Abstract
Purpose
Encouraged by the excellent outcomes of one anastomosis gastric bypass (OAGB) reported by many authors, we added this procedure to our bariatric armamentarium in 2015. Here we present our initial experience of 68 cases and findings from routine upper gastrointestinal endoscopy at 1 year.
Materials and Methods
This is a retrospective analysis of a prospectively maintained database of a single surgical unit in a tertiary referral centre. Patients undergoing OAGB from January 2015 to May 2019 were included. A fixed biliopancreatic (BP) limb length of 200 cm was used in all patients. Surveillance endoscopy was done at 1-year follow-up.
Results
Sixty-eight patients, of whom 67.6% were females, were analysed. Mean age was 40.8 ± 1 years. Mean preoperative weight and body mass index (BMI) were 131 ± 24.7 kg and 51 ± 7 kg/m2, respectively. Median follow-up was 23 months (range 9–55 months), with 88% follow-up at 6 months and 1 year. At 1 year, mean total weight loss (TWL) and excess weight loss (EWL) were 35% and 71%, respectively. Endoscopy at 1 year revealed a 9.5% rate of marginal ulcers, majority of which healed with conservative treatment. Eighty-eight percent patients had complete remission of diabetes, and 94% had complete remission of hypertension. There was no 30-day mortality.
Conclusion
OAGB is a safe and effective bariatric procedure with excellent short-term outcomes in terms of weight loss, resolution of obesity-related co-morbidities and complications. Routine surveillance endoscopy at 1 year may detect asymptomatic marginal ulcers and, thus, prevent ulcer-related complications.
Similar content being viewed by others
References
Bhasker AG, Prasad A, Raj PP, Wadhawan R, Khaitan M, Agrawal AJ, et al. Trends and progress of bariatric and metabolic surgery in India. Updat Surg. 2020
Kaplan U, Romano-Zelekha O, Goitein D, et al. Trends in bariatric surgery: a 5-year analysis of the Israel National Bariatric Surgery Registry. Obes Surg. 2020;30:1761–7.
Ramos AC, Chevallier J-M, Mahawar K, et al. IFSO (International Federation for Surgery of Obesity and Metabolic Disorders) Consensus Conference statement on one-anastomosis gastric bypass (OAGB-MGB): results of a modified Delphi Study. Obes Surg. 2020;30(5):1625–34.
Mahawar KK, Jennings N, Brown J, et al. “Mini” gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23(11):1890–8.
Gumbs AA, Duffy AJ, Bell RL. Incidence and management of marginal ulceration after laparoscopic Roux-Y gastric bypass. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2006;2(4):460–3.
Edholm D, Ottosson J, Sundbom M. Importance of pouch size in laparoscopic roux-en-Y gastric bypass: a cohort study of 14,168 patients. Surg Endosc. 2016;30(5):2011–5.
Mahawar KK, Reed AN, Graham YNH. Marginal ulcers after one anastomosis (mini) gastric bypass: a survey of surgeons. Clin Obes. 2017;7(3):151–6.
Brethauer SA, Kim J, el Chaar M, et al. Standardized outcomes reporting in metabolic and bariatric surgery. Surg Obes Relat Dis. 2015;11(3):489–506.
Scott-Conner CEH, editor. Chassin’s operative strategy in general surgery: an expositive atlas. 4th ed. New York: Springer-Verlag; 2014.
Musella M, Susa A, Greco F, et al. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc. 2014;28(1):156–63.
Noun R, Zeidan S, Riachi E, et al. Mini-gastric bypass for revision of failed primary restrictive procedures: a valuable option. Obes Surg. 2007;17(5):684–8.
Kular KS, Manchanda N, Rutledge R. A 6-year experience with 1,054 mini-gastric bypasses-first study from Indian subcontinent. Obes Surg. 2014;24(9):1430–5.
Taha O, Abdelaal M, Abozeid M, et al. Outcomes of omega loop gastric bypass, 6-years experience of 1520 cases. Obes Surg. 2017;27(8):1952–60.
Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001;11(3):276–80.
Schulman AR, Abougergi MS, Thompson CC. H. pylori as a predictor of marginal ulceration: a nationwide analysis. Obes Silver Spring Md. 2017;25(3):522–6.
Kelly JJ, Perugini RA, Wang QL, et al. The presence of Helicobacter pylori is not associated with long-term anastomotic complications in gastric bypass patients. Surg Endosc. 2015;29(10):2885–90.
De Luca M, Tie T, Ooi G, et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSO position statement. Obes Surg. 2018;28(5):1188–206.
Quan Y, Huang A, Ye M, et al. Efficacy of laparoscopic mini gastric bypass for obesity and type 2 diabetes mellitus: a systematic review and meta-analysis. Gastroenterol Res Pract. 2015;2015:152852.
Lauti M, Lemanu D, Zeng ISL, et al. Definition determines weight regain outcomes after sleeve gastrectomy. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2017;13(7):1123–9.
Jamal W, Zagzoog MM, Sait SH, et al. Initial outcomes of one anastomosis gastric bypass at a single institution. Diabetes Metab Syndr Obes Targets Ther. 2019;12:35–41.
Parmar CD, Mahawar KK, Boyle M, et al. Mini gastric bypass: first report of 125 consecutive cases from United Kingdom. Clin Obes. 2016;6(1):61–7.
Singla V, Aggarwal S, Garg H, et al. Outcomes in super obese patients undergoing laparoscopic sleeve gastrectomy. J Laparoendosc Adv Surg Tech A. 2018;28(3):256–62.
Garg H, Aggarwal S, Misra MC, et al. Mid to long term outcomes of laparoscopic sleeve gastrectomy in Indian population: 3-7 year results - a retrospective cohort study. Int J Surg Lond Engl. 2017;48:201–9.
Musella M, Susa A, Manno E, et al. Complications following the mini/one anastomosis gastric bypass (MGB/OAGB): a multi-institutional survey on 2678 patients with a mid-term (5 years) follow-up. Obes Surg. 2017;27(11):2956–67.
Bruzzi M, Rau C, Voron T, et al. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2015;11(2):321–6.
Carbajo M, García-Caballero M, Toledano M, et al. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg. 2005;15(3):398–404.
Lee W-J, Yu P-J, Wang W, et al. Laparoscopic roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242(1):20–8.
Shivakumar S, Tantia O, Goyal G, et al. LSG vs MGB-OAGB-3 year follow-up data: a randomised control trial. Obes Surg. 2018;28(9):2820–8.
Mahawar KK, Parmar C, Carr WRJ, et al. Impact of biliopancreatic limb length on severe protein–calorie malnutrition requiring revisional surgery after one anastomosis (mini) gastric bypass. J Minimal Access Surg. 2018;14(1):37–43.
Mahawar KK, Borg C-M, Kular KS, et al. Understanding objections to one anastomosis (mini) gastric bypass: a survey of 417 surgeons not performing this procedure. Obes Surg. 2017;27(9):2222–8.
Genco A, Soricelli E, Casella G, et al. Gastroesophageal reflux disease and Barrett’s esophagus after laparoscopic sleeve gastrectomy: a possible, underestimated long-term complication. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2017;13(4):568–74.
Kassir R, Kassir R, Deparseval B, Bekkar S, Serayssol C, Favre O, Garnier P.P. Routine surveillance endoscopy before and after sleeve gastrectomy? World J Gastrointest Endosc 2019;11(1):1–4, 1.
Csendes A, Burgos AM, Altuve J, et al. Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Obes Surg. 2009;19(2):135–8.
Spinosa SR, Valezi AC. Endoscopic findings of asymptomatic patients one year after roux-en-Y gastric bypass for treatment of obesity. Obes Surg. 2013;23(9):1431–5.
Wang E, Blackham R, Tan J, et al. Giant perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass. BMJ Case Rep. 2017;11:2017.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Statement
All procedures performed in this study were in accordance with the ethical standards of the Institute Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Baksi, A., Kamtam, D.N.H., Aggarwal, S. et al. Should Surveillance Endoscopy Be Routine After One Anastomosis Gastric Bypass to Detect Marginal Ulcers: Initial Outcomes in a Tertiary Referral Centre. OBES SURG 30, 4974–4980 (2020). https://doi.org/10.1007/s11695-020-04864-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-020-04864-y