SJLA_2024_A6: Comparison of One Anastomosis Gastric Bypass versus Roux-en-Y Gastric Bypass Outcome for Treatment of Obesity in Oman: A 3-year Study

Abstract

Background: Obesity and its comorbidities remain a priority public health issue, 30% of the Omani population having body mass index (BMI) of more 30. Roux-en-Y gastric bypass (RYGB) remains one of the gold standard procedures for morbid obesity and metabolic disorders in most of the reference centers. One-anastomosis gastric bypass (OAGB), gaining wide acceptance OAGB, was proposed as a simple and effective treatment for morbid obesity. Published data essentially come from retrospective studies, meta-analysis, and few root canal treatment have been reported the value of OAGB remains debated, high-level evidence regarding its efficacy and safety. Methods: A single-institution qualitative retrospective cohort study was conducted in Royal Hospital in the period between 2017 and 2020. Total sample: 45 (28 OAGB and 17 RYGB, the data were collected from the medical record system (Al-Shifa system). Inclusion criteria: all patients who aged 18–65 years with a BMI between 35 and 50 kg/m2. Exclusion criteria who have esophagitis, malignancy “Inflammatory bowel disease” Pregnancy, BMI over 50 kg/m2, and previous bariatric surgery. Results: The mean BMI at 3 years was 31.9 for OAGB and 32 for RYGB. There was no significant difference in EWL% in the OAGB compared with the RYGB group, P = 0.86; mean HbA1c at 3 years was not statistically different P = 0.49. The mean decrease in HbA1c was significantly greater in the OAGB arm 2.4% than in the RYGB arm 2%. There was a 68% (n = 15/23) complete type 2 diabetes (T2D) remission rate in the OAGB group versus 31% in the RYGB group. The proportions of T2D remission were not significantly different (P = 0·722). The incidence of malnutrition, anemia, and vitamin deficiencies at 3 years was not significantly different. Discussion: RYGB was first described in 1967, and an IFSO survey showed that RYGB was the most common bariatric procedure from 2003 to 2013 (11, 28). According to the 2018 IFSO survey results, OAGB was considered the third most popular bariatric surgery. Previous studies have suggested that the OAGB learning curve is shorter than that of RYGB and that the learning curve is closely related to surgical complications. However, there is no consistent confirmation of the effect and comorbid remission rate of the two bariatric surgeries. Many articles have shown that the weight loss effect of OAGB is not as worse as that of RYGB; however, the sample size of the comparison articles is small, the randomized trials are few, and they mainly focused on the comparison of weight loss effect, with less research on postoperative complications. Conclusion: OAGB appeared to be safe, effective, and not inferior to LRYG. OAGB is associated with more weight loss and better resolution of comorbid conditions. No difference between both surgeries in nutritional outcomes. The clinical utility of OAGB needs to be further validated by future prospective RCTS.