Abstract
A systematic review and meta-analysis were carried out involving studies that compared the nutritional complications of Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB); these included the incidence of malnutrition as well as deficiencies of other nutritional elements, such as total protein, albumin, calcium and iron. A comprehensive search strategy was implemented in PubMed, Embase, and the Cochrane Library. Effect sizes included the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs), as well as mean differences (MDs) and 95% CIs of the percentage total weight loss (%TWL) and excess weight loss percentage (%EWL).Thirteen studies were included (12,964 patients, 66.27% females, 53.82% underwent OAGB). At the longest follow-up period (≥3 years), OAGB was associated with significantly higher %TWL (MD=5.41%, 95%CI, 1.52 to 9.29) and %EWL (MD=13.81%, 95%CI, 9.60 to 18.02) compared to RYGB. However, OAGB procedures were associated with malnutrition (OR=3.00, 95%CI, 1.68 to 5.36, p<0.0001), hypoalbuminemia (OR=2.38, 95%CI, 1.65 to 3.43, p<0.0001), hypoproteinemia (OR=1.85, 95%CI, 1.09 to 3.14, p=0.022), anemia (OR=1.38, 95%CI, 1.08 to 1.77, p=0.011), and hypocalcemia (OR=1.78, 95%CI, 1.01 to 3.12, p=0.046). On subgroup analyses, the proportions of anemia and hypoalbuminemia remained significantly higher at longer follow-up periods and in studies published in Asia.Despite the favorable weight loss profile, the unfavorable nutritional consequences of OAGB merits further investigations to explore the malabsorptive element, ethnic variation, and the role of biliopancreatic limb length.
Highlights
We found that studies published in Asia showed significantly higher odds of anemia (OR = 1.41, 95%confidence intervals (CIs), 1.07 to 1.86, Figure 3A) and hypoalbuminemia (OR = 2.49, 95%CI, 1.70 to 3.65, Figure 3B) among patients who underwent one-anastomosis gastric bypass (OAGB) compared to Roux-en-Y gastric bypass (RYGB); these differences were not evident in the studies published in European countries
In the present meta-analysis, we found that OAGB procedures were associated with malnutrition and anemia, as well as deficiencies of blood albumin, total proteins, and calcium
We found that OAGB was associated with hypocalcemia, and this might be related to the exclusion of a significant proportion of the proximal small bowel [56]
Summary
The prevalence of obesity has dramatically increased worldwide, with more than 650 million obese adults and 2.5 million obesity-related deaths as of 2016 [1]. Roux-en-Y gastric bypass (RYGB) is a restrictive-malabsorptive procedure that is superior to non-surgical treatment in terms of weight loss outcomes and resolution of co-morbidities [5,6]. It was first introduced by Mason in 1966 [7] and the first laparoscopic procedure was performed in 1994 by Alan Wittgrove [8].
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