Abstract
BackgroundFailure occurs in up to 60% of the patients that were treated with primary restrictive bariatric operations such as Laparoscopic Adjustable Gastric Banding (LAGB), or restrictive/metabolic operations like Laparoscopic Sleeve Gastrectomy (LSG). Insufficient weight loss and weight regain are the most commonly reported reasons of failure. The aim of this retrospective multicenter study was to compare One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) as a revisional procedure in terms of weight loss, procedure time, complication rate and morbidity.Methods491 patients operated on between 2012 and 2017 for failed restrictive surgery were included in this study (OAGB (n=185) or RYGB (n=306)). Failure was defined as total weight loss (TWL) less than 25%, excess weight loss (EWL) less than 50% and/or a remaining body mass index (BMI) larger than 40 kg/m2 at two years of follow up. Primary outcome measures were %TWL and % excess BMI loss (EBMIL) at 12, 24 and 36 months of follow-up. Secondary outcomes were procedure time, reduction of comorbidity, early and late complication rate, and mortality.Results%TWL was significantly larger in the OAGB group at 12 months (mean 24.1±9.8 vs. 21.9±9.7, p = 0.023) and 24 months (mean 23.9±11.7 vs. 20.5±11.2, p = 0.023) of follow-up. %EBMIL was significantly larger in the OAGB group at 12 months (mean 69.0±44.6 vs. 60.0±30.1, p = 0.014) and 24 months (mean 68.6±51.6 vs. 56.4±35.4, p = 0.025) of follow-up. Intra-abdominal complications (leakage, bleeding, intra-abdominal abscess and perforation) occurred less frequently after revisional OAGB (1.1% vs. 4.9%, p = 0.025). Surgical intervention for biliary reflux (5.4% vs. 0.3%, p < 0.001) was more prevalent in the OAGB group. Surgical intervention for internal herniation (0.0% vs. 4.9%, p = 0.002) was more prevalent in the RYGB group.ConclusionsThis study suggests that OAGB is superior to RYGB as a remedy for insufficient weight loss and weight regain after failed restrictive surgery with more weight loss and a lower early complication rate. To substantiate these findings, further research from prospective randomized controlled trials is needed.
Highlights
Obesity is a global health problem of increasing proportions and is a major risk factor for premature death and morbidity such as type 2 diabetes mellitus (T2DM), obstructive sleep apnea syndrome (OSAS), hypertension, dyslipidemia and osteoarthritis [1].Bariatric surgery is the most effective treatment in morbidly obese patients, in terms of weight loss and reduction of these comorbidities [2, 3].Primary restrictive procedures such as Vertical Banded Gastroplasty (VBG), Laparoscopic Adjustable Gastric Banding (LAGB) or Laparoscopic Sleeve GastrectomyOBES SURG (2020) 30:3287–3294(LSG), the latter is considered to be a metabolic procedure, seem to be a safe and effective strategy for weight reduction in short and mid-term follow-up
The aim of the current study was to compare One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) as a revisional procedure after failed restrictive surgery in terms of weight loss, procedure time, complication rate, reduction of comorbidity, complication rate and mortality
Sleeve gastrectomy was more often performed as primary procedure (35.1% vs. 24.5%, p = 0.012) in the OAGB group, and adjustable gastric banding was more often performed (64.9% vs. 75.5%, p = 0.012) in the RYGB group
Summary
Obesity is a global health problem of increasing proportions and is a major risk factor for premature death and morbidity such as type 2 diabetes mellitus (T2DM), obstructive sleep apnea syndrome (OSAS), hypertension, dyslipidemia and osteoarthritis [1].Bariatric surgery is the most effective treatment in morbidly obese patients, in terms of weight loss and reduction of these comorbidities [2, 3].Primary restrictive procedures such as Vertical Banded Gastroplasty (VBG), Laparoscopic Adjustable Gastric Banding (LAGB) or Laparoscopic Sleeve GastrectomyOBES SURG (2020) 30:3287–3294(LSG), the latter is considered to be a metabolic procedure, seem to be a safe and effective strategy for weight reduction in short and mid-term follow-up. Bariatric surgery is the most effective treatment in morbidly obese patients, in terms of weight loss and reduction of these comorbidities [2, 3] Primary restrictive procedures such as Vertical Banded Gastroplasty (VBG), Laparoscopic Adjustable Gastric Banding (LAGB) or Laparoscopic Sleeve Gastrectomy. Patients who underwent these procedures are at risk of having insufficient weight loss and weight regain [4,5,6,7,8] These complications can be an indication for revisional surgery [8, 9]. Insufficient weight loss and weight regain are the most commonly reported reasons of failure The aim of this retrospective multicenter study was to compare One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) as a revisional procedure in terms of weight loss, procedure time, complication rate and morbidity.
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