Original article
Comparison of one-anastomosis gastric bypass and Roux-en-Y gastric bypass for treatment of obesity: a 5-year study

https://doi.org/10.1016/j.soard.2019.05.025Get rights and content

Highlights

  • Both bariatric procedures i.e., RYGB and OAGB, produce very good to excellent weight-loss at Intermediate to long term follow-up.

  • In this study, we analysed routinely collected data and compared a cohort of patients undergoing RYGB with those undergoing OAGB at a single centre, with follow-up over five years.

  • The OAGB yields better weight loss, weight loss maintenance and resolution of co-morbid conditions in the treatment of severe obesity at the expense of increased nutrient deficiencies.

Abstract

Background

Roux-en-Y gastric bypass (RYGB) is the gold standard in bariatric surgery. One-anastomosis gastric bypass (OAGB) has been reported to have equivalent or better weight loss, with added advantages of being technically easy, amenable to reintervention/reversal, and offering better food tolerance.

Objective

This study was undertaken to compare weight loss, metabolic syndrome outcome, complications, and long-term nutritional outcomes between the 2 procedures.

Settings

A high-volume, private-practice bariatric surgery center in India.

Method

This retrospective study is based on prospectively maintained data in a cohort of patients who had either RYGB or OAGB in 2012 at a single institution by a single surgeon. Patients were all eligible for 5-year follow-up.

Results

On hundred twenty-two patients had RYGB and 90 had OAGB. The mean age was 44 and 46.4 years, body mass index was 45.8 and 42, percentage of total weight loss was 36.4 and 25.9, and percentage of excess weight loss was 81.6 and 66.7 for OAGB and RYGB groups, respectively. Resolution of type 2 diabetes was 79%, hypertension 57%, dyslipidemia 56%, and sleep apnea 94.54% in OAGB patients compared with type 2 diabetes of 61%, hypertension of 43%, dyslipidemia of 53%, and sleep apnea of 90.74% in RYGB patients. OAGB patients had more nutritional deficiencies than RYGB patients: anemia 44% versus 17%, hypoalbuminemia 32% versus 15%, and hypocalcemia 19% versus 8%, and other complications 7.8% versus 1.6%, respectively. There were no deaths in this study.

Conclusion

OAGB is associated with more weight loss and better resolution of co-morbid conditions. However, it is also associated with more nutritional deficiencies. There is a need for long-term follow-up and multicenter reports to confirm these findings.

Section snippets

Methods

Preoperatively, all patients provided written informed consent for their operation and to have de-identified data analyzed for presentation and/or publication. The institutional review board approved this study. Data from a prospectively maintained database of all bariatric metabolic operations performed at [Mohak Bariatrics and Robotics Center, Indore] in 2012 were identified. Patients who had either RYGB or OAGBP were identified. Patients were usually offered either of the procedures. The

Results

Seven hundred twenty-four patients were identified who had bariatric procedures at our center in 2012. One hundred twenty-two had RYGB and 90 had OAGB. The average age was 44 and 46.4 years in the OAGB and RYGB groups, respectively. The OAGB group (66.7%) included more male patients compared with the RYGB group (53.2%) (Table 1). Mean body mass index and the incidence of T2D and OSAS were statistically significantly more in the OAGB group (Table 1). The average surgical time for the OAGB was 55

Technical ease of performing the OAGB

Among all bariatric procedures, RYGB has stood the test of time and is considered the gold standard [4], [5], [12]. However, it is a technically demanding procedure, with a long learning curve and increased perioperative morbidity [6], [7]. OAGB is fast emerging as an alternative bypass procedure that is not only technically easy but is reported to have similar if not better results regarding weight loss and resolution of metabolic syndrome (MS) [8], [9], [10], [11], [13]. In this study, the

Conclusion

At intermediate- to midterm follow-up of 5 years in this study, both RYGB with the 80-cm BP limb and 120-cm Roux limb and OAGB with a >200-cm BP limb appear to be effective procedures resulting in good weight loss outcomes and resolution of co-morbidities, including T2D and HTN. However, OAGB with a biliopancreatic limb of >200 cm yields better weight loss and weight loss maintenance in addition to resolution of co-morbid conditions in the treatment of severe obesity, albeit at the expense of a

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

References (21)

  • M.M. Finucane et al.

    National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9.1 million participants

    Lancet

    (2011)
  • IDF Diabetes Atlas

    (2015)
  • A. Misra et al.

    Obesity and dyslipidemia in South Asians

    Nutrients

    (2013)
  • M. Golzarand et al.

    The bariatric surgery and weight losing: a meta-analysis in the long- and very long-term effects of laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy on weight loss in adults

    Surg Endosc

    (2017)
  • P.R. Schauer et al.

    Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity

    Ann Surg

    (2000)
  • P. Schauer et al.

    The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases

    Surg Endosc

    (2003)
  • S.H. Chang et al.

    The effectiveness and risks of bariatric surgery, an updates systematic review and meta-analysis

    JAMA Surg

    (2014)
  • R. Rutledge et al.

    Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients

    Obes Surg

    (2005)
  • M.A. Carbajo et al.

    Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 120 patients

    Obes Surg

    (2017)
  • W.J. Lee et al.

    Laparoscopic Roux-en-Y vs mini-gastric bypass for the treatment of morbid obesity: a 10-year experience

    Obes Surg

    (2012)
There are more references available in the full text version of this article.

Cited by (52)

  • Conversion to Roux-en-Y gastric bypass versus one-anastomosis gastric bypass after a failed primary gastric band: a matched nationwide study

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    Previous studies have shown that failed primary LAGB is best managed by converting to another bariatric technique such as OAGB or RYGB [14,21]. Furthermore, for primary procedures, previous studies have shown significantly greater weight loss for primary OAGB versus primary RYGB after a 5-year follow-up [8–10,22,23]. However, results for conversion procedures and particularly comparing the 2 techniques after a failed LAGB remain scarce.

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