One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150cm: Weight Loss, Nutritional Outcomes, Endoscopic Results, and Quality of Life at 8-Year Follow-Up.

Abstract

One anastomosis gastric bypass (OAGB) is now recognized as a mainstream bariatric procedure, nonetheless concerns about the risk of nutritional deficiencies and biliary reflux persist, and the ideal length of the biliopancreatic limb (BPL) is debated. Data of patients who underwent OAGB between May 2010 and December 2010 were collected prospectively and analyzed retrospectively. At an 8-year follow-up, a complete evaluation included clinical examination, blood tests, upper gastrointestinal endoscopy, and quality of life (QoL) assessed through the BAROS score. Overall, 115 patients underwent OAGB with a BPL of 150cm. Thirty-six (31%) were lost at the 8-year follow-up. Mean preoperative weight was 117 ± 20.8kg and mean BMI 43.2 ± 5.8kg/m2. At 8years, weight was 76.5 ± 17.3kg, BMI 28.3 ± 5.8, %TWL 34.8 ± 10.7, and %EWL 84.8 ± 27.1. No patients were readmitted for nutritional complications or underwent revisional surgery for malnutrition; 6 patients were converted to Roux-en-Y gastric bypass for intractable reflux. High rates of vitamin D and A deficiencies and secondary hyperparathyroidism were found at 8years. The BAROS score was > 3 at 8years for 93% of patients. Upper gastrointestinal endoscopy was available for 46 patients and found esophagitis in 6.5% of cases but no cases of Barrett's esophagus. OAGB performed with a 150-cm BPL is an effective bariatric procedure, associated with good long-term outcomes in relation to weight loss, QoL, resolution of comorbidities, and a very low rate of protein-calorie malnutrition. Fat-soluble vitamin deficiencies represent the main long-term concern. Endoscopic findings at 8years are reassuring.