Mini/One Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass as a Second Step Procedure After Sleeve Gastrectomy—a Retrospective Cohort Study

• Published in: Obesity surgery Vol. 29; no. 3; pp. 819 - 827
• Main Authors: Chiappetta, Sonja, Stier, Christine, Scheffel, Oliver, Squillante, Simone, Weiner, Rudolf A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2019; Springer Nature B.V
• Subjects: Cohort analysis; Gastrectomy - adverse effects; Gastrectomy - methods; Gastrectomy - statistics & numerical data; Gastroesophageal Reflux; Gastrointestinal surgery; Humans; Medicine; Medicine & Public Health; Obesity, Morbid - surgery; Operative Time; Original Contribution; Postoperative Complications; Reoperation - adverse effects; Reoperation - methods; Reoperation - statistics & numerical data; Retrospective Studies; Surgery; OAGB-MGB; RYGB; SG; Revisional surgery
• ISSN: 0960-8923; 1708-0428
• DOI: 10.1007/s11695-018-03629-y

Background Whether one anastomosis gastric bypass (OAGB) or Roux-en-Y gastric bypass (RYGB) is a better revisional bariatric surgery (RBS) after sleeve gastrectomy (SG) is still under debate. The aim is to compare short-term outcomes of RYGB and OAGB as a RBS after SG, pertaining to their effects on weight loss, resolution of comorbidities, and complications. Methods We performed a single-center analysis of 55 patients ( n  = 34 OAGB, n  = 21 RYGB). Indications for revisional surgery included weight regain/loss failure (67%) and intractable gastroesophageal reflux disease (33%). Data were collected up to 1-year follow-up (FU) and included time of revisional surgery, operation time, weight, body mass index, excess weight loss, and total weight loss (TWL), both in percent, complications and resolution of comorbidities. Results Operation time was 79 ± 36 (OAGB-MGB) and 98 ± 24 min (RYGB) ( p  = 0.03). In the first 30 postoperative days, three patients in the RYGB group, and no patient in the OAGB group, had postoperative complications. FU was 100%. Minor complication rates at 12 months were 33.3% (RYGB) and 35.3% (OAGB). At 12 months, mean % TWL was 10.3 ± 7.6% (RYGB) and 15.8 ± 7.8% (OAGB) ( p  = 0.0132). Conclusions OAGB after failed SG was found to be a quicker procedure with less perioperative complications. At 1-year FU, no significant differences were seen between RYGB and OAGB regarding readmission and minor complications. Still long-term FU including the risk of malnutrition is needed to have a complete evaluation of OAGB as a RBS for the future.