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Anastomotic Gastro-Jejunal Ulcer Perforation Following One Anastomosis Gastric Bypass: Clinical Presentation and Options of Management—Case Series and Review of Literature

Authors:
Bassem Abou Hussein at Rashid Hospital
Bassem Abou Hussein
Omar ali Almarzooqi at american university in the emirate
Omar ali Almarzooqi
  • american university in the emirate
Ali Khammas
Ali Khammas
Ali Khammas
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Abstract and Figures

Background One anastomosis gastric bypass (OAGB) is an attractive bariatric procedure compared with the gold standard Roux-en-Y gastric bypass (RYGB) with one less anastomosis. Thousands of these procedures have now been performed by different surgeons who believe that it could hold fewer complications than RYGB. However, postoperative complications including the formation of anastomotic ulcers and possible perforation remain a main concern following OAGB.Methods We report three cases of perforation of an ulcer at the gastro-jejunal anastomosis following laparoscopic one anastomosis gastric bypass. All cases needed surgical intervention after adequate resuscitation.ResultsAll patients were successfully managed using a minimally invasive approach with different techniques of repair (primary suturing of the perforation or resection and conversion to Roux-En-Y gastric bypass). All patients did well and were discharge in a stable condition after 4–5 days.Conclusion Perforation of an anastomotic ulcer post-one anastomosis gastric bypass is a serious condition and can be a life threatening complication. A high index of suspicion helps to diagnose these cases in patients presenting with acute abdomen following OAGB. Adequate resuscitation and repair of the perforation are main lines of treatment. Definitive surgical option depends on the general condition of the patient, timing of presentation, size and site of the perforation, and experience of the surgeon.
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HOW I DO IT
Anastomotic Gastro-Jejunal Ulcer Perforation Following One
Anastomosis Gastric Bypass: Clinical Presentation and Options
of Management—Case Series and Review of Literature
Bassem Abou Hussein
1
&Omar Al Marzouqi
1
&Ali Khammas
1
#Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Background One anastomosis gastric bypass (OAGB) is an attractive bariatric procedure compared with the gold standard Roux-
en-Y gastric bypass (RYGB) with one less anastomosis. Thousands of these procedures have now been performed by different
surgeons who believe that it could hold fewer complications than RYGB. However, postoperative complications including the
formation of anastomotic ulcers and possible perforation remain a main concern following OAGB.
Methods We report three cases of perforation of an ulcer at the gastro-jejunal anastomosis following laparoscopic one anasto-
mosis gastric bypass. All cases needed surgical intervention after adequate resuscitation.
Results All patients were successfully managed using a minimally invasive approach with different techniques of repair (primary
suturing of the perforation or resection and conversion to Roux-En-Y gastric bypass). All patients did well and were discharge in
a stable condition after 4–5days.
Conclusion Perforation of an anastomotic ulcer post-one anastomosis gastric bypass is a serious condition and can be a life
threatening complication. A high index of suspicion helps to diagnose these cases in patients presenting with acute abdomen
following OAGB. Adequate resuscitation and repair of the perforation are main lines of treatment. Definitive surgical option
depends on the general condition of the patient, timing of presentation, size and site of the perforation, and experience of the
surgeon.
Keywords One anastomosis gastric bypass .Perforation .Anastomosis .Gastro-jejunal .Bariatric
Introduction
Laparoscopic one anastomosis gastric bypass (OAGB)
surgery is a safe and simple surgical intervention for
treating morbid obesity and diabetes mellitus and is now
being performed more frequently [1]. The technical sim-
plicity (Fig. 1) and quickness of this operation with the
effective weight loss results and amelioration of the co-
morbidities have played a role in a remarkable recent suc-
cess [2–4]. The risk of symptomatic (bile) reflux, margin-
al ulceration, severe malnutrition, and long-term risk of
gastric and esophageal cancers is some of the commonly
voiced concerns [5].
Many articles have described anastomotic ulcers at the
gastro-jejunal anastomosis, but few cases have been reported
describing perforation of these ulcers and options of
management.
We report three cases of anastomotic gastro-jejunal ulcer
perforation following OAGB that were successfully treated by
a minimally invasive approach.
Case Number 1
Thirty-two-year old male presented to the emergency de-
partment with epigastric and right upper quadrant
*Bassem Abou Hussein
bassem.abouhussein@gmail.com
Omar Al Marzouqi
dromar.almarzouqi@gmail.com
Ali Khammas
ali.khammas@gmail.com
1
General Surgery Department, Rashid Hospital-DHA, Oud Meitha
Street, PO Box: 4545, Dubai, United Arab Emirates
https://doi.org/10.1007/s11695-020-04423-5
Obesity Surgery (2020) 30:2423–2428
Published online: 15 February 2020
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Several risk factors have been reported to be involved with AU formation and AU perforation. They include smoking, NSAID use, and noncompliance with PPI following OAGB [24]. Chronic steroid use has not been reported as a risk factor for AU development following OAGB; however, it has been linked to all other risk factors for AU formation after RYGB [25]. ...
... To our best knowledge, we are the first to address the rate of AU perforation in a single bariatric center. Furthermore, only two studies regarding perforated AU were published describing 7 patients [13] and 3 patients [24]. We encourage surgeons to report their incidence and experience with this significant complication, to better appreciate its clinical implications on OAGB patients, and especially high-risk ones. ...
... Since the clinical picture and laboratory tests are non-specific, and lack of free air under the diaphragm on plain upright radiographs does not rule out the diagnosis, abdominal CT scan is necessary. Abdominal CT scan is the most specific modality for the diagnosis of AU perforation [13,24]. It can show presence of free air, free fluid, or oral contrast extravasation. ...
Anastomotic Ulcer Perforation Following One Anastomosis Gastric Bypass
Article
Full-text available
  • Jul 2022
  • OBES SURG
Perforated anastomotic ulcer after one anastomosis gastric bypass Background One anastomosis gastric bypass (OAGB) is a common bariatric metabolic surgery. Anastomotic ulcer (AU) perforation is a delayed complication, liable to cause sepsis and death. We present a cohort of twelve patients who underwent emergent surgery due to AU perforation. Materials and Methods A retrospective analysis of a single center database of patients operated for AU perforation after OAGB (January 2015 to December 2021). Data retrieved included perioperative characteristics and postoperative outcomes. Results The incidence of AU perforation among 1425 OAGB patients is 0.7%. AU perforation occurred after OAGB at a median time interval of 13 months (interquartile range (IQR) 5, 23). Eight patients had at least one risk factor for AU perforation. All patients presented with acute abdominal pain. Pneumoperitoneum was evident in ten patients on imaging studies. Surgery was laparoscopic in eleven patients, with one conversion to laparotomy. Operative findings were AU perforation, with a median perforation size of 5 mm (IQR 1.1, 18.7). Laparoscopic omentopexy ± primary AU repair, open omentopexy ± primary AU repair, and laparoscopic conversion to Roux-en-Y gastric bypass were performed (n = 9, 2, 1 patients, respectively). Median length of stay was 7.5 days (IQR 5, 11.5). No major complications occurred. All patients are doing well at a median follow-up of 11.5 months (IQR 2.2, 19.2). Four out of seven smoking patients still smoke. Conclusion AU perforation after OAGB mandates a high index of suspicion, prompt diagnosis, and surgical treatment. Laparoscopic omentopexy ± primary AU repair is feasible in most cases, safe, and confers good outcomes.
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... In general, RYGB has been regarded as the gold standard for such revisions in the USA. However, the international literature and experience have brought the OAGB into discourse regarding such revisions [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Conversions of SG and LAGB to OAGB are well described internationally, and many international surgeons are utilizing the OAGB as their preferred revisional procedure [18-23, 25, 28]. ...
... This study looked at OAGB and RYGB as revisional options in regard to feasibility and short-term safety. Greater concerns lie in the longterm complications specifically bile reflux (reported to occur in 1-10% of OAGB patients requiring conversion to RYGB) [26][27][28][29][30][31][32][33][34][35][36] and nutritional deficiencies due to malabsorption. Given the retrospective nature of this study, the operative technique was not standardized with some RYGB performed with EEA and some stapled with hand-sewn anastomosis. ...
One Anastomosis Gastric Bypass for Revisional Bariatric Surgery: Assessment of Short-Term Safety
Article
Full-text available
  • May 2023
  • OBES SURG
Purpose With the continued increase in bariatric procedures being performed in the USA, a growing percentage are revisions for weight regain after sleeve gastrectomy (SG) and gastric banding (LAGB). Standard practice in the USA involves conversion to Roux-en-Y gastric bypass (RYGB). Internationally, one anastomosis gastric bypass (OAGB) has become a popular and effective alternative. Without the jejuno-jejunal anastomosis, OAGB has reduced potential related long-term complications. The purpose of this study is to compare the short-term safety of revision to OAGB versus RYGB. Materials and Methods Patients who underwent conversion to OAGB from LAGB or SG for weight regain from January 2019 to October 2021 were compared to BMI, sex, and age-matched patients who underwent conversion to RYGB. Results In our study, 82 patients were included, 41 in each cohort (41 OAGB vs. 41 RYGB). The majority in both groups underwent conversion from SG (71% vs. 78%). Operative time, estimated blood loss, and length of stay were comparable. There was no difference in 30-day complications (9.8% vs. 12.2%, p = .99) or reoperation (4.9% vs. 4.9%, p = .99). Mean weight loss at 1 month was also comparable (7.91 lbs vs 6.36 lbs). Conclusions Patients undergoing conversion to OAGB for weight regain had similar operative times, post-operative complication rates, and 1-month weight loss compared to those who underwent RYGB. While more research is needed, this early data suggests that OAGB and RYGB provide comparable outcomes when used as conversion procedures for to failed weight loss. Therefore, OAGB may present a safe alternative to RYGB. Graphical Abstract
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... Regarding long-term complications, some authors have reported a higher occurrence of marginal ulcer (MU) after revisional surgery [30] especially due to the risk of retained gastric antrum syndrome (RGA) after conversion to gastric bypass [31,32]. Conversely, in this systematic review, after a follow-up ranging from 12 to 60 months, the rate of MU was 1% both for RYGB and OAGB. ...
One-anastomosis gastric bypass (OAGB) versus Roux-en-Y gastric bypass (RYGB) as revisional procedures after failed laparoscopic sleeve gastrectomy (LSG): systematic review and meta-analysis of comparative studies
Article
Full-text available
  • Nov 2023
  • LANGENBECK ARCH SURG
Introduction The aim of this study was to compare weight loss and gastroesophageal reflux disease (GERD) remission after one-anastomosis gastric bypass (OAGB) versus Roux-en-Y gastric bypass (RYGB) as revisional procedures after laparoscopic sleeve gastrectomy (LSG). Methods In PubMed, Embase, and Cochrane Library, a search was performed using the terms “Roux-en-Y gastric bypass versus one anastomosis gastric bypass,” “revisional surgery,” and “sleeve gastrectomy.” Only original articles in English language comparing OAGB and RYGB were included. No temporal interval was set. The primary outcome measure was weight loss (%TWL). The secondary endpoints were leak, bleeding, marginal ulcer, and GERD. PRISMA flowchart was used. Differences in continuous and dichotomous outcome variables were expressed as mean difference (MD) and risk difference (RD) with 95% CI, respectively. Heterogeneity was assessed by using I² statistic. Results Six retrospective comparative articles were included in the present meta-analysis. Weight loss analysis showed a MD = 5.70 (95% CI 4.84–6.57) in favor of the OAGB procedure with a statistical significance (p = 0.00001) and no significant statistical heterogeneity (I² = 0.00%). There was no significant RD for leak, bleeding, or marginal ulcer after the two revisional procedures. After conversion to OAGB, remission from GERD was 68.6% (81/118), and it was 80.6% (150/186) after conversion to RYGB with a RD = 0.10 (95% CI −0.04, 0.24), no statistical significance (p = 0.19), and high heterogeneity (I² = 96%). De novo GERD was 6.3% (16/255) after conversional OAGB, and it was 0.5% (1/180) after conversion to RYGB with a RD = −0.23 (95% CI −0.57, 0.11), no statistical significance (p = 0.16), and high heterogeneity (I² = 92%).
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... In the absence of these risk factors, perforation is rare. Other risk factors for gastrointestinal perforation include instrumentation, trauma, ingested foreign body, Crohn's disease, diverticular disease, smoking, typhoid, tuberculosis and malignancy [1][2][3]. Marginal ulcers are the most common cause of jejunal perforation following Roux-en-Y gastric bypass (RYGB) and are reported up to 2% [4]. However, marginal ulcers usually confined to the first few centimetres after an anastomosis [5], and the incidence is highest within the first month following surgery. ...
Non-marginal jejunal ulcer perforation following Roux-en-Y gastric bypass
Article
Full-text available
  • Mar 2022
We present a rare case of a jejunal ulcer perforation in the alimentary limb ~15 cm distal to the gastro-jejunal anastomosis on the background of a previous Roux-en-Y gastric bypass (RYGB) 4 months prior to presentation. Marginal ulcer is the most common cause of jejunal perforation following RYGB. However, this is usually confined to the first few centimetres, and the incidence is highest within the first month following surgery. Other risk factors include smoking and non-steroidal anti-inflammatory drug use, Helicobacter pylori infection, trauma, foreign body ingestion, Crohn's disease, typhoid, tuberculosis and malignancy. This case does not possess any of these risk factors and thus represents a unique presentation. Not all jejunal ulcers will present with classical risks factors but still will need to be excluded, given their life-threatening nature. Also, the whole alimentary limb can be susceptible to ulceration; therefore, a thorough investigation of this limb is important to exclude perforation.
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... Besides, an article reported three cases of a perforated ulcer at the gastrojejunal anastomosis site. While small perforations can be repaired by omental patches, larger perforations, accompanied by further complications, might require conversion to RYGB or normal anatomy [12]. Recently, a study presented seven patients with delayed perforated MUs after OAGB. ...
Perforation as the First Manifestation of Marginal Ulcer Following One Anastomosis Gastric Bypass: a Multicenter Case Series and Review of Literature
Article
  • Jan 2022
One anastomosis gastric bypass (OAGB) has attracted increasing attention over the past decades due to its higher safety, simplicity, and efficacy over other bariatric techniques. Marginal ulcers (MUs) after OAGB are usually asymptomatic, potentially leading to life-threatening conditions, such as bleeding and perforation. However, the precise mechanisms and predisposing factors of perforation at the anastomotic site of OAGB remain unknown. In this study, we report six patients with a history of laparoscopic OAGB presenting with an acute abdomen and pneumoperitoneum. All patients underwent an open surgical intervention after the initial resuscitation. All patients underwent an exploratory laparotomy. Four patients were treated with omental patch repair. For one of them, Braun’s side-to-side jejunojejunostomy was also performed. One patient converted to Roux-en-Y gastric bypass (RYGB), and one patient converted to normal anatomy. Five out of six patients showed favorable outcomes after management. However, one of the patients, which presented with septic shock, expired 24 h after the emergent exploratory laparotomy. The mean interval between OAGB and MU perforation was 19 months, and the mean size of perforation was 2.08 cm. Perforation of an anastomotic ulcer after OAGB is rare and should be included in the differential diagnosis of patients presenting with an acute abdomen following OAGB; this may even occur years after OAGB. Patients can present with a perforated MU as the first manifestation. Adequate fluid resuscitation, along with administration of proton pump inhibitors (PPI) and antibiotics, should be considered in the primary management. Surgical options (oversewing, conversion to RYGB, and conversion to normal anatomy) vary according to the patient’s general condition, size and location of the perforation, and degree of contamination.
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Marginal Ulcer Perforation After One-Anastomosis Gastric Bypass: Case Report and Literature Review
Article
  • Jan 2023
One-anastomosis gastric bypass is an accepted bariatric procedure performed worldwide. Perforation of the gastrojejunal anastomosis ulcer is a rare and rather serious complication for which there is no well-defined treatment. Suturing of perforation with omentopexy is the most common treatment. Bile diversion from the anastomotic ulcer may be additionally required in some cases.
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Perforated Marginal Ulcer After Gastric Bypass for Obesity: A Systematic Review
Article
  • May 2022
  • SURG OBES RELAT DIS
Introduction Marginal ulcers are a recognised complication of gastric bypass procedures for obesity. Perforated Marginal Ulcer (PMU) is a life-threatening complication of marginal ulcers. We performed a systematic review to understand the presentation, management, and outcomes of PMUs. Methods We searched PubMed, Google Scholar, and Embase databases to identify all studies on PMUs after gastric bypass procedures. Results A total of 610 patients were identified from 26 articles. The mean age was 39.8+/-2.59 years and females represented the majority of the cohort (67%). The mean BMI was 43.2+/-5.67 kg/m². Most of the patients had undergone an RYGB (98%). The time gap between the primary bariatric surgery and the diagnosis of PMU was 27.5+/-8.56 months. The most common presenting symptom was abdominal pain (99.5%) and a CT scan was the diagnostic modality used in 72% of the patients. Only 15% of patients were on prophylactic PPI or H2 blocker at the time of perforation and 41% of patients were smoking at the time. 23% of patients were on nonsteroidal anti-inflammatory drugs. Laparoscopic omental patch repair of the perforation (59%) was the most used technique; 18% of patients underwent open surgery and 20% were managed non-surgically. 30-day mortality was 0.97%; it was 1.21% (n=5) and 0% (n=0) in those who were managed surgically and non-surgically respectively. Ulcers recurred in 5% of patients. Conclusion PMU is a surgical emergency after gastric bypass that can result in significant morbidity and even mortality. This is the first systematic review in scientific literature characterising this condition.
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Single-Anastomosis Procedures in Metabolic Surgery
Article
  • Dec 2021
The most effective long-term treatment for severe obesity is bariatric surgery with improvement or resolution of obesity-related comorbidities. Single-anastomosis procedures including single-anastomosis duodenoileal bypass and one-anastomosis gastric bypass are relatively new procedures that are gaining popularity worldwide. These surgical techniques are perceived to be less complex with a shorter learning curve in comparison to the standard biliopancreatic diversion with duodenal switch and Roux-en-Y gastric bypass; however, long-term outcomes and complications remain controversial. This article aims to review one-anastomosis procedures, evaluate their outcomes, and review potential complications.
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Marginal ulcer causing delayed anastomotic perforation following one anastomosis gastric bypass (OAGB)
Article
  • Sep 2020
  • SURG OBES RELAT DIS
Background One anastomosis gastric bypass (OAGB) is gaining favor. Anastomotic perforation is a dreaded complication. Objectives To describe a series of patients presenting with delayed (> 90 days) perforation of a marginal ulcer (MU) following OAGB. Setting Two university hospitals, Israel. Methods A retrospective query identifying patients after OAGB admitted with delayed MU perforation. Demographic characteristics, time between OAGB to presentation, clinical, laboratory and imaging at presentation and management data were collected. Results Between 1/2017–1/2020, 7 patients were identified. Mean body mass index (BMI) and time difference between OAGB and perforation were 14 kg/m² (range 7–23) and 13 months (range 4–23), respectively. All presented with upper abdominal pain, 4 had concomitant nausea and vomiting. One patient displayed tachycardia, none had fever and 3 exhibited leukocyte abnormalities. C-reactive protein ranged widely (2–311 mg/L). Mean albumin level was 2.9 g/dL (range 1.9–4). Pneumoperitoneum was demonstrated in half of plain abdominal films and all computed tomography (CT) scans. Management was tailored to clinical status. Four patients underwent laparoscopic primary repair with omentopexy. Two patients were initially managed nonoperatively, one eventually requiring conversion to Roux-en-Y gastric bypass (RYGB) while the other recovered without further intervention. One patient underwent exploratory laparotomy and “damage control” management with pouch gastrostomy and double-barrel jejunostomy. Risk factors for MU were present in 4 cases. Mean length of hospital stay was 18 days (range 3–79 days). Conclusions Perforation of MU may occur months to years after OAGB even without risk factors. Laboratory results are unreliable. The CT scan is diagnostic. A tailored approach can achieve good outcomes.
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Efficiency and risks of laparoscopic conversion of omega anastomosis gastric bypass to Roux-en-Y gastric bypass
Article
Full-text available
  • Aug 2019
  • SURG ENDOSC
Background There is a paucity on literature data related to conversion of Omega anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB). Methods This is a retrospective study. Records of all patients who underwent this conversion were analyzed. Additionally, patients were contacted to answer a questionnaire on their current clinical condition. Results Twenty-eight patients underwent laparoscopic conversion between September 2007 and June 2016. Indications were peritonitis in 7 patients (leaks after OAGB in 5, perforated marginal ulcer (MU) and blow-out remnant with concomitant leak in one patient each), anastomotic bleeding in one, bile reflux in 6, recalcitrant MU in 4, afferent loop syndrome in 6, postprandial vomiting in 2 (related to anastomotic stenosis and perianastomotic diverticulum, one each), and malnutrition and hypoglycemia both in 1. Thirty-day mortality was zero, complication rate (Clavien–Dindo grade III or more) 5% ((N = 1/20), abscess) when conversion was elective and 50.0% ((N = 4/8), all persisting leaks) when conversion was urgent. All 4 leaks persisting after conversion were successfully treated by endoscopic stenting, despite stent migration in 2 patients. Follow-up was available in 92.9%, for a mean time of 64.5 ± 30.1 months. Successful symptom relief (Likert score 4 or more) was noted for bile reflux and postprandial vomiting. Additionally, malnutrition was corrected. Conclusions When indicated, conversion of OAGB to RYGB is a safe treatment strategy. In case conversion is performed for leak after OAGB, persisting subclinical leaks are frequent but can be efficiently addressed by endoscopic stenting.
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A brief history of bariatric surgery
Article
Full-text available
  • Mar 2017
Obesity has been a problem since medieval times, but only in the latter 20 years it has been recognized as a worldwide epidemic. Treating obesity is challenging and difficult, but surgery has led to an increased success and novel insights on the pathophysiology of obesity. Several surgical techniques have been developed during the last 50 years and the advent of laparoscopic surgery has increased its safety, efficacy and demand from the population. Nowadays, the ever increasing and successful use of novel techniques have been responsible for several changes in the established treatment paradigms.
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Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients
Article
Full-text available
  • May 2017
  • OBES SURG
Background: Excellent results have been reported with mini-gastric bypass. We adopted and modified the one-anastomosis gastric bypass (OAGB) concept. Herein is our approach, results, and long-term follow-up (FU). Methods: Initial 1200 patients submitted to laparoscopic OAGB between 2002 and 2008 were analyzed after a 6-12-year FU. Mean age was 43 years (12-74) and body mass index (BMI) 46 kg/m(2) (33-86). There were 697 (58 %) without previous or simultaneous abdominal operations, 273 (23 %) with previous, 203 (17 %) with simultaneous, and 27 (2 %) performed as revisions. Results: Mean operating time (min) was as follows: (a) primary procedure, 86 (45-180); (b) with other operations, 112 (95-230); and (c) revisions, 180 (130-240). Intraoperative complications led to 4 (0.3 %) conversions. Complications prompted operations in 16 (1.3 %) and were solved conservatively in 12 (1 %). Long-term complications occurred in 12 (1 %). There were 2 (0.16 %) deaths. Thirty-day and late readmission rates were 0.8 and 1 %. Cumulative FU was 87 and 70 % at 6 and 12 years. The highest mean percent excess weight loss was 88 % (at 2 years), then 77 and 70 %, 6 and 12 years postoperatively. Mean BMI (kg/m(2)) decreased from 46 to 26.6 and was 28.5 and 29.9 at those time frames. Remission or improvement of comorbidities was achieved in most patients. The quality of life index was satisfactory in all parameters from 6 months onwards. Conclusions: Laparoscopic OAGB is safe and effective. It reduces difficulty, operating time, and early and late complications of Roux-en-Y gastric bypass. Long-term weight loss, resolution of comorbidities, and degree of satisfaction are similar to results obtained with more aggressive and complex techniques. It is currently a robust and powerful alternative in bariatric surgery.
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Current status of mini-gastric bypass
Article
Full-text available
  • Apr 2016
Mini-gastric bypass (MGP) is a promising bariatric procedure. Tens of thousands of this procedure have been performed throughout the world since Rutledge performed the first procedure in the United States of America in 1997. Several thousands of these have even been documented in the published scientific literature. Despite a proven track record over nearly two decades, this operation continues to polarise the bariatric community. A large number of surgeons across the world have strong objections to this procedure and do not perform it. The risk of symptomatic (bile) reflux, marginal ulceration, severe malnutrition, and long-term risk of gastric and oesophageal cancers are some of the commonly voiced concerns. Despite these expressed fears, several advantages such as technical simplicity, shorter learning curve, ease of revision and reversal, non-inferior weight loss and comorbidity resolution outcomes have prompted some surgeons to advocate a wider adoption of this procedure. This review examines the current status of these controversial aspects in the light of the published academic literature in English.
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Mini Gastric Bypass: first report of 125 consecutive cases from United Kingdom
Article
Full-text available
  • Feb 2016
Mini Gastric Bypass is a promising bariatric procedure with multiple apparent benefits. Ours is the first unit within the National Health Service of the United Kingdom to be routinely performing this procedure. This retrospective cohort study reports our experience with first 125 procedures. Data were retrospectively analysed from a prospective database. Information was further supplemented by interviewing team members, contacting patients' general practitioners and telephonic follow-up. The mean follow-up was 11.4 months. There were 86 (68.8%) females and the mean age was 45 (range 20-70) years. Mean weight and body mass index was 135.8 (range 85-244) kilograms and 48.1 (range 34.5-73.8) kg m(-2) , respectively. The mean operating time was 92.4 (range 45-150) minutes and the mean post-operative hospital stay was 2.2 (range 2-17) days. There was no leak, one 30-day reoperation and no mortality in this study. Three patients required late reoperations and four patients developed marginal ulcers. At 6 months follow-up (n = 114), 27.5 (range 11.4-47.4) % total body weight loss and 60.1 (range 23.2-117.5) % excess body weight loss was seen. The figures at 12 months follow-up (n = 65) were 36.8 (range 23.7-55.4) % and 79.5 (range 44.9-138.3) %, respectively. This study demonstrates early safety and efficacy of Mini Gastric Bypass in a carefully selected British obese population in a high-volume centre.
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Mini-Gastric Bypass to Control Morbid Obesity and Diabetes Mellitus: What Radiologists Need to Know
Article
Full-text available
  • Mar 2015
  • KOREAN J RADIOL
Laparoscopic mini-gastric bypass surgery is a safe and simple surgical intervention for treating morbid obesity and diabetes mellitus and is now being performed more frequently. Radiologists must be critical in their postoperative evaluation of these patients. In this pictorial review, we explain and illustrate the surgical technique, normal postoperative anatomy, and associated complications as seen on imaging examinations, including fluoroscopy and computed tomography.
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One Thousand Single Anastomosis (Omega Loop) Gastric Bypasses to Treat Morbid Obesity in a 7-Year Period: Outcomes Show Few Complications and Good Efficacy
Article
  • Jan 2015
A short-term randomized controlled trial shows that the one anastomosis gastric bypass (OAGB) is a safe and effective alternative to the Roux-en-Y gastric bypass (RYGB). The aim of this study is to evaluate the OAGB at our University Hospital between 2006 and 2013. One thousand patients have undergone an OAGB. Data were collected on all consecutive patients. The mean follow-up period was 31 months (SD, 26.3; range, 12-82.9), and complete follow-up was available in 126 of 175 patients (72 %) at 5 years after surgery. Mortality rate was 0.2 %. Overall morbidity was 5.5 %; 34 required reoperations: i.e., 6 leaks, 5 obstructions, 5 incisional hernias, 7 biliary refluxes, 2 perforated ulcers, 2 bleeds, 2 abscesses, and 1 anastomotic stricture. Four patients were reoperated for weight regain. Overall rate of marginal ulcers was 2 % (n = 20), all in heavy smokers. Conversion from an OAGB to a RYGB was required in nine cases (0.9 %): seven for intractable biliary reflux, two for a marginal ulcer. At 5 years, percent excess body mass index loss was 71.6 ± 27 %. One hundred patients with type-2 diabetes, with a mean preoperative HbA1C of 7.7 ± 1.9 %, were followed for >2 years; the total resolution rate was 85.7 %. This study confirms that the OAGB is an effective procedure for morbid obesity with comparable outcomes to RYGB; in addition, it seems to be safer with lower morbidity. Its technical simplicity represents a real advantage and makes it an option that should be considered by all bariatric surgeons.
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