Management of super–super obese patients: comparison between one anastomosis (mini) gastric bypass and Roux-en-Y gastric bypass

Parmar, Chetan; Abdelhalim, Mohamed Ahmed; Mahawar, Kamal; Boyle, Maureen; Carr, William; Jennings, Neil; Small, Peter

doi:10.1007/s00464-016-5376-x

Cited by 48 publications

(23 citation statements)

References 18 publications

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“…The higher weight loss amongst the MGB group compared to RYGB group is in keeping with previously published studies including from our group . The reported incidence of anaemia after MGB varies from 5.0% to 27.0% .…”

Section: Discussionsupporting

confidence: 91%

Haematological indices and haematinic levels after mini gastric bypass: a matched comparison with Roux‐en‐Y gastric bypass

et al. 2017

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What is already known about this subject• Nutritional deficiencies after gastric bypass are a cause for concern.• The reported rates of anaemia following mini gastric bypass and Rouxen-Y gastric bypass vary amongst the published studies.• There is sparse scientific literature comparing haematological indices and haematinic levels following the two types of gastric bypass. What this study adds• This is a first detailed study comparing haemoglobin, mean corpuscular volume, and haematinic levels in a matched cohort of patients who underwent mini gastric bypass and Roux-en-Y gastric bypass.• There is a marginally higher risk of being anaemic following mini gastric bypass compared to Roux-en-Y gastric bypass, although overall incidence of anaemia is comparable.• The mean corpuscular volume and haematinic levels are very similar between the two groups. SummaryMany surgeons believe mini gastric bypass (MGB) is more likely to cause micronutrient malabsorption compared to Roux-en-Y gastric bypass (RYGB). Till date, there is no published study evaluating haematological indices and haematinic levels in patients undergoing MGB and comparing these with a matched cohort of RYGB. Two hundred patients who underwent MGB between October 2012 and October 2015 were matched to 200 patients who underwent RYGB for age, sex, body mass index and time of surgery. We then compared haemoglobin, mean corpuscular volume, iron, ferritin, vitamin B12 and folic acid levels preoperatively and at 6 monthly intervals after surgery until 2 years. The percentage total weight loss was significantly higher in the MGB group compared to the RYGB group at all time points. At 2 years, MGB and RYGB both led to an increase in anaemia rates but the difference was only significant for MGB group. Compared to RYGB, MGB patients were more likely to be anaemic at 2 years, although the difference was not significant statistically (16.6% vs. 12.7%; P value = 0.55). There was a trend for lower iron and folate levels in MGB group compared to RYGB group but the difference was statistically significant at some of the time periods only (significantly lower folate at 6 and 12 months and lower iron at 6 months in the MGB group). MGB leads to a significant increase in anaemia rates in a supplemented cohort. There is a trend towards lower iron and folate levels and higher anaemia rates in MGB group in comparison with RYGB. Larger studies with longer follow-up should evaluate results of MGB with a shorter biliopancreatic limb.

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Section: Discussionsupporting

confidence: 91%

Haematological indices and haematinic levels after mini gastric bypass: a matched comparison with Roux‐en‐Y gastric bypass

et al. 2017

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“…Alimentary limb elongation, cruroplasty, Hill-type gastropexy, or partial fundoplication using the gastric remnant or even a Belsey-Mark IV procedure are possible solutions [19]. Endoscopic procedures and techniques (Stretta®, LINX®) may become valuable in the near future, as new devices are now available with interesting outcomes [20,21,29].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases

et al. 2019

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Background One of the most important complications of the one anastomosis gastric bypass (OAGB) is enterobilio acid reflux (EBAR). We report the concept of the long pouch Roux-en-Y gastric bypass (LPRYGB) meaning a Roux-en-Y with a long pouch and a 100-cm alimentary limb to avoid EBAR, with a long biliopancreatic limb to increase metabolic effects. Methods A total of 300 LPRYGB cases in a 4-year period, with a 90% follow-up rate, were analysed. Anthropometric, technical feasibility, morbidity, weight loss and comorbidity outcomes were analysed. Results The percentage total weight loss (%TWL) was 30.5% at 4 years of follow-up (32.3% in primary and 28.3% in revisions). Six intra-operative (2%) and 28 postoperative complications (9.3%) were seen. Out of this 28 complications, 11 (3.6%) were late complications. Reoperations were performed in 15 patients (5.0%). Clinically relevant EBAR was present in 3 cases only (1%) 4 years after the operation. Conclusions The LPRYGB combines the main advantages of the OAGB (light restriction and moderate malabsorption) with the anti-reflux effect from the Roux-en-Y diversion.

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“…The mini‐gastric bypass, or more recently termed single‐ or one‐anastomosis gastric bypass (OAGB), is a simple alternative to RYGB performed with one anastomosis but results in more acid and bile reflux . In patients with very high BMI (≥ 60 kg/m 2 ), Parmar et al found that OAGB achieved greater weight loss at 18 and 24 months compared with RYGB. Moreover, in patients with milder BMI elevations, OAGB with a longer (80 cm) biliopancreatic limb had better T2D remission rates than RYGB .…”

Section: Executive Summarymentioning

confidence: 99%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

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Apovian

Brethauer

et al. 2020

Obesity

324

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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Management of super–super obese patients: comparison between one anastomosis (mini) gastric bypass and Roux-en-Y gastric bypass

Abstract: One anastomosis (mini) gastric bypass yields superior weight loss at 18 and 24 months in comparison with Roux-en-Y gastric bypass in patients with BMI of ≥60 kg/m. Findings need confirmation in larger randomized studies.

Cited by 48 publications

References 18 publications

Haematological indices and haematinic levels after mini gastric bypass: a matched comparison with Roux‐en‐Y gastric bypass

Haematological indices and haematinic levels after mini gastric bypass: a matched comparison with Roux‐en‐Y gastric bypass

Outcomes of Long Pouch Gastric Bypass (LPGB): 4-Year Experience in Primary and Revision Cases

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