Omega Loop Gastric Bypass Research Articles

Incidence and risk factors of post-metabolic and bariatric surgery hypoglycemia: a systematic review.

This study aimed to systematically review the existing literature to summarize the incidence and risk factors of post-metabolic and bariatric surgery hypoglycemia (MBSH). We searched PubMed, Medline, Embase, and the Cochrane Library databases for the studies published from inception to August 2023. Randomized controlled trials and analytical studies that investigated the incidence or risk factors of MBSH after different surgery techniques (including Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding, duodenal switch, omega-loop gastric bypass, and vertical banded gastroplasty) were involved. The incidence and risk factors of MBSH were extracted and described separately based on different diagnostic criteria and then summarized the risk factors and their statistical findings collectively. Twenty-nine studies were reviewed with follow-up ranging from 1 to 22 years. The incidence of MBSH ranged significantly across different diagnostic methods: 2.6-66.4% (self-report), 6.6-61.8% (oral glucose tolerance test), 29.4-78.6% (mixed-meal tolerance test), and 50-75% (continuous glucose monitoring). Patients with a mean age of 49.8 years and 89.0% of them were women with a better glycemic control who undergo RYGB and achieve 86.5% of estimated weight loss from surgery should be particularly vigilant about the possibility of developing MBSH. Distinct biomarkers such as IGF-1 (OR 1.06), fasting glicentin (AUC 0.81), HbA1c (AUC 0.76), and absolute weight reduction (AUC 0.72), greater fluctuations in glucose (OR 1.98) are valuable in promptly detecting MBSH. Specifically, patients with prior cholecystectomy or antidepressant therapy should be particularly cautious. The review highlights higher MBSH risk in younger women with significant weight loss after RYGB, and those with prior cholecystectomy or antidepressant use. Systematic summarization of MBSH criteria allowed us to identify the predictors for MBSH, which can aid in early diagnosis and treatment, reducing the need for prolonged monitoring.

Postoperative Dumping Syndrome, Health-Related Quality of Life, Anxiety, Depression, and Eating Disturbances: Results of a Longitudinal Obesity Surgery Study

Introduction: Given the lack of research on the relationship of post-surgery dumping syndrome and eating disturbances, the purpose of the present longitudinal study was to investigate whether dumping after obesity surgery is associated with pre-/postoperative eating disorder symptoms or addiction-like eating beyond the type of surgery, gender, health-realted quality of life (HRQoL) and anxiety/depressive symptoms. Methods: The study included 220 patients (76% women) before (t0) and 6 months after (t1) obesity surgery (sleeve gastrectomy [n = 152], Roux-en-Y gastric bypass [n = 53], omega loop gastric bypass [n = 15]). The Sigstad Dumping Score was used to assess post-surgery dumping syndrome. Participants further answered the Eating Disorder Examination Questionnaire (EDE-Q), Yale Food Addiction Scale 2.0 (YFAS 2.0), Short-Form Health Survey (SF-12), and Hospital Anxiety and Depression Scale (HADS) at t0 and t1. Results: The point prevalence of symptoms suggestive of post-surgery dumping syndrome was 33%. Regression analyses indicate an association of dumping with surgical procedure (bypass), female gender, reduced HRQoL, more anxiety/depressive symptoms, and potentially with binge eating but not with eating disorder symptoms in general or with addiction-like eating. Conclusion: The current study failed to show a close relationship between the presence of self-reported dumping syndrome and eating disorder symptoms or addiction-like eating following obesity surgery. Further studies with longer follow-up periods should make use of clinical interviews to assess psychosocial variables and of objective measures to diagnose dumping in addition to standardized self-ratings.

The Effectiveness of Endoscopic Argon Plasma Coagulation (APC) of Dilated Gastrojejunostomy in the Treatment of Weight Regain After Omega Loop Gastric Bypass Surgery

The Effectiveness of Endoscopic Argon Plasma Coagulation (APC) of Dilated Gastrojejunostomy in the Treatment of Weight Regain After Omega Loop Gastric Bypass Surgery

Persistent post-bariatric-surgery hypoglycemia: A long-term follow-up reassessment

Background and aimPost-bariatric-surgery hypoglycemia (PBH) is a serious complication of bariatric surgery (BS). In our previous study about three quarters of the patients developed PBH. However long-term follow-up data is lacking to determine whether this condition improves with time. The aim of the current study was to re-assess post-BS patients who participated in our previous study and determine whether there are changes in the frequency and/or severity of hypoglycemic events. Methods and resultsTwenty-four post-BS, post Roux-en-Y gastric-bypass (RYGB = 10), post omega-loop gastric-bypass (OLGB = 9) and post sleeve-gastrectomy (SG = 5) individuals were reevaluated in a follow-up study 34.4 ± 4 months after their previous assessment and 67 ± 17 months since surgery. The evaluation included: a dietitian assessment, a questionnaire, meal-tolerance test (MTT) and a one-week masked continuous glucose monitoring (CGM). Hypoglycemia and severe hypoglycemia were defined by glucose levels ≤54 mg/dl and ≤40 mg/dl, respectively.Thirteen patients reported questionnaire meal-related complaints, mainly non-specific. During MTT, hypoglycemia occurred in 75% of the patients, and severe hypoglycemia in a third, but none was associated with specific complaints. During CGM, 66% of patients developed hypoglycemia and 37% had severe hypoglycemia. We did not observe significant improvements in hypoglycemic events compared to the previous assessment. Despite the high frequency of hypoglycemia, it did not necessitate hospitalizations or lead to death. ConclusionsPBH did not resolve within long-term follow-up. Intriguingly, most patient were unaware of these events which can lead to underestimation by the medical staff. Further studies are needed to determine possible long term sequela of repeated hypoglycemia.

A Woman With Recurrent Upper Gastrointestinal Bleeding

Question: A 45-year-old woman was admitted to the intensive care unit for hemorrhagic shock and hematemesis. She had a known history of omega-loop gastric bypass 10 years ago and mixed alcohol-related/NASH-related cirrhosis, and she was followed up using screening ultrasound every 6 months according to current recommendations. She never had an abdominal computed tomography (CT) scan. She had been lost to follow up in hepatology for 2 years.

Evaluation of the Incidence of the Esophagogastric Pre-Cancerous Mucosal Lesions after Bariatric Surgery.

Bariatric surgery is associated with significant risk reduction for obesity-related and hormone-mediated cancers; however, few studies report gastric or esophageal cancer development after bariatric surgery. This study evaluates the incidence of pre-cancerous mucosal lesions one year after bariatric surgery. Eligible patients for omega-loop gastric bypass and classic Roux-en-Y gastric bypass (RYGB) underwent upper endoscopy before bariatric surgery and one year after the procedure. Several biopsies were obtained from esophagogastric mucosa, all of which were evaluated by pathologists regarding the development of any pre-cancerous lesion. A total of 108 patients were included in the study. Seventy-one underwent omega bypass and 37 classic RYGB. Follow-up endoscopy indicated no dysplastic changes in esophagogastric mucosa one year after the surgery. The number of patients with gastric intestinal metaplasia was 22 and 25 before and after the surgery, respectively, which was not a statistically significant increase. Bariatric surgeries might not increase the risk of developing pre-cancerous lesions in the esophagogastric mucosa. Further epidemiological studies may help to establish this finding.

Is development in bariatric surgery in Germany compatible with international standards? A review of 16years of data.

Bariatric surgery has expanded tremendously internationally over the past decade. In recent years, bariatric surgery has experienced a significant growth in Germany. However, the question arises as to whether this development is in line with international developments or whether there is still room for improvement that could be challenged. 63,990 primary bariatric procedures recorded in the German Bariatric Surgery Registry (GBSR) were analyzed from 2005 to April 2021. The distribution of procedures according to different variants was analyzed and presented. In the last 16years, 17 different procedures have been performed. The most common surgical procedure was sleeve gastrectomy (SG), followed by Roux-Y gastric bypass (RYGB) (42%). Adjustable gastric banding (AGB) has declined over time, from 23.5% in the first 5 years to 0.2% in recent years. In comparison, omega-loop gastric bypass has increased over the past 5 years (from 0.4% in the first 5 years to 5.9% in the last 5 years). Laparoscopic procedures have accounted for 96.4% of all bariatric surgeries in recent years. The frequency of some procedures has decreased and some bariatric procedures have lost significance. Overall, bariatric surgery in Germany has developed positively compared to the international trend. Nevertheless, there is one area that needs to be optimized: the development of robotic bariatric surgery, which crawls behind in Germany compared to other countries. To establish the technology in bariatric surgery in a timely manner, a balance must be found between cost neutrality and patient-oriented applications.

Laparoscopic conversion of omega loop gastric bypass to Roux-en-Y gastric bypass for Barrett’s esophagus: case report

BackgroundThe number of mini gastric bypass / one anastomosis bypass (MGB-OAGB) procedures in bariatric patients that have been performed world-wide has drastically increased during the past decade. Nevertheless, due to the risk of subsequent biliary reflux and development of ulcer and neoplastic (pre)lesions caused by long-time bile exposure, the procedure is still controversially discussed. In here presented case report, we could endoscopically demonstrate a transformation from reflux oesophagitis to Barrett’s metaplasia most likely caused by bile reflux after mini-gastric bypass. To our knowledge, this is a first case study that shows development of Barrett’s metaplasia after MGB-OAGB.Case presentationWe present the case of a 50-year-old female which received a mini-gastric bypass due to morbid obesity (body mass index (BMI) 42.4 kg/m2). Because of history gastroesophageal reflux disease (GERD), a fundoplication had been performed earlier. Preoperative gastroscopy showed reflux esophagitis (Los Angeles classification grade B) with no signs of Barrett’s metaplasia. Three months post mini-gastric bypass, the patient complained about severe bile reflux under 40 mg pantoprazole daily. Six months postoperative, Endoscopically Barrett’s epithelium was detected and histopathologically confirmed (C1M0 after Prague classification). A conversion into Roux-en-Y gastric bypass was performed. The postoperative course was without complications. In a follow up after 6 months the patient denied reflux and showed no signs of malnutrition.ConclusionsThe rapid progress from inflammatory changes of the distal esophagus towards Barrett’s metaplasia under bile reflux in our case is most likely a result of previous reflux disease. Nevertheless, bile reflux appears to be a potential decisive factor. Study results regarding presence of bile reflux or development of endoscopically de-novo findings after MGB-OAGB are widely non-conclusive. Long-term prospective studies with regular endoscopic surveillance independent of clinical symptoms are needed.

The effect of Roux-en-Y gastric bypass compared with omega-loop gastric bypass on weight loss, perioperative surgical events, and comorbidities.

In comparison to conservative therapy, bariatric surgery has shown many reasonable results. The current study investigates whether Omega-loop-gastric-bypass (OAGB) or Roux-en-Y gastric-bypass (RYGB) improves weight loss, comorbidities, and perioperative complications. The study included 28,683 patients after RYGB and OAGB. Outcome criteria were perioperative morbidity, perioperative complications, and remission of comorbidities after one year of follow-up. Of them 14,253 patients had completed a one-year follow-up (13,483 patients by RYGB and 770 by OAGB). BMI reduction was a significant difference in favor of OAGB (17.5±5.6 kg/m2 for OAGB vs. 15.2±5.0 for RYGB; P<0.001). The %EWL was not significantly different between the two groups (P=0.073). There was also no significant difference in perioperative complications between the two groups (overall P>5%). Significant differences in favor of OAGB were observed in remission of insulin-dependent diabetes mellitus (IDDM) (P<0.001), and sleep apnea (P=0.002). Remission of reflux was more observed in RYGB than OAGB (P<0.001). Operating time was significantly higher in RYGB than OAGB (P<0.001). Compared with RYGB, OAGB showed significant advantages in many respects. In particular, remission of comorbidities was significantly better after OAGB than in patients after RYGB during the one-year follow-up period. Nevertheless, many other factors such as medical history, long-term expected goals of bariatric surgery, and preexisting comorbidities should be taken into account when determining indications between the two procedures. Further studies with longer follow-up periods should be conducted to determine the efficacy of the two methods more accurately.

Effects of sleeve gastrectomy versus omega-loop gastric bypass. What is best for weight loss, perioperative adverse events, and comorbidities?

Aim of the study: This study investigated whether Sleeve Gastrectomy (SG) or Omega-Loop-Gastric-Bypass (OAGB) has the best benefit in weight loss, perioperative risk, and remission of comorbidities. Methods: 29,407 patients after SG and OAGB were included in the German Bariatric Surgery Registry (GBSR). Outcome criteria were perioperative morbidity, perioperative complications, and remission of comorbidities after one year of follow-up. Results: 15,169 patients had completed 1-year follow-up (770 patients after OAGB and 14,399 after SG). The %EWL was higher for OAGB than for SG (70.4 ± 18.5 for OAGB and 62.4 ± 22.6 for SG; p&lt;0.001). BMI reduction was also a significant difference in favor of OAGB (17.5 ± 5.6 kg/m2 for OAGB vs. 15.5 ± 5.9 for SG; p&lt;0.001). There was no significant difference between the two groups in perioperative complications (p&lt;5%). Significant differences in favor of OAGB were found in remission of hypertension (p&lt;0.001), IDDM (p&lt;0.001), NIDDM (p&lt;0.001), reflux (p&lt;0.001), and sleep apnea (p&lt;0.001). Conclusion: Our analysis showed that OAGB surgery was associated with more significant BMI reduction and weight loss one year after surgery. In addition, OAGB surgery was significantly more effective in improving obesity-related comorbidities. Our results support the performance of OAGB over SG in patients with obesity and comorbidities. However, the contraindications and general condition of the patient should be considered in the context of this.

Effects of sleeve gastrectomy versus omega-loop gastric bypass. What is best for weight loss, perioperative adverse events, and comorbidities?

Effects of sleeve gastrectomy versus omega-loop gastric bypass. What is best for weight loss, perioperative adverse events, and comorbidities?

Vasoconstrictor nasal spray causing life-threatening complications after bariatric surgery: A case report

Introduction and importanceBariatric surgery is an evolving surgical field with increasing cases per year, as obesity is prevalent, especially in developed countries. Complication diagnosis and management can be challenging. Marginal ulcers and anastomosis perforation are rare, but their incidence is likely underestimated.Case presentationTo the best of our knowledge, we present the first case with a two and a half years history of recurrent ischemia, marginal ulcers, and recurrent perforation after laparoscopic omega loop gastric bypass, most likely due to an abuse of an over-the-counter (OTC) sympathomimetic nasal spray. The complications (Clavien-Dindo classification IIIb) caused the necessity of recurrent hospitalizations and diagnostic interventions and an open conversion into Roux-Y gastric bypass in a damage control manner.Clinical discussion and conclusionConclusively, we advocate evaluating drug abuse, including OTC medications that patients might not report on a daily-based medical history, as an etiology for marginal ulcers and anastomosis perforation, especially in late and recurrent cases.

1139 Effectiveness of One-Anastomosis Gastric Bypass Vs Sleeve Gastrectomy in Short- And Long-Term Weight Loss – A Review

Abstract Aim Bariatric surgery has been the most efficient treatment option for moderate to severe obesity. Recently, the sleeve gastrectomy (SG) has become the most widely performed bariatric surgery. However, the one-anastomosis gastric bypass (OAGB) has exponentially increased recently and is associated with excellent short- and long-term weight loss benefits. Hence, the aim of this review is to compare the effectiveness of OAGB vs SG in short- (≤ 1 year) and long-term (&amp;gt; 1 year) weight loss. Method A comprehensive literature search of PubMed, Scopus and Google Scholar databases were conducted. Search criteria included keywords such as one-anastomosis gastric bypass, mini-gastric bypass, omega-loop gastric bypass, sleeve gastrectomy, short-term weight loss and long-term weight loss. Selection criteria included any randomised controlled trials (RCTs) and cohort studies comparing the effects of OAGB vs SG in weight loss, published from the years 2010 onwards. Only full text studies and papers published in English language were chosen. Results nine studies were selected to be reviewed in this study. 62.5% of studies which had reports for short-term weight loss showed that OAGB was able to achieve a significantly greater % excess weight loss (%EWL) or % excess BMI loss (%EBMIL) (P &amp;lt; 0.05). Whereas 80% of studies which had reports for long-term weight loss showed that OAGB achieved a significantly greater %EWL or %EBMIL, up to five years. Conclusions This review suggests that OAGB is associated with significantly greater short-and long-term weight loss than SG. However, due to the small number of RCTs on OAGB vs SG, more long-term RCTs should be conducted for greater evaluation.

Fungal liver abscesses in an immunocompetent patient post cholecystectomy – a case report

Candida albicans is known to colonise the biliary tract but rarely causes invasive candidiasis post gastrointestinal or hepatobiliary surgery in the absence of host immunosuppression. This case study reports a 33-year-old immunocompetent female with a past surgical history of sleeve gastrectomy, omega loop (mini) gastric bypass and gastric ulcer repair. Two weeks post laparoscopic cholecystectomy and intraoperative cholangiogram (IOC) the patient presented with right upper quadrant abdominal pain, rigors, nausea, vomiting, fevers (39.5 degrees) and tachycardia. Liver function tests were mildly deranged, the white cell count was 10×109/L and the C-reactive protein was elevated at 327 mg/L. Computed tomography (CT) revealed multiple right lobe liver abscesses and mild splenomegaly. The patient underwent ultrasound guided drainage and Candida albicans was subsequently grown from the aspirate sample. After a 4-week course of oral fluconazole, a repeat CT abdomen and pelvis showed good resolution with 3-4 remaining small liver collections. An abdominal ultrasound 8-weeks post initial presentation showed complete resolution and subsequent gastroscope, echocardiogram and ophthalmological examination were unremarkable. Although liver abscesses caused by Candida albicans rarely occur in immunocompetent patients, it should be included in the differential diagnosis in such patients presenting with suspicious features post laparoscopic cholecystectomy and IOC.

Protein (A-FABP) in Obese Patients before and after Omega Loop Gastric Bypass: 1 Year Follow up

Protein (A-FABP) in Obese Patients before and after Omega Loop Gastric Bypass: 1 Year Follow up

A498 Calibrated Gastro-Jejunostomy Reduces the Incidence of Stenosis in Omega Loop Bypass

The numbers of Omega Loop Gastric Bypass have increased dramatically in the middle east area in the last 15 years. It has been demonstrated that it is a rapid, safe and effective bariatric operation. Advantages include; lower risk of anastomotic leakage, internal herniation and the ease of reversibility. Potential complications include; marginal ulcers, chronic alkaline reflux and gastro-jejunostomy (GJ) stenosis. This retrospective analysis evaluates whether suturing the gastro-jejunostomy (GJ) over a boogie effects the rate of GJ stenosis and the need for endoscopic balloon dilatation or refashioning later on. Retrospective analysis to assess the effectiveness of anastomosing the GJ on a calibration tube in reducing GJ stenosis after omega loop surgery.

SYMPTOMATIC AND ASYMPTOMATIC HYPOGLYCEMIA POST THREE DIFFERENT BARIATRIC PROCEDURES: A COMMON AND SEVERE COMPLICATION.

Background: The prevalence of post-bariatric surgery hypoglycemia (PBH) remains unclear due to diagnostic criteria variability, types of bariatric procedures and possible unawareness. Objective: To determine the frequency, pattern and severity of symptomatic and asymptomatic hypoglycemia in subjects post three different bariatric procedures performed >1 year before evaluation and a group of obese subjects before surgery. Design and Setting: Observational cohort study. Fifty-one consecutive patients participated: post Roux-en-Y gastric-bypass (RYGB) (n=16), post omega-loop gastric-bypass (OLGB) (n=12), post sleeve-gastrectomy (SG) (n=15), obese subjects before surgery (controls) (n=8). Hypoglycemic events (glucose ≤54 mg/dL) and severe hypoglycemia (glucose ≤40 mg/dL) were evaluated by symptoms' questionnaire, mixed-meal tolerance test (MMTT) and continuous glucose monitoring (CGM). Results: According to questionnaires, meal-related complaints were reported in 11 (26%) of the surgical group and in one control subject. During MMTT, 88%, 82% and 67% experienced hypoglycemia in RYGB, OMGB and SG groups, respectively, vs. none of the controls (P<0.001). Severe hypoglycemia occurred in 38%, 45% and 7% in RYGB, OMGB and SG groups, respectively (P=0.025), but only 10 of the total operated patients (24%) reported any symptoms. During CGM, fasting hypoglycemic events occurred more in RYGB and OLGB vs. SG group: 55%, 63% and 17% respectively (P=0.036). Conclusions: PBH is very common after RYGB, OMGB and SG and can be severe especially following bypass procedures. Our results show that hypoglycemia occurs not only postprandially but also in the fasting state, especially following bypass procedures. In most cases, there were no specific complaints, possibly leading to its underestimation.

Laparoscopic one-anastomosis gastric bypass: results of the first 310 patients

Background Laparoscopic one-anastomosis gastric bypass (LOAGB) is an effective, relatively low-risk procedure and can be reversed. Patients and methods Between June 2014 and September 2018, 310 morbidly obese patients have undergone LOAGB surgery. Results The mean operating room time was 69 min. Median postoperative length of stay was 2.1 days. The;Deg;BM;Deg;I has decreased from 49.3±9.9 to 38.8±9.7 kg/m2, 33.7±4.7 and 28.8 kg/m2 at 6, 12, and 24 months postoperatively, respectively. The percentage of excess weight loss is, respectively, 50±26, 62±25, and 72±18% at 6, 12, and 24 months postoperatively.. Major complications have occurred in a total of 11 (3.5%) patients. One patient has suffered from postoperative gastrojejunal anastomotic leakage. Five patients have suffered from massive postoperative bleeding. Two patients have intractable bile reflux after minigastric bypass. Omega loop gastric bypass was converted to Roux-en-Y gastric bypass in these two patients. One anastomotic stenosis needed dilatation over three sessions. One patient developed port site hernia 6 months postoperatively. This patient was explored and managed laparoscopically. One patient presented 15 months after minigastric bypass with perforated gastrojejunal anastomotic ulcer that was treated by omental patch repair. There were no postoperative mortalities. Conclusion LOAGB can be regarded as a simple, safe, effective, and reversible bariatric procedure.

2109-P: Symptomatic and Asymptomatic Hypoglycemia following Three Different Bariatric Procedures Is a Frequent and Severe Complication

Background: Post-bariatric surgery hypoglycemia has been previously reported. However, its prevalence remains uncertain due to variability of diagnostic criteria, types of bariatric procedures and possible lack of awareness. Objective: To determine the frequency and severity of symptomatic and asymptomatic hypoglycemia in persons following 3 different surgical procedures ≥ 1 years before evaluation, and a group of non-operated obese persons. Design and Setting: Observational cohort study conducted at an out-patient clinic. Fifty-one consecutive individuals were enrolled: post Roux-en-Y gastric bypass (RYGB) (n=16), post omega loop gastric bypass (OLGB) (n=12), post sleeve gastrectomy (SG) (n=15), obese persons prior to surgery (controls) (n=8). Hypoglycemic events (blood glucose ≤ 54 mg/dL) and severe hypoglycemia (blood glucose ≤ 40 mg/dL) were evaluated by: symptoms' questionnaire, mixed meal tolerance test (MMT) and continuous glucose monitoring (CGM). Results: According to questionnaires, meal-related complaints were reported in 11 (26%) of the surgical group and 1/8 of controls. During MMT, 88%, 82% and 67% experienced hypoglycemia in the RYGB, OLGB and SG groups respectively, vs. none in the controls (P &amp;lt; 0.001). Severe hypoglycemia occurred in 38%, 45% and 7% of the RYGB, OLGB and SG groups respectively, (P= 0.025) but only 10 of the total operated group (24%) reported any symptoms. During CGM, fasting hypoglycemic events occurred more in the RYGB and OLGB vs. the SG group: 55%, 63% vs.17% respectively, (P= 0.036). Conclusions: Post-bariatric surgery hypoglycemia is a very common phenomenon after 3 types of bariatric surgery and can be severe especially following bypass procedures. Intriguingly, our results show that hypoglycemia occurs not only in postprandial but also in fasting state, especially following bypass procedures. In many cases there were no specific complaints that may lead to underestimation of this serious complication. Disclosure H. Knobler: Advisory Panel; Self; AstraZeneca, Novo Nordisk A/S. L. Lazar: None. S. Sapojnikov: None. G. Pines: None. E. Mavor: None. V. Ostrovsky: None. T. Schiller: Advisory Panel; Self; Novo Nordisk Inc., Sanofi-Aventis. T. Zornitzki: None.

Internal hernia after omega loop gastric bypass: Beware of ischemic stenosis of small intestine!

Internal hernia after omega loop gastric bypass: Beware of ischemic stenosis of small intestine!