Comment on: Conversion from one anastomosis gastric bypass to Roux-en-Y gastric bypass.

Abstract

We read with great interest the article by Jedamzik et al. “Conversion from one anastomosis gastric bypass to Roux-en-Y gastric bypass: when and why – a single center experience of all consecutive OAGB procedures” [ 1 Jedamzik J. Bichler C. Felsenreich D.M. et al. Conversion from one anastomosis gastric bypass to Roux-en-Y gastric bypass: when and why – a single center experience of all consecutive OAGB procedures. Surg Obes Relat Dis. 2021 Oct 27; (https://doi.org/10.1016/j.soard.2021.10.019, accessed December 13, 2021.) Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar ]. The authors analyzed a series of patients who underwent conversion from one anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB). Eighty-two of 1025 patients (8%) underwent conversion to RYGB; 7 were early interventions for fistula (.7%), whereas at long term, 42 patients underwent conversion for reflux (4%), 11 for ulcers (1%), 10 for stenosis (1%), 9 for malnutrition (.9%), and 3 for weight regain (.3%). Seven patients (.7%) showed Barrett's metaplasia before conversion. The shift from RYGB to OAGB has been carried out by some surgeons to reduce nonseptic complications (ulcer and early anastomotic stenosis) at the gastrojejunal anastomosis and to eliminate complications at the jejuno-jejunal anastomosis. Two major problems arose with the shift from RYGB to OAGB: 1) the realization of a high-flow anastomosis allowing a high-volume bile flow, with difficult healing in case of fistula; and 2) a conversion rate of approximately 1% for malnutrition when a bilio-pancreatic loop of 200 cm was fashioned [ 2 Rutledge R. Walsh T.R. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005; 15: 1304-1308 Crossref PubMed Scopus (213) Google Scholar ]. Surgeons in our bariatric center fashion a semi-mechanical 60-mm-wide gastrojejunal anastomosis and a biliopancreatic limb of 150 cm when OAGB is performed. The assembly is a low-pressure high-flow system and the rate of conversion to RYGB for fistula becomes exceptional [ 3 Liagre A. Queralto M. Juglard G. Anduze Y. Iannelli A. Martini F. Multidisciplinary management of leaks after one-anastomosis gastric bypass in a single-center series of 2780 consecutive patients. Obes Surg. 2019; 29: 1452-1461 Crossref PubMed Scopus (14) Google Scholar ]. The OAGB seems to be associated with a lower rate of ulcers for vascular reasons and/or because of HCl buffering by bile. It seems illogical to convert OAGB into RYGB for persistent ulcers. Reply to comment on: Conversion from one-anastomosis gastric bypass to Roux-en-Y gastric bypassSurgery for Obesity and Related DiseasesVol. 18Issue 5PreviewWe thank Liagre et al. (2021) for the interesting letter [1] and want to clarify some of the comments/issues raised. We reported our retrospective data on conversion from one anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB). The reasons stated in the herein presented study are common among bariatric-metabolic surgeons when it comes to revisional bariatric surgery [2]. Full-Text PDF