Revisional One-Anastomosis Gastric Bypass After Restrictive Index Surgery—a Metaanalysis and Comparison with Revisional Roux-en-Y Gastric Bypass

Yeo, Chia Rou; Ho, G. W. P.; Syn, Nicholas; Mak, Malcolm Han Wen; Ahmed, Saleem; Oo, Aung Myint; Koura, Aaryan; Sanghvi, Kaushal; Yeo, Danson

doi:10.1007/s11695-020-05094-y

Cited by 12 publications

(13 citation statements)

References 56 publications

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“…The overall complication rates were comparable between the OAGB and RYGB groups in this study, which was consistent with previously published data [ 29 , 31 ]. This study showed no leaks in the OAGB group and one (1.3%) case of leak in the RYGB group.…”

Section: Discussionsupporting

confidence: 93%

“…Additionally, we observed a pattern of improvement or resolution of dyslipidemia, hypertension, and type 2 diabetes. Consistent with our findings, previous studies showed that both revisional RYGB and OAGB had high rates of resolution and/or improvement of associated medical problems, which were comparable to each other and to those of primary procedures [ 3 , 7 , 8 , 14 , 15 , 17 , 19 , 28 – 31 ].…”

Section: Discussionsupporting

confidence: 92%

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Revisional Roux-en-Y Gastric Bypass Versus Revisional One-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy: a Randomized Controlled Trial

et al. 2022

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Background High rates of revision surgery have been reported for laparoscopic sleeve gastrectomy (LSG), with weight regain (WR) as the most frequently reported cause. Roux-en-Y gastric bypass (RYGB) is the most commonly performed revision procedure, whereas one-anastomosis gastric bypass (OAGB) is a less popular approach. Methods A single-blinded randomized controlled trial was conducted. One hundred seventy-six patients were enrolled and randomized. After loss to follow-up, 80 patients for RYGB and 80 patients for OAGB were analyzed, with a 2-year follow-up. Patients with grade B or higher gastroesophageal reflux disease (GERD) were excluded. Early and late postoperative complications were recorded. Body mass index (BMI), percentage of excess BMI loss (%EBMIL), nutritional laboratory test results, and the resolution of associated medical problems were assessed after revision surgery. Results After 2 years, both groups achieved significantly lower BMI than their post-LSG nadir BMI (p < 0.001). The %EBMIL changes showed significantly faster weight loss in the OAGB group than in the RYGB at the 6-month follow-up (mean difference: 8.5%, 95% confidence interval [CI]: 0.2 to 16.9%). However, at 1-year and 2-year follow-ups, the differences were statistically insignificant (p > 0.05). Early and late complications were similar between two groups. Both groups showed improvement or resolution of associated medical problems, with no statistically significant differences after 2 years (p = 1.00). Conclusion Both revisional RYGB and OAGB have comparable significant weight loss effects when performed for WR after LSG. After a 2-year follow-up, both procedures were safe, with no significant differences in the occurrence of complications and nutritional deficits. Graphical abstract

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Revisional Roux-en-Y Gastric Bypass Versus Revisional One-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy: a Randomized Controlled Trial

et al. 2022

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“…Moreover, a 2022 randomized controlled trial reported that revisional RYGB and one-anastomosis gastric bypass had comparable significant weight loss effects after failed LSG with % excessive BMI loss of 89.3±15.4 and 84.8±18.2%, respectively, after two years; both procedures were safe with no significant differences in complications and nutritional deficits [ 33 ]. Multiple systematic reviews and studies that tested alternative revision surgeries after (failed)-LSG confirmed the same result [ 31 , 34 - 40 ]. Therefore, consultation with the patient and a multi-disciplinary team on the choice of revision surgery is essential, whereby all interventions achieve good health-related benefits.…”

Section: Discussionmentioning

confidence: 66%

Two-Year Results of the Banded Versus Non-banded Re-sleeve Gastrectomy as a Secondary Weight Loss Procedure After the Failure of Primary Sleeve Gastrectomy: a Randomized Controlled Trial

et al. 2023

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Background Insufficient weight loss or weight regain has been reported in up to 30% of patients after laparoscopic sleeve gastrectomy (LSG). Approximately 4.5% of patients who undergo LSG need revisional surgery for a dilated sleeve. Methods This randomized controlled trial compared the outcomes between banded (BLSG) and non-banded re-LSG (NBLSG) after weight regain. Percentage excess body weight loss (%EWL), percentage total weight loss (%TWL), associated medical problems, gastric volume measurement, and endoscopy were measured preoperatively and 1 and 2 years postoperatively. Results Both groups (25 patients each) achieved similar % EWL and %TWL at six months, one year, and two years postoperatively (%EWL 46.9 vs. 43.6, 83.7 vs. 86.3, and 85.7 vs. 83.9) (p= > 0.151) (%TWL 23.9 vs. 21.8, 43.1 vs .43.3, 44.2 vs. 42.2) (p=>0.342), respectively. However, the body mass index was significantly lower with BLSG (24.9 vs. NBLSG, 26.9). Both groups showed a significant reduction in stomach volume after two years (BLSG -248.4 mL vs. NBLSG -215.8 mL). Food tolerance (FT) scores were significantly reduced in both groups, whereby BSLG had significantly lower FT with an average of -1.1 point. No significant differences were observed regarding improvement of the associated medical problems after the first and two years after revisional LSG or the postoperative complications between both groups. Conclusion Laparoscopic re-LSG is feasible and safe with satisfactory outcomes in patients with weight regain after LSG who have gastric dilatation without reflux esophagitis. Both groups had comparable significant weight loss effects and improvement of associated medical problems. The BLSG tends to have a more stable weight loss after two years with a significantly lower BMI, lower stomach volume, and less weight regain. Food tolerance decreased in both groups but reduced more in the BLSG group. After a 2-year follow-up, we may regard both procedures are safe, with no significant differences in the occurrence of complications and nutritional deficits. Graphical Abstract

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“…Comparing OAGB and RYGB as RBS, Velotti et al noted a comparable or lower complication rate and better weight loss after revisional OAGB. Similarly, Yeo et al in another meta-analysis emphasized greater weight loss in the first 2 years after revisional OAGB and its potential for achieving diabetes and hypertension remission [ 37 , 38 ]. The metabolic effect after RBS in our study concerned 63 (7.88%) patients who achieved remission of T2D, and 87 (10.89%) patients who had complete remission of arterial hypertension.…”

Section: Discussionmentioning

confidence: 99%

Revisional operations among patients after surgical treatment of obesity: a multicenter Polish Revision Obesity Surgery Study (PROSS).

Major¹,

Zarzycki²,

Rymarowicz³

et al. 2022

Videosurgery and Other Miniinvasive Techniques

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Introduction Revisional surgery is more technically challenging and associated with increased morbidity and mortality. Nevertheless, the frequency of revisional bariatric surgery (RBS) is increasing. Therefore, investigating this group of patients appears to be currently valid. Aim The objective of this multicenter study was to collect, systematize and present the available data on RBS after surgical treatment of morbid obesity among Polish patients. Material and methods This multicenter study included a retrospective analysis of a prospectively maintained database. Outcomes included an analysis of the indications for RBS, the type of surgery most frequently chosen as RBS and the course of the perioperative period of treatment among patients undergoing RBS. Results The group consisted of 799 patients (624 (78.1%) women, 175 (21.9%) men). The mean age was 38.96 ±9.72 years. Recurrence of obesity was the most common indication for RBS. The most frequently performed RBS procedures were one anastomosis gastric bypass (OAGB) – 294 (36.8%) patients, Roux-en-Y gastric bypass (RYGB) – 289 (36.17%) patients and sleeve gastrectomy (SG) – 172 (21.52%) patients. After primary surgery 63.58% of patients achieved sufficient weight loss, but after RBS only 38.87%. Complications were noted in 222 (27.78%) cases after RBS with GERD being the most common – 117 (14.64%) patients. Conclusions RBS most often concerns patients after SG. The main indication for RBS is weight regain. OAGB and RYGB were the two most frequently chosen types of RBS. Secondary operations lead to further weight reduction. However, RBS are associated with a significant risk of complications.

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Revisional One-Anastomosis Gastric Bypass After Restrictive Index Surgery—a Metaanalysis and Comparison with Revisional Roux-en-Y Gastric Bypass

Cited by 12 publications

References 56 publications

Revisional Roux-en-Y Gastric Bypass Versus Revisional One-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy: a Randomized Controlled Trial

Revisional Roux-en-Y Gastric Bypass Versus Revisional One-Anastomosis Gastric Bypass After Failed Sleeve Gastrectomy: a Randomized Controlled Trial

Two-Year Results of the Banded Versus Non-banded Re-sleeve Gastrectomy as a Secondary Weight Loss Procedure After the Failure of Primary Sleeve Gastrectomy: a Randomized Controlled Trial

Revisional operations among patients after surgical treatment of obesity: a multicenter Polish Revision Obesity Surgery Study (PROSS).

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