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

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.

• Authors: Meshari Almuhanna, Tien-Chou Soong, Wei-Jei Lee, Jung-Chien Chen, Chun-Chi Wu, Yi-Chih Lee
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) Vol. 17 Issue 5 Pg. 968-975 (May 2021) ISSN: 1878-7533 [Electronic] United States
• PMID: 33619007 (Publication Type: Journal Article)
• Copyright: Copyright © 2021. Published by Elsevier Inc.

Topics

• 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