric intake. IWL patients had more WL compared to WR patients. WL was not related to GT dilation type. Large-scale longer-FU studies are still needed.

TRIAL REGISTRATION

PACTR202310644487566 (retrospectively registered).

Roux-en-Y Gastric Bypass Versus One Anastomosis Gastric Bypass as Revisional Surgery After Failed Sleeve Gastrectomy: A Systematic Review and Meta-analysis

Purpose

This study aimed to assess the outcomes of revisional procedures, namely Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) following unsuccessful laparoscopic sleeve gastrectomy.

Materials and Methods

This systematic review and meta-analysis included 817 patients (404 in OAGB group, 413 in RYGB group) from seven retrospective comparative studies. Data on sample size, demographics, perioperative complications, operative time, pre- and post-revisional body mass index, total weight loss, and global weight loss over follow-up were extracted.

Results

The mean operative time was 98.2-201 minutes for RYGB versus 78.7-168 minutes for OAGB. Despite classical RYGB gastric bypass taking longer, mini gastric bypass resulted in greater weight loss than RYGB, with a mean difference of -5.84 (95% confidence interval [CI], -6.74 to -4.94; P<0.00001; I2=0%), greater total weight loss, and a higher diabetes remission rate (odds ratio [OR], 0.32; 95% CI, 0.14 to 0.71). However, OAGB was associated with a significantly higher incidence of postoperative gastroesophageal reflux than RYGB (52 vs. 31: OR, 0.40; 95% CI, 0.24 to 0.67; P=0.0005; I2=0%).

Conclusion

OAGB was performed more quickly and boasted greater total weight loss and higher diabetes remission rates compared to RYGB after failed sleeve gastrectomy. However, OAGB also demonstrated a higher incidence of postoperative gastroesophageal reflux disease. Thus, careful patient selection is essential when considering OAGB.

Trial Registration

PROSPERO Identifier: CRD42023474966.

Does One-Anastomosis Gastric Bypass Expose Patients to Gastroesophageal Reflux: a Systematic Review and Meta-analysis

This systematic review and meta-analysis aimed to investigate the incidence of new-onset gastroesophageal reflux, reflux change, esophagitis, Barrett's esophagus, and revision due to reflux, gastritis, and marginal ulcer after one-anastomosis gastric bypass (OAGB). We performed subgroup analyses based on primary and revisional OAGB and time of follow-up. Meta-analysis of 87 studies with 27,775 patients showed a 6% rate of new-onset reflux after OAGB. Preoperative reflux status did not change significantly after OAGB. The rate of esophagitis and Barrett's esophagus was 15% and 1%, respectively. The new-onset reflux rate after OAGB was significantly higher than gastric bypass but not different with sleeve gastrectomy. The current study showed a relatively low rate of reflux and its complications after OAGB, but it was significantly higher than Roux-en-Y gastric bypass.

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

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%).

The Effect of Revisional One Anastomosis Gastric Bypass After Sleeve Gastrectomy on Gastroesophageal Reflux Disease, Compared with Revisional Roux-en-Y Gastric Bypass: Symptoms and Quality of Life Outcomes

BACKGROUND

Gastroesophageal reflux disease (GERD) is common after sleeve gastrectomy (SG). We aimed to evaluate the effect of revisional one anastomosis gastric bypass (OAGB) on GERD, compared with revisional Roux-en-Y gastric bypass (RYGB) METHODS: A retrospective single-center study of a prospectively maintained patient registry (2018-2022). All patients with GERD undergoing OAGB and RYGB after SG were retrieved and included in the study.

RESULTS

Seventy-eight SG patients had conversion to OAGB (n=31) and RYGB (n=47). Baseline characteristics were similar except age (43.8±11.5 vs. 50.3±13.4 years; p=0.03), body mass index (39.9±8.8 vs. 30.6±6 kg/m2; p<0.001), time interval (8±2.7 vs. 6.4±3.4 years; p=0.01), and sleep apnea (29% vs 8.5%; p=0.01), respectively. There was no significant difference between groups in number of patients consuming proton pump inhibitors (70.1% vs. 72.3%; p=0.66), GERD-health-related quality of life (HRQL) score (9.6±7.2 vs. 13.1±8; p=0.06), and pathological endoscopic findings (48.4% vs. 46.8%; p=0.89). Major complication rates were 0% vs. 8.5% (p=0.09). At 32.4 months follow-up, total weight loss was 22%±12.9 and 4.4%±14.6 (p<0.001), GERD resolution 77.4% and 91.9% (p=0.03), HRQL scoring improved to 1.7±4.5 and 1.7±2.7; p=0.94 for OAGB and RYGB, respectively.

CONCLUSIONS

SG conversion to RYGB provides better chances for definitive treatment of GERD. OAGB results in good symptom resolution and improved quality of life and may be considered for post-SG GERD treatment. The most appropriate solution should be individualized to each patient.

Clinical influence of conversion of laparoscopic sleeve gastrectomy to one anastomosis gastric bypass on gastroesophageal reflux disease

PURPOSE

Assess the subjective impact of gastro-esophageal reflux disease (GERD) symptoms on patients undergoing revision from laparoscopic sleeve gastrectomy (LSG) to one-anastomosis gastric bypass (OAGB) using the Reflux Disease Questionnaire for GERD (RDQ) and the GERD-health related quality of life score (GERD-HRQL), prior to- and following conversion.

METHODS

Patients undergoing revision from LSG to OAGB were prospectively followed between May 2015 and December 2020. Data retrieved included demographics, anthropometrics, previous bariatric history, time interval between LSG and OAGB, weight loss, and co-morbidities. Pre- and post-OAGB RDQ and GERD-HRQL questionnaires were obtained. In the case of sleeve dilatation, sleeve resizing was performed.

RESULTS

During the study period, 37 patients underwent revision from LSG to OAGB. Mean ages at LSG and pre-OAGB were 38 ± 11.74 and 46 ± 12.75, respectively. Median follow-up time was 21.5 months (range 3-65). All patients underwent sleeve resizing. RDQ and GERD-HRQL scores were obtained at a median of 14 months (range 3-51) between pre- and post-OAGB. Median RDQ score pre-OAGB vs post-OAGB was significantly reduced (30 (range 12-72) vs 14 (range 12-60), p = 0.007). All 3 parts of the GERD- HRQL questionnaires were significantly reduced between pre-OAGB and post-OAGB: Symptoms (20; 62.5% vs 10; 31.3%, p = 0.012), overall score (15 (0-39) vs 7 (0-28), p = 0.04) and subjective improvement (10; 31% vs 20; 62.5%, p = 0.025).

CONCLUSION

Conversion of LSG to OAGB showed subjective improvement of GERD symptoms both in RDQ and in GERD-HRQL.

A Long-Term Comparative Study Between One Anastomosis Gastric Bypass and Sleeve Gastrectomy

BACKGROUND

One anastomosis gastric bypass (OAGB) has become increasingly accepted in bariatric surgery and meanwhile represents the third most common procedure worldwide. While it shows promising weight loss results and comorbidity resolution, questions about issues such as reflux or nutritional deficiencies (ND) persist in the long term. On the other hand, the most frequently performed sleeve gastrectomy (SG) has to accept growing criticism regarding long-term results and reflux issues. There is a particular lack of long-term comparative data for both procedures. This study presents our long-term experience.

METHODS

We evaluated OAGB and SG patients retrospectively comparing for weight loss and resolution of comorbidities as well as perioperative and long-term complications in a follow-up period of 5 years.

RESULTS

Nine hundred eleven OAGB and 241 SG were included in the study. OAGB had a shorter operation time and hospital stay. Overall complication rate did not differ in both groups. Ulcers were more frequent in OAGB (7.7% vs. 1.7%, p = 0.001), whereas insufficient weight loss (IWL)/weight regain (WR) proved to be more prevalent in SG (25.7% vs. 6.4%, p < 0.001). The same held true for reflux (17.8% vs. 8.3%, p < .001). On the other hand, ND were more common in OAGB (20.0% vs. 12.0%, p = 0.005). Revisional surgery was more often indicated after SG. Analysis by linear mixed model showed that OAGB achieved a lower BMI/higher loss of BMI. Improvement of T2DM (94.6% vs. 85.2%, p = 0.008) and sleep apnea (88.8% vs. 78.8%, p = 0.01) was superior in OAGB.

CONCLUSIONS

OAGB had a superior effect on weight loss as well as improvement of T2DM and sleep apnea. Furthermore, long-term problems such as IWL/WR and reflux were more related to SG. On the other hand, a malabsorptive procedure such as OAGB showed a higher risk for ND. Our findings support the available data in the literature.

One-Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass as Revisional Surgery After Sleeve Gastrectomy: a Systematic Review and Meta-analysis

The demand for revisional bariatric surgery after sleeve gastrectomy (SG) has increased, but the ideal procedure remains unclear. A systematic review and meta-analysis were performed to compare the outcomes of weight loss and safety of one-anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) as revisional procedures for failed SG. Four retrospective comparative studies were included, comprising 499 individuals. Patients submitted to OAGB had a more significant total weight loss (TWL) (MD =  - 5.89%; 95% CI - 6.80 to - 4.97) after revisional surgery. Overall early complication rate was similar between procedures (RD = 0.04; 95% CI: - 0.05 to 0.12). Limited and heterogeneous data prevent meaningful conclusions, but the present analysis suggests that OAGB has a better TWL after revisional surgery.

Visual Analysis of Nutrient Deficiency and Treatment Protocols in Bariatric Surgery Based on VOSviewer

Objective

To analyze the global literature on nutritional deficiencies in bariatric surgery (BS) since January 1, 1985, and to discuss the current status of research, research hotspots, and new development trend and treatment of nutritional deficiency in bariatric surgery. It provides ideas and basis for promoting the development of bariatric surgery and new alternative therapy or treatment protocols.

Methods

The Web of Science (WOS) database core collection was used as the data source, and VOSviewer 1.6.17 software was used to search the literature on the topic of “nutritional deficiencies in bariatric surgery.” The number of published literature, the distribution of authors, institutions, and countries, keyword cooccurrences, and journal cocitations were visualized and analyzed.

Results

A total of 1015 relevant publications was obtained after searching and screening, and the overall trend of literature published was on the rise. The most published countries, institutions, and authors were USA, University of Sao Paulo, Ramalho, Andrea; Obesity Surgery has been the most frequently cited journal (7943 citations), and the top 10 journals had high impact factors. Keyword cooccurrence analysis showed that “bariatric surgery” and “nutritional deficiencies” are the hot topics of research in this field.

Conclusion

There is an urgent need for bariatric surgery issuing institutions and authors to strengthen cross-institutional, cross-team, and multicenter and multidisciplinary cooperation, to promote and facilitate the exchange and cooperation in the field of bariatric surgery between developed countries in Europe and America and developing countries in Asia, Africa, and Latin America, to draw the attention of developing countries to the health problems caused by obesity, and to encourage and support the development of developing countries in this field. Bariatric surgery, obesity, weight loss, Y-type gastric bypass, gastric bypass, and nutritional deficiency are the hot research topics in the field of nutritional deficiency in bariatric surgery, and metabolic surgery, single anastomosis gastric bypass, micronutrient supplementation, micronutrient deficiency, intestinal microbiology, and guidelines are the new trends in this field.

Indocyanine Green Fluorescence Angiography During Laparoscopic Bariatric Surgery: A Pilot Study

Aims

Indocyanine green (ICG) fluorescence angiography (FA) is used for several purposes in general surgery, but its use in bariatric surgery is still debated. The objective of the present pilot study is to evaluate the intraoperative utility of ICG-FA during bariatric surgery in order to focus future research on a reliable tool to reduce the postoperative leak rate.

Methods

Thirteen patients (4 men, 30.8%, 9 women, 69.2%) with median age of 52 years (confidence interval, CI, 95% 46.2–58.7 years) and preoperative median body mass index of 42.6 kg/m² (CI, 95% 36 to 49.3 kg/m²) underwent bariatric surgery with ICG-FA in our center. Three mL of ICG diluted with 10 cc sterile water were intravenously injected after gastric tube creation during laparoscopic sleeve gastrectomy (LSG) and after the gastric pouch and gastro-jejunal anastomosis creation during laparoscopic gastric by-pass (LGB). For the ICG-FA, Karl Storz Image 1S D-Light system (Karl Storz Endoscope GmbH & C. K., Tuttlingen, Germany) placed at a fixed distance of 5 cm from the structures of interest and zoomed vision modality were used to identify the vascular supply. The perfusion pattern was assessed by the surgical team according to a score. The score ranged from 1 (poor vascularization) to 5 (excellent vascularization) based on the intensity and timing of fluorescence of the vascularized structures.

Results

Fom January 2021 to February 2022, six patients underwent LSG (46.2%), three patients underwent LGB (23.1%), and four patients underwent re-do LGB after LSG (30.8%). No adverse effects to ICG were observed. In 11 patients (84.6%) ICG-FA score was 5. During two laparoscopic re-do LGB, the vascular supply was not satisfactory (score 2/5) and the surgical strategy was changed based on ICG-FA (15.4%). At a median follow-up of five months postoperatively, leaks did not occur in any case.

Conclusions

ICG-FA during bariatric surgery is a safe, feasible and promising procedure. It could help to reduce the ischemic leak rate, even if standardization of the procedure and objective fluorescence quantification are still missing. Further prospective studies with a larger sample of patients are required to draw definitive conclusions.