Twenty years' experience of laparoscopic 1-anastomosis gastric bypass: surgical risk and long-term results

Meshari Almuhanna; Tien-Chou Soong; Wei-Jei Lee; Jung-Chien Chen; Chun-Chi Wu; Yi-Chih Lee

doi:10.1016/j.soard.2021.01.010

Twenty years' experience of laparoscopic 1-anastomosis gastric bypass: surgical risk and long-term results

Surg Obes Relat Dis. 2021 May;17(5):968-975. doi: 10.1016/j.soard.2021.01.010. Epub 2021 Jan 21.

Authors

Meshari Almuhanna¹, Tien-Chou Soong², Wei-Jei Lee³, Jung-Chien Chen⁴, Chun-Chi Wu⁴, Yi-Chih Lee⁵

Affiliations

¹ Department of Surgery, Jaber Al-Ahmad Al-Sabah Hospital, Kuwait City, Kuwait; Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.
² Department of Weight Loss and Health Management Center, E-DA Dachang Hospital, Kaohsiung, Taiwan; Department of Asia Obesity Medical Research Center, E-DA Hospital, Kaohsiung, Taiwan; College of Medicine, I-Shou University, Kaohsiung, Taiwan.
³ Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan. Electronic address: wjlee_obessurg_tw@yahoo.com.tw.
⁴ Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.
⁵ Department of International Business, Chien Hsin University, Taoyuan, Taiwan.

PMID: 33619007
DOI: 10.1016/j.soard.2021.01.010

Abstract

Background: Laparoscopic 1- (single-) anastomosis gastric bypass (OAGB) was developed as a simplified technique of Roux-en-Y gastric bypass (RYGB), but super long-term data are lacking.

Objectives: To evaluate the risks and long-term results of OAGB over a period of 20 years.

Setting: Tertiary teaching hospital.

Methods: A total of 2223 patients underwent OAGB from 2001 to 2020; the mean age was 35.3 ± 11.4 years (range, 14-71 yr), 70.2% were female, and the mean body mass index was 40.2 ± 11.9 kg/m². All data were kept in a prospective bariatric database. Patients were divided into 4 groups, based on the 5-year period in which their surgery was performed, and a retrospective analysis was conducted.

Results: The means for operating time, intraoperative blood loss, and length of hospital stay after OAGB were 131.9 ± 40.1 minutes, 38.5 ± 30.7 mL, and 4.5 ± 4.0 days, respectively. There were 27 patients (1.2%) with 30-day postoperative major complications overall, but the group rate decreased to .4% in the last 5-year period. At postoperative years 5, 10, and 15, the percentages of total weight loss were 31.9%, 29.6%, and 29.5%, respectively, and the percentages of excess weight loss were 77.2%, 68.4%, and 65.5%, respectively. Among 739 patients (33.2%) with type 2 diabetes (T2D), the rates of complete remission (glycated hemoglobin < 60%) at 5, 10, and 15 years were 67.3%, 73.8%, and 66.7%, respectively. The weight loss and antimetabolic effects were similar in each 5-year period, but a significant malnutrition effect was observed. A total of 113 (5.1%) patients needed revision surgery at follow-up, due to malnutrition (n = 51), weight regain (n = 24), acid or bile reflux (n = 22), marginal ulcer (n = 8), ileus (n = 3), and other causes (n = 5). At 15 years, the overall revision rate was 11.9% (27/226), and 80% of the patients were very satisfied with their procedures.

Conclusion: Our results showed that OAGB is a safe and durable primary bariatric procedure, with sustained weight loss and a high resolution of T2D up to 20 years post surgery in Taiwan, although malnutrition is a major side effect.

Keywords: OAGB; Revision; Weight loss.

MeSH terms

Adult
Diabetes Mellitus, Type 2*
Female
Gastric Bypass* / adverse effects
Humans
Laparoscopy*
Male
Middle Aged
Obesity, Morbid* / surgery
Prospective Studies
Retrospective Studies
Taiwan
Young Adult