Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50?

Abstract

Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract

One anastomosis gastric bypass as a one-stage bariatric surgical procedure in patients with BMI ≥ 50 kg/m2

“…Our study also showed the efficacy of OAGB in remission of obesity associated medical problems including T2DM, DLP, HTN, OSA and GERD in 94.2%, 72.9%, 90.9%, 100% and 91.6% of patients with BMI ≥ 50 kg/m 2 respectively. Liagre et al 7 showed evolution of T2DM, DLP, HTN and OSA after OAGB in 92%, 98%, 76% and 97% of patients with BMI ≥ 50 kg/m 2 respectively that were nearly similar to our findings. Although the efficacy of OAGB in remission of T2DM was as the same as SG in some studies 6 , 22 , 23 , OAGB has significant superiority in remission of other obesity associated medical problems in patients with BMI ≥ 50 kg/m2.…”

“…Liagre et al 7 in a study on 245 patients with BMI ≥ 50 kg/m 2 who underwent OAGB with a BPL of 150 cm, showed that OAGB is an effective method with low complication rates(5.7%) and no mortality. In their study, only 0.8% of patients needed to be underwent for second bariatric procedure due to weight loss failure.…”

“…Although in a recently published experts consensus, more than 90% of experts believed that OAGB is an appropriate one-stage bariatric surgical procedure in patients with BMI ≥ 50 kg/m 2 4 . There are few published paper about the efficacy of one-stage OAGB in patients with BMI ≥ 50 kg/m 2 5 – 7 and need to be supported by more studies.…”

One Anastomosis Gastric Bypass: Weight Loss Results Are Not a Function of the Biliary Limb Length!

“…Our experience of OAGB with a constant biliary loop of 150 cm in patients with BMI > 50 showed results comparable to those published by Eskandaros [2]. It has been demonstrated that the increase of the biliary loop dangerously increases the risk of malnutrition by decreasing the total alimentary limb length (TALL) [3,4].…”