Twenty years’ experience of laparoscopic 1-anastomosis gastric bypass: surgical risk and long-term results
Journal
Surgery for Obesity and Related Diseases
Journal Volume
17
Journal Issue
5
Pages
968-975
Date Issued
2021
Author(s)
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. ? 2021
Subjects
antidiabetic agent; citrate calcium; colecalciferol; glycosylated hemoglobin; multivitamin; adolescent; adult; aged; Article; Asian; bile reflux; body mass; body weight loss; controlled study; female; follow up; gastrectomy Billroth II; gastric bypass surgery; gastroesophageal reflux; human; ileus; jejunum ulcer; laparoscopic surgery; length of stay; major clinical study; male; malnutrition; non insulin dependent diabetes mellitus; nutritional status; obesity; one anastomosis gastric bypass; operation duration; operative blood loss; patient satisfaction; postoperative complication; priority journal; remission; reoperation; retrospective study; risk assessment; Roux-en-Y gastric bypass; surgical risk; treatment outcome; adverse event; laparoscopy; middle aged; morbid obesity; non insulin dependent diabetes mellitus; prospective study; Taiwan; young adult; Adult; Diabetes Mellitus, Type 2; Female; Gastric Bypass; Humans; Laparoscopy; Male; Middle Aged; Obesity, Morbid; Prospective Studies; Retrospective Studies; Taiwan; Young Adult
Type
journal article