Comparing the Efficacy and Safety of Roux-en-Y Gastric Bypass with One-Anastomosis Gastric Bypass with a Biliopancreatic Limb of 200 or 160 cm: 1-Year Results of the Tehran Obesity Treatment Study (TOTS)

Pouria Mousapour | Mohammad Ali Kalantar Motamedi | Maryam Mahdavi | Majid Valizadeh | Farhad Hosseinpanah | Maryam Barzin | Alireza Khlaj

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URL :   http://research.shahed.ac.ir/WSR/WebPages/Report/PaperView.aspx?PaperID=137923
Date :  2020/05/14
Publish in :    Obesity Surgery: The Journal of Metabolic Surgery and Allied Care
DOI :  https://doi.org/10.1007/s11695-020-04681-3
Link :  http://dx.doi.org/10.1007/s11695-020-04681-3
Keywords :One-anastomosis gastric bypass . Roux-en-Y gastric bypass . Biliopancreatic limb length . Complication . Safety . Effectiveness

Abstract :

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Purpose One-anastomosis gastric bypass (OAGB) has raised concerns about nutritional complications possibly attributed to the biliopancreatic limb (BPL) length. We aimed to assess the results of a conservative approach of OAGB compared with the original OAGB and Roux-en-Y gastric bypass (RYGB) in a 1-year follow-up study. Materials and Methods This retrospective study was conducted based on prospectively maintained data in a cohort of patients whounderwenteitherRYGBwithaRouxlimbofa150cmandaBPLof50cm(n=145),OAGBwitha200-cmBPL(n=272), or OAGB with a 160-cm BPL (n=383), from March 2013 to 2017 at three university hospitals by a single surgical team. Results Groups were comparable regarding age and sex. Mean preoperative body mass indexes of the RYGB, OAGB-160, and OAGB-200groupswere44.5±5.8,45.6±6.3,and46.7±6.4kg/m2,respectively.One-yearfollow-uprateswere83.4,85.3, and82.5fortheRYGB,OAGB-200,andOAGB-160groups,respectively.One-yearpercenttotalweightlossvalueswere33.8 ±6.7 after OAGB-160 and 35.3±6.9 after OAGB-200 (P =0.056), which were significantly greater compared with 30.9±8.9 after RYGB (P 0.001). All groups were comparable regarding remission of type 2 diabetes mellitus, hypertension, dyslipidemia, and fatty liver. Mean operative time was longer with RYGB thanwith either OAGB techniques. Groups were comparable for postoperative complications except for the incidence of protein-calorie malnutrition (PCM), occurring in 11 patients (4.7) after OAGB-200, 7 of whom required revisional surgery, in one patient (0.3) after OAGB-160 who responded to parenteral alimentation, but in no patients after RYGB. Conclusion After 1 year, OAGB with a 160-cm BPL was as effective as OAGB with a 200-cm BPL and RYGB, but safer than OAGB-200. This approach also avoided the need for revisional surgery following postoperative malnutrition.