One-anastomosis Gastric Bypass Research Articles

BS O03 - One-stage conversion of Adjustable Gastric band (AGB) to One-anastomosis Gastric Bypass (cOAGB) versus Sleeve Gastrectomy (cSG): A single-center experience with a short and mid-term Follow-up

Abstract Background Laparoscopic adjustable gastric band was a common bariatric procedure . However; due to its failure rate some patients sought another revisional surgery. In which, we compared two of the most common Bariatric metabolic surgery (BMS) performed nowadays: the laparoscopic sleeve gastrectomy and laparoscopic one- anastomosis gastric bypass. Method A prospective cohort study was conducted from June 2020 to June 2022 at a single medical center, which included 77 patients undergoing single-stage conversion to (cOAGB) vs (cSG). Patients were reassessed for weight loss, associated medical problems remission and post-operative complications at 6, 12, and 18 months. Results Group (I) was 43 patients who underwent cOAGB and Group (II) was 34 patients who underwent cSG. The BMI was calculated post-operative at three visits. Both groups had no statistically significant values at 6 and 12 months follow-up. However, patients who underwent cOAGB after 18 months of follow-up achieved lower BMI than those who underwent cSG . Regarding EBWL% there was a statistically significant difference between the two groups after 6, 12 and 18 months follow-up. Regarding associated medical problems remission with follow-up 18 months post-operative , there were no statistically significant differences between the two groups Conclusion This study suggests that the conversion of LAGB to either cOAGB or cSG could be feasibly performed in a single-stage operation. cOAGB had a significant difference as regards the weight loss results than cSG among the mid-term follow-up. However, there is no significant difference in the postoperative complications and the resolution of the co-morbidities. Therefore, cOAGB could provide a reliable alternative but needs to be substantiated in future long-term studies.

Comparative study of midterm outcomes between Roux-en-Y gastric bypass (RYGB), diverted one-anastomosis gastric bypass (D-OAGB), and one anastomosis gastric bypass (OAGB)

PurposeDiverted one anastomosis gastric bypass (D-OAGB) is a new procedure that entails performing Roux-en-Y diversion during OAGB to preclude post-OAGB bile reflux. This study aimed to compare the mid-term outcomes of Roux-en-Y gastric bypass (RYGB) and OAGB versus D-OAGB.MethodsThis is a retrospective study that encompassed the analysis of data from patients undergoing bypass surgeries from 2015 to May 2021. The patients’ data until 2 years of follow-up were compared.ResultsThis study included 140 patients who underwent OAGB (n = 64), RYGB (n = 24), and D-OAGB (n = 52). In the OAGB, RYGB, and D-OAGB groups, complication rates were 3.1%, 8.3%, and 5.8%, respectively. At the 3-month and 6-month follow-ups, the OAGB and D-OAGB groups showed a statistically significant higher percentage of excess weight loss (EWL%). Otherwise, the weight measures and weight loss outcome were comparable among the three groups in the other follow-up visits (p > 0.05). There was a significantly lower number of gastroesophageal reflux disease (GERD) remission cases and a higher number of de novo GERD cases in the OAGB group.ConclusionD-OAGB demonstrated favorable outcomes, including lower early adverse events and superior weight loss results in the first 6 months post-surgery when compared to RYGB. The D-OAGB group also showed higher rates of GERD remission and lower de novo GERD occurrence than OAGB. Further research is warranted to validate these findings and expand our understanding of this innovative surgical approach.

Efficacy of One-Anastomosis Gastric Bypass Versus Roux-en-Y Gastric Bypass for Gastroesophageal Reflux Disease: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

This study aimed to investigate the efficacy of one-anastomosis gastric bypass (OAGB) on gastroesophageal reflux disease (GERD) compared with Roux-en-Y gastric bypass (RYGB) in patients with obesity. Three databases (Medline, Cochrane Central, and Scopus) were searched for relevant articles published until August 12, 2024. A total of nine randomized controlled trials, including 643 patients, were selected. OAGB was statistically significantly associated with a higher risk of GERD than RYGB (OR = 3.14, 95% CI 1.23-8.03, p < 0.05). The odds for de novo GERD after OAGB are almost six times higher than after RYGB (OR = 5.65, 95% CI 1.53-20.82, p < 0.05). RYGB has a lower incidence of de novo GERD cases and is more effective than OAGB in reducing GERD.

Efficacy of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for the Treatment of Type 2 Diabetes Mellitus: a Systematic Review and Meta-Analysis of Randomized Clinical Trials.

The worldwide prevalence of type 2 diabetes mellitus (T2DM) is increasing in parallel with obesity. One anastomosis gastric bypass (OAGB) is considered effective to treat both T2DM and obesity. The aim of this study was to evaluate the efficacy of OAGB versus sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for treatment of T2DM, analyzing data exclusively from randomized control trials (RCTs). Α systematic review of published RCTs comparing OAGB versus RYGB or SG (control groups) in T2DM patients regarding diabetes remission and weight loss was performed. Primary endpoints were T2DM remission rate and 1-year and 5-year % weight loss postoperatively. Initial search identified 39 references, of which 8 RCTs were considered eligible for meta-analysis inclusion, comprising 636 patients (311 OAGB, 122 RYGB, 203 SG patients). Main meta-analysis findings were: i) higher 1-year %EWL for OAGB than control group (p = 0.04); ii) higher 5-year %EWL for OAGB than control group (p < 0.01); iii) no difference in 1-year remission rate of T2DM between OAGB and control group (p = 0.14); iv) 28% higher 5-year remission rate of T2DM for OAGB than control group (p < 0.01). OAGB had statistically significant better outcomes compared to RYGB and SG regarding T2DM remission and %EWL at 5years. Further pathophysiologic studies are needed to indicate the most potent bariatric procedure in patients with T2DM and obesity.

Comparison of calcium citrate and calcium carbonate absorption in patients with a Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and One-Anastomosis Gastric Bypass: A double-blind, randomized cross-over trial.

Comparison of calcium citrate and calcium carbonate absorption in patients with a Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and One-Anastomosis Gastric Bypass: A double-blind, randomized cross-over trial.

Alterations in taste preferences one year following sleeve gastrectomy, Roux-en-Y gastric bypass, and one anastomosis gastric bypass: a cross-sectional study

The influence of metabolic and bariatric surgery (MBS) on taste preferences and the pleasurable aspects of appetite may be mediated through its effects on gut hormones, potentially affecting weight loss results. Research indicates that the nature of the MBS performed significantly impacts food cravings in the year following the procedure, with no clear relationship to psychological factors or pre-surgery eating behaviors. During the period from August 2021 to August 2022, a group of adult patients with a body mass index (BMI) of 40 kg/m2 or above, or 35 kg/m2 or above with obesity-related medical complications, underwent Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), or sleeve gastrectomy (SG) at a tertiary academic center focused on MBS. This research included 294 patients who completed the Taste Desire and Enjoyment Change Questionnaire (TDECQ) one year after their surgical procedures, which were primary RYGB, OAGB, or SG. Most participants noted changes in their taste perception, cravings, and enjoyment of flavors after undergoing SG, RYGB, and OAGB. The study’s findings suggest that the type of MBS significantly affects taste preferences. Additionally, RYGB and OAGB were associated with a more substantial decrease in the craving for sweet and fatty flavors relative to SG.

Metabolic and bariatric surgery in vegetarians and vegans.

Vegetarianism is constantly increasing worldwide. However, the role of metabolic and bariatric surgery (MBS) in vegetarians/vegans is unclear as there is very limited data on this topic. The aim of this study was to evaluate MBS outcomes in vegetarians or vegans. Retrospective analysis of a prospectively maintained database of a single-bariatric surgeon was carried out. All patients with a vegetarian or vegan lifestyle undergoing MBS were included. Eleven patients were included; none were lost to follow-up. Ten patients were women, the mean age and Body Mass Index (BMI) were 40.8±14 years and 43.5±4.9 kg/m2, respectively. Five patients (45%) were lacto-ovo-vegetarians, one (9%) was ovo-vegetarian, two (18%) were lacto-ovo-pesco-vegetarians, and three (27%) were vegans. Eight patients consumed vitamin supplements preoperatively, the mean albumin level was 4.1±0.2, 3/11 patients had vitamin D deficiency, 2/11 patients had vitamin-B12 deficiency, and 2/11 patients had iron deficiency. Eight patients (73%) underwent one anastomosis gastric bypass (OAGB), 2/11 patients (18%) underwent single anastomosis duodeno-ileal bypass with sleeve gastrectomy, and one patient (9%) underwent sleeve gastrectomy, the mean biliopancreatic limb length in OAGB was 225 cm. The median follow-up time was 17 months, the mean BMI and percentage of total weight loss during follow-up were 28.2±5 kg/m2 and 35.3±10.7%, respectively. The mean albumin level was 3.82±0.27, 3/11 patients had vitamin D deficiency, and 3/11 patients had iron deficiency. This study reports preliminary data on MBS outcomes in vegetarian/vegan patients. It was shown to be safe, effective, and an acceptable rate of nutritional deficiencies during follow-up. Further large cohort studies are required to clarify this data.

Comparison of Micronutrient Deficiencies Following Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass

Comparison of Micronutrient Deficiencies Following Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass

Gastric Cancer in One-Anastomosis Mini-gastric Bypass: Case Report and Systematic Review.

In the last years, one-anastomosis gastric bypass (OAGB) has been proposed more frequently as obesity surgery technique. Several trials have demonstrated that the easier technical feasibility does not affect the long-term surgical result. However, concern about increased risk of gastric and esophageal cancers has been expressed by several bariatric surgeons. The present study reports the 2nd case of cancer of the gastrointestinal-jejunal anastomosis in a OAGB patient focusing the attention on some technical issues correlated and offering a systematic review of the literature.

Anemia rates after one-anastomosis gastric bypass versus sleeve gastrectomy: a retrospective cohort study.

To compare postoperative anemia rates after one-anastomosis gastric bypass (OAGB) with those after sleeve gastrectomy (SG) in a large nationwide, population-based cohort study. We sourced data from the Israeli Bariatric Surgery Registry. The study included a cohort of adults who underwent bariatric surgery (BS) between 2013 and 2017. Hemoglobin (Hb) was measured preoperatively and then 1 and 2 years post-BS. Anemia rates were compared between the patients who underwent OAGB and those who underwent SG, using multivariable analyses. The study comprised 1,052 patients who underwent OAGB and 5,885 patients who underwent SG. Among them, 24.1% and 23.6% were men, respectively, and the preoperative mean body mass index values were 41.7 ± 5.0 and 42.1 ± 5.1kg/m2, respectively. The 1-year and 2-year postoperative anemia rates were significantly higher after OAGB than after SG, when adjusted for age, pre-surgery BMI, sex and other covariates (1 year: 37.5% vs. 20.2%; adj-OR = 2.43; 95% CI 2.08-2.86; 2 years: 45.1% vs. 28.5%; adj-OR = 1.92; 95% CI 1.59-2.32). Patients who underwent OAGB had significantly higher anemia rates 1 year and 2 years postoperatively than those who underwent SG. Consequently, vigilant surveillance and intervention strategies post-OAGB should be considered to mitigate the incidence of anemia and its associated complications.

A Comprehensive Review of the Literature: Does an Optimal Type of Anastomosis Exist for One Anastomosis Gastric Bypass?

One anastomosis gastric bypass (OAGB) is a popular bariatric procedure known for its efficacy in promoting weight loss and improving metabolic outcomes. However, the optimal anastomotic technique for OAGB remains a subject of debate. This literature review comprehensively examines the three primary anastomotic techniques - linear stapled, circular stapled, and hand-sewn - to determine their suitability for OAGB. Linear stapled anastomosis is favored for its shorter operative time and lower complication rates, such as a reduced incidence of gastrojejunal stenosis. However, its larger anastomotic diameter increases the risk of marginal ulcers due to greater exposure of the gastric mucosa to bile and gastric acids. Circular stapled anastomosis offers a uniform and consistent lumen, which may reduce the risk of postoperative stenosis but is associated with a higher incidence of strictures and ulcers, making it less ideal for use in OAGB. Hand-sewn anastomosis, while time-intensive, provides superior control over anastomotic size and tension, resulting in the lowest rates of strictures and anastomotic leaks, although its effectiveness is highly dependent on surgical expertise. Overall, the current literature lacks large-scale, multicenter studies directly comparing these techniques in the context of OAGB. Future research should focus on randomized controlled trials to establish the most effective and safe anastomotic method for this procedure. Understanding the nuanced benefits and drawbacks of each technique is crucial for optimizing clinical outcomes in OAGB.

Conversion of one-anastomosis gastric bypass to Roux-En-Y gastric bypass: mid-term results from the United Arab Emirates.

One-Anastomosis Gastric Bypass (OAGB) is becoming popular, but some patients may need to convert to Roux-en-Y Gastric Bypass (RYGB) due weight-related difficulties or postoperative complications. The data on conversions is currently limited to 30-day or short-term follow-up studies. As such, the objective of this study was to evaluate the indications and mid-term outcomes for OAGB conversions to RYGB at a tertiary referral center in the United Arab Emirates. A retrospective analysis was conducted on patients who underwent conversion from OAGB to RYGB between February 2016 and May 2023. Demographic information, indications for conversion, intraoperative details, and mid-term outcomes were collected and analyzed. Sixty-four patients underwent conversion from previous OAGB to RYGB. The cohort was 73.4% female (n = 47) with a mean age of 40.8years. Indications for conversion included acid reflux (n = 28, 43.7%), intractable nausea/vomiting (n = 20, 31.2%), protein-calorie malnutrition (n = 7, 10.9%), anastomotic ulcer (n = 6, 9.3%) and weight recidivism (n = 3, 4.7%). The mean operative time was 238 ± 78.3min. During the procedure, three intraoperative complications occurred: two cases of bleeding and one case of bowel perforation; all successfully addressed during surgery. The median hospital stay was 3 ± 15.8days. Three patients (4.6%) experienced major postoperative complications comprising 2 anastomotic leaks and 1 small bowel obstruction. The mean follow-up time was 26.2 ± 19.7months, with 96.2% of patients reporting resolution of symptoms. There were no mortalities. Acid reflux is representing 43.7% of the indications for conversion from OAGB to RYGB. The symptom resolution rate holds significance, standing at a remarkable 96.8%. Despite surgical technique advancements, the complication rate after conversions remains significant at 4.6%, with no mortality reported. OAGB patients should be informed about these risks prior to undergoing conversions from OAGB to RYGB.

Comparable results 5 years after one anastomosis gastric bypass compared to Roux-en-Y gastric bypass: a propensity-score matched analysis

BackgroundPrevious studies comparing one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) are often limited by retrospective designs, or in randomized controlled trials, by small sample sizes or limited follow-up durations. ObjectivesThis study aims to compare OAGB and RYGB during 5years of follow-up in terms of weight loss, remission of comorbidities, and complications. SettingThis longitudinal prospective study includes all patients who underwent a primary OAGB or RYGB between 2015 and 2016 in the Netherlands, utilizing data from the nationwide registry, Dutch Audit for Treatment of Obesity. MethodsA 1:1 propensity-score matched (PSM) comparison between patients with OAGB and RYGB. ResultsAfter 1:1 PSM, 2 nearly identical cohorts of 860 patients were obtained. OAGB was associated with more intraoperative complications (2.0% versus .6%; P = .031). Conversely, RYGB had a higher rate of short-term complications (7.6% versus 3.8%; P < .001). Five-year data were available from 40.7% of the patients with OAGB and 34.9% with RYGB. No significant differences were observed in percentage total weight loss after 5years (30.0% after OAGB and 28.8% after RYGB; P = .099). The total remission rate of diabetes mellitus was 60.5% for OAGB and 69.4% for RYGB (P = .656). However, OAGB resulted in a significantly higher remission rate of hypertension compared to RYGB (60.2% versus 45.5%; P = .015). ConclusionsOAGB and RYGB yield comparable weight loss outcomes. However, OAGB had more intraoperative complications, while RYGB had more short-term complications. Both procedures show similar efficacy in diabetes mellitus remission, but OAGB is more effective in achieving hypertension remission.

Comparative Safety and Efficacy of Roux-en-Y Gastric Bypass Versus One-Anastomosis Gastric Bypass: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Obesity has become a global epidemic, affecting both developed and developing nations. Despite extensive efforts, historical outcomes of medical interventions for obesity have been unsatisfactory. Bariatric surgeries, including sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB), are now recognized as the primary treatment for severe obesity. However, laparoscopic one-anastomosis gastric bypass (OAGB) has emerged as a promising alternative, offering simplified procedures compared to RYGB. While OAGB's initial outcomes are optimistic, concerns about biliary reflux persist. Our systematic review aims to compare the safety and efficacy outcomes of RYGB and OAGB to inform clinical decision-making in managing obesity. We searched five databases up to February 2024. We included randomized controlled trials (RCTs) comparing RYGB and OAGB in obese patients, focusing on safety and efficacy outcomes. Data extraction covered study details, participant demographics, interventions, and outcomes related to operative details, complications, follow-up results, and weight changes. The risk of bias was assessed using the Cochrane tool. The analysis involved risk ratios for dichotomous data and mean differences for continuous data, using fixed or random effects models based on heterogeneity. Analyses were performed with Review Manager software v5.4. A total of 1057 patients were included in the analysis, sourced from 12 distinct RCTs. The analysis indicated OAGB outperformed RYGB in BMI reduction (MD = -0.69, p = 0.005), whereas RYGB was more effective in excess weight loss (MD = 6.51, p < 0.0001) and excess BMI loss (MD = 3.91, p < 0.0001). OAGB led to shorter operation times (MD = -34.89 minutes, p < 0.0001) and shorter periods of hospital stays (MD = -0.27 days, p = 0.01), along with fewer overall complications (RR = 0.58, p = 0.02) and lower incidence of upper gastrointestinal endoscopy complications (RR = 2.98, p = 0.0001). On the other hand, RYGB showed higher remission rates for dyslipidemia (RR = 0.60, p = 0.0003) and higher remissions of hypertension (RR = 0.83, p = 0.04). The majority of results were homogenous. Both OAGB and RYGB have their respective advantages and limitations. OAGB appears to offer benefits in terms of operation efficiency and early postoperative recovery, making it a potentially preferable option for patients and surgeons focused on these aspects. On the other hand, RYGB might be more suitable for patients prioritizing long-term weight loss and remission of certain comorbidities like hypertension. Ultimately, the choice between OAGB and RYGB should be made on an individual basis, considering the specific needs, conditions, and goals of each patient.

Remission and relapse of diabetes after sleeve gastrectomy and one-anastomosis gastric bypass: The Tehran Obesity Treatment Study.

To evaluate the rates and predictors of remission and relapse of type 2 diabetes mellitus (T2DM) in individuals with T2DM undergoing sleeve gastrectomy (SG) or one-anastomosis gastric bypass (OAGB). An observational prospective study with 5 years of follow-up was conducted in a total of 891 patients (82.5% female) with concomitant T2DM and obesity (body mass index ≥ 30.0 kg/m2) undergoing SG or OAGB between March 2013 and March 2021. T2DM remission was defined as achieving a glycated haemoglobin (HbA1c) level < 48 mmol/mol and a fasting plasma glucose (FPG) level <7 mmol/L, and being off glucose-lowering agents/insulin. T2DM relapse was defined as when FPG or HbA1c reverted to the diabetic range (≥7 mmol/L and ≥48 mmol/mol, respectively), or there was a need for pharmacotherapy. After bariatric surgery, the overall T2DM remission and relapse rates were 61.4 per 1000 person-months (95% confidence interval [CI] 56.8-66.4) and 5.7 per 1000 person-months (95% CI 4.1-7.9), respectively. These rates were similar in the SG and OAGB groups. Multivariate hazard ratio analysis identified history of insulin therapy and T2DM duration prior to surgery as predictors of remission, while treatment with ≥2 glucose-lowering agents was the only relapse predictor. Additionally, patients undergoing SG experienced either remission or relapse within a significantly shorter time frame compared to those undergoing OAGB. After 5 years of follow-up, there were no significant differences between the SG and OAGB groups with regard to T2DM remission and relapse. Bariatric surgery was less likely to result in remission in patients with a history of insulin therapy and longer durations of T2DM prior to surgery. Furthermore, patients who received ≥2 glucose-lowering agents, despite possible remission, were at a higher risk of experiencing late relapse.

Comparative analysis of the effectiveness of laparoscopic sleeve gastrectomy and one-anastomosis gastric bypass in patients with morbid obesity and type 2 diabetes mellitus

Background. The effect of sleeve gastrectomy (SG) and mini-gastric bypass (MGB) are still being studied; there is a reason to believe that these methods are completely comparable in terms of achieving good bariatric results and metabolic effects.The aim of the study. To assess the effectiveness of laparoscopic sleeve gastrectomy and one-anastomosis gastric bypass in patients with morbid obesity and type 2 diabetes mellitus by conducting a comparative analysis.Methods. We carried out retrospective cohort study. From August 2019 to May 2023, we operated 55 patients with morbid obesity and type 2 diabetes mellitus (DM): 23 patients – in the MGB group, 32 patients – in the SG group. Median follow-up was 21 and 15 months, average age 47.6 ± 9.6 and 47.6 ± 10.7 years, body mass index (BMI) – 51.4 ± 7.8 and 50.8 ± 7.7 kg/m2, median duration of type 2 DM – 36 and 17 months, respectively. Fasting blood glucose was 7.16 ± 1.5 and 8.61 ± 2.95 mmol/l (U = 249; p = 0.022), and glycosylated hemoglobin (%HbA1c) – 6.66 ± 1.04 and 7.35 ± 1.86 % (U = 296; p = 0.222), respectively.Results. BMI at the follow-up was 33.8 ± 6.5 kg/m2 in the MGB group and 35.5 ± 5.2 kg/m2 in the SG group (p = 0.147). Excess weight loss percentage was 68.4 ± 16.4 and 59.8 ± 14.4 (p = 0.040); total weight loss percentage – 34.1 ± 8.6 and 29.7 ± 8.0 (p = 0.109), respectively. Fasting blood glucose was 5.48 ± 1.84 and 5.39 ± 0.59 (p = 0.247), %HbA1c level – 5.3 ± 0.5 and 5.44 ± 0.58 (p = 0.230), respectively. All patients in the SG group and 22 patients in the MGB group were normoglycemic with target values of %HbA1c achieved after the surgery within a period from 3 to 12 months. There were no statistically significant differences in the number of complications (according to Clavien – Dindo II).Conclusion. Sleeve gastrectomy and mini-gastric bypass in patients with morbid obesity and type 2 diabetes demonstrate almost similar bariatric results in the medium term. Both methods make it possible to achieve compensation for type 2 diabetes mellitus with equal efficiency within a period from 3 to 12 months after surgery.

Bikini line one-anastomosis gastric bypass (BLOGB): initial report

BackgroundThis study introduces a new access method for one-anastomosis gastric bypass (OAGB) by placing ports at the bikini line.ObjectiveTo describe our initial experience and assess the feasibility, safety, and effectiveness of this novel access.SettingUniversity Hospital.MethodsThis prospective case–control study included 72 patients: 42 were allocated to the bikini line one-anastomosis gastric bypass (BLOGB) group, and 30 were assigned to the control group. Exclusion criteria included a history of major abdominal surgery, hiatal hernia, extensive lower abdominal adhesions, or a body mass index (BMI) exceeding 55 kg/m2.ResultsThe mean preoperative BMI of the study sample was 40.01 ± 2.84. Weight loss was satisfactory, with the highest percent excess weight loss (%EWL) observed at 12 months: 90.88 ± 7.90 and 91 ± 7.11 (p = 0.474) in both groups, respectively. Both groups showed no significant differences in operative complications, hospital stay, weight loss, or resolution of obesity-associated diseases. However, the BLOGB patients had a longer mean operative time of 110.71 ± 17.72 min compared to 98 ± 18.27 min in the control group (p = 0.002). Moreover, they experienced less postoperative pain and reported greater satisfaction with the appearance of their scars.ConclusionBLOGB was found to be potentially feasible, safe, and effective, offering improved aesthetic outcomes and reduced postoperative pain. This approach may be suitable for a select group of patients concerned with scar appearance. However, large-scale studies are necessary to ensure that safety is not compromised in pursuit of aesthetic benefits.

National introduction of one-anastomosis gastric bypass in the UK National Bariatric Surgery Registry – a cohort study

Aim: There is a paucity of evidence regarding the national introduction of newer bariatric metabolic surgery procedures. This study assessed the impact of introducing one-anastomosis gastric bypass (OAGB) in bariatric surgical practice in the UK on 30-day postoperative morbidity and early postoperative weight loss. Methods: Patients who underwent primary BMS in the UK National Bariatric Surgical Registry (2010-2019) were identified. Patient characteristics, 30-day postoperative morbidity, and 12-month total body weight loss (TBWL) were also assessed. Multivariate regression was performed for associations between 30-day postoperative morbidity and 12-month TBWL, with SG as a reference. Learning effects were assessed by factoring in the institutional OAGB caseload (0-24/25-49/50+ cases). Results: A total of 59,226 patients underwent primary BMS during the study period (RYGB, 38,434; SG, 24,702; AGB, 12,627; OAGB, 3,408; and Others, 276). The 30-day postoperative morbidity was lower for OAGB 1.8% (51/2,802) compared to RYGB 4.2% (1,391/32,853) and SG 3.4% (725/21,333) but higher than AGB 1.2% (123/9,915), while on multivariate regression, OAGB was associated with reduced morbidity once the institution caseload exceeded 50 operations (OR 0.35 (95% CI, 0.22-0.56; P&lt;0.001) and no statistical difference to SG at lesser caseloads. Overall, 12-month greater than 25% TBWL was seen in 69.4% (27736/39971) (RYGB: 82.9% (17617/21246)), SG: 65.4% (7383/11283)), AGB: 23.9% (1382/5572)) and OAGB: 82.9% (1328/1601)). On multivariate regression, OAGB was associated with the highest 12-month TBWL once the institution caseload exceeded 50 operations (OR 3.47 (95% CI 2.75-4.39; P&lt;0.001). Conclusion: OAGB has been safely implemented in UK national bariatric surgery practice. It has lower reported postoperative morbidity and comparable weight loss to RYGB or SG, despite being offered to patients with more severe and complex obesity.

Prognostic Characteristics of Metabolic Dysfunction-Associated Steatotic Liver in Patients with Obesity Who Undergo One Anastomosis Gastric Bypass Surgery: A Secondary Analysis of Randomized Controlled Trial Data.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with obesity and insulin resistance (IR). Identifying characteristics that predict a higher risk of fibrosis using noninvasive methods is particularly important. We performed a secondary analysis of data from an RCT of 48 patients after one anastomosis gastric bypass (OAGB) surgery, supplemented with specifically formulated probiotics and micronutrients or control treatment for 12 weeks. Patients were categorized using alanine aminotransferase (ALAT; >35 U/L for women, >50 U/L for men), higher NAFLD fibrosis score (NFS) > -1.455), and IR (HOMA-IR > 2.0). This trial was registered at Clinicaltrials.gov (ID: NCT03585413). Abnormal ALAT was associated with high triglycerides, blood pressure (BP), glucose, and fatty liver index (FLI). NFS > -1.455 was linked to higher age, body mass, waist circumference, and FLI, and lower albumin and platelet count. HOMA-IR > 2.0 was associated with higher BP and triglycerides, lower HDL-cholesterol, higher serum transaminases, and higher probabilities of steatosis and fibrosis. Twelve weeks postoperatively, patients with NFS > -1.455 showed greater reductions in body mass, systolic BP, serum insulin, and HbA1c, whereas those with NFS ≤ -1.455 showed improvements in FLI and lipid metabolism but had high glucose concentrations. Patients with HOMA-IR ≤ 2.0 also had high glucose concentrations. The evaluation of common biomarker scores for fibrosis and IR may help clinicians to recognize severe NAFLD and improve the outcomes of OAGB surgery.

Nonoperative Management Strategies for Anastomotic Leaks After One Anastomosis Gastric Bypass (OAGB): A Literature Review.

One Anastomosis Gastric Bypass (OAGB) has gained widespread acceptance as an effective bariatric surgery due to its relative simplicity and favorable outcomes in weight loss and metabolic improvement. However, anastomotic leaks, though uncommon, present a significant complication with the potential for severe morbidity and mortality if not managed appropriately. This review examines the range of nonoperative strategies currently employed to manage anastomotic leaks and fistulae following OAGB. The focus is on endoscopic techniques, including the use of clips, stents, suturing systems, internal drainage, vacuum therapy, and tissue sealants, which have been successfully used in various gastrointestinal surgeries. Although a proportion of patients will require surgical treatments, these strategies offer less invasive alternatives to surgical intervention and can be tailored to the specific characteristics of the leak and patient condition. However, the application of these techniques specifically for OAGB-related leaks is not as well-documented. This review lists the available evidence on these nonoperative approaches, highlighting some of their potential benefits and limitations. While these methods show promise, there is a clear need for further research to establish standardized protocols and optimize their use in the context of OAGB-related leaks and fistulae.