Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 5/2017

Open Access 01-05-2017 | Original Contributions

Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients

Authors: Miguel A. Carbajo, Enrique Luque-de-León, José M. Jiménez, Javier Ortiz-de-Solórzano, Manuel Pérez-Miranda, María J. Castro-Alija

Published in: Obesity Surgery | Issue 5/2017

Login to get access

Abstract

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/m2 (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/m2) 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.
Literature
1.
Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol. 2013;9:13–27.CrossRefPubMed
2.
3.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMed
4.
Rutledge R. The mini-gastric bypass: experience with the first 1274 cases. Obes Surg. 2001;11(3):276–80.CrossRefPubMed
5.
Carbajo M, Garcia-Caballero M, Toledano M, et al. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg. 2005;15(3):398–404.CrossRefPubMed
6.
Gastrointestinal surgery for severe obesity. National Institutes of Health consensus development conference draft statement. Obes Surg. 1991;1:257–66.CrossRef
7.
Buchwald H. Consensus conference statement: bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. J Am Coll Surg. 2005;200:593–604.CrossRefPubMed
8.
Metropolitan Life Foundation. Metropolitan height and weight tables. Metropolitan Life Foundation Statistical Bulletin. 1983;64(1):2–9.
9.
10.
Reinhold RB. Critical analysis of long term weight loss following gastric bypass. Surg Gynecol Obstet. 1982;155:385–94.PubMed
11.
Carbajo MA, Castro MJ, Kleinfinger S, et al. Effects of a balanced energy and high protein formula diet (Vegestart complet®) vs. low-calorie regular diet in morbid obese patients prior to bariatric surgery (laparoscopic single anastomosis gastric bypass): a prospective, double-blind randomized study. Nutr Hosp. 2010;25(6):939–48.PubMed
12.
Kolotkin RL, Head S, Hamilton M, et al. Assessing impact of weight on quality of life. Obes Res. 1995;3:49–56.CrossRefPubMed
13.
Jones KB. The left subcostal incision revisited. Obes Surg. 1998;8:29–34.CrossRef
14.
Carbajo MA, Martin del Olmo JC, Toledano M. Left subcostal minilaparotomy in silastic ring vertical gastroplasty and transected Roux-en-Y gastric bypass. Obes Surg. 2002;2:124–5.CrossRef
15.
Himpens J, Dobbeleir J, Peeters G. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010;252:319–24.CrossRefPubMed
16.
Padwal R, Klarenbach S, Wiebe N, et al. Bariatric surgery: a systematic review and network meta-analysis of randomized trials. Obes Rev. 2011;12:602–21.CrossRefPubMed
17.
18.
Pope GD, Birkmeyer JD, Finlayson SRG. National trends in utilization and in hospital outcome of bariatric surgery. J Gastrointest Surg. 2002;6:855–61.CrossRefPubMed
19.
El-Kadre L, Tinoco AC, Tinoco RC, et al. Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience. Surg Obes Relat Dis. 2013;9(6):867–72.CrossRefPubMed
20.
Higa K, Ho T, Tercero F, et al. Laparoscopic Roux- en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7:516–25.CrossRefPubMed
21.
Rutledge R, Walsh W. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005;15:1304–8.CrossRefPubMed
22.
Lee WJ, Wang W, Lee YC, et al. Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg. 2008;18:294–9.CrossRefPubMed
23.
Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short and long-term outcome. Obes Surg. 2012;22:697–703.CrossRefPubMed
24.
Musella M, Sousa A, Greco F, et al. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multi-center review. Surg Endosc. 2014;28:156–63.CrossRefPubMed
25.
Kular KS, Manchanda N, Rutledge R. A 6-year experience with 1,054 mini-gastric bypasses—first study from Indian subcontinent. Obes Surg. 2014;24:1430–5.CrossRefPubMed
26.
Chevallier JM, Arman GA, Guenzi M, et al. One thousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy. Obes Surg. 2015;25:951–8.CrossRefPubMed
27.
Disse E, Pasquer A, Espalieu P, et al. Greater weight loss with the omega loop bypass compared to Roux-en-Y gastric bypass: a comparative study. Obes Surg. 2014;24:841–6.CrossRefPubMed
28.
Jammu GS, Sharma R. A 7-year clinical audit of 1107 cases comparing sleeve gastrectomy, Roux-en-Y gastric bypass, and mini-gastric bypass, to determine an effective and safe bariatric and metabolic procedure. Obes Surg. 2016;26:926–32.CrossRefPubMed
29.
Lee WJ, Ser KH, Lee YC, et al. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22:1827–34.CrossRefPubMed
30.
Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242:20–8.CrossRefPubMedPubMedCentral
31.
Lee WJ, Wang W, Lee YC, et al. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus: comparison of BMI > 35 and <35 kg/m2. J Gastrointest Surg. 2008;12(5):945–52.CrossRefPubMed
32.
Carbajo MA, Jimenez JM, Castro MJ, et al. Outcomes in weight loss, fasting blood glucose and glycosylated hemoglobin in a sample of 415 obese patients, included in the database of the European Accreditation Council for Excellence Centers for Bariatric Surgery with laparoscopic one anastomosis gastric bypass. Nutr Hosp. 2014;30(5):1032–8.PubMed
33.
Coskun H, Hasbahceci M, Bozkurt S, et al. Effect of laparoscopic mini-gastric bypass on diabetes in morbidly obese patients. Eur J Laparosc Surg. 2014;1:40–4.
34.
García-Caballero M, Reyes-Ortiz A, Garcia M, et al. Changes of body composition in patients with BMI 23-50 after tailored one anastomosis gastric bypass (BAGUA): influence of diabetes and metabolic syndrome. Obes Surg. 2014;24:2040–7.CrossRef
35.
Guenzi M, Arman G, Rau C, et al. Remission of type 2 diabetes after omega loop gastric bypass for morbid obesity. Surg Endosc. 2015;29:2669–74.CrossRefPubMed
36.
Carbajo MA, Fong-Hirales A, Luque-de-Leon E, et al. Weight loss and improvement of lipid profiles in morbidly obese patients after laparoscopic one anastomosis gastric bypass: 2-year follow-up. Surg Endosc. 2016; doi:10.​1007/​s00464-016-4990-y.PubMed
37.
Lee WJ, Lee YC, Ser KH, et al. Improvement of insulin resistance after obesity surgery: a comparison of gastric banding and bypass procedures. Obes Surg. 2008;18:1119–25.CrossRefPubMed
38.
Milone M, Di Minno MN, Leongito M, et al. Bariatric surgery and diabetes remission: sleeve gastrectomy or mini-gastric bypass? World J Gastroenterol. 2013;19:6590–7.CrossRefPubMedPubMedCentral
39.
Milone M, Lupoli R, Maletta P, et al. Lipid profile changes in patients undergoing bariatric surgery: a comparative study between sleeve gastrectomy and mini-gastric bypass. Int J Surg. 2015;14:28–32.CrossRefPubMed
40.
Lee WJ, Chong K, Lin YH, et al. Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect. Obes Surg. 2014;24:1552–62.CrossRefPubMed
41.
Mahawar KK, Carr WR, Balupuri S, et al. Controversy surrounding ‘mini’ gastric bypass. Obes Surg. 2014;24(2):324–33.CrossRefPubMed
42.
Mahawar KK, Jennings N, Brown J, et al. “Mini” gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23:1890–8.CrossRefPubMed
43.
Lee WJ, Lin YH. Single-anastomosis gastric bypass (SAGB): appraisal of clinical evidence. Obes Surg. 2014;24:1749–56.CrossRefPubMed
44.
Georgiadou D, Sergentanis TN, Nixon A, et al. Efficacy and safety of laparoscopic mini-gastric bypass. A systematic review. Surg Obes Relat Dis. 2014;10:984–91.CrossRefPubMed
45.
Fernandez Jr AZ, DeMaria EJ, Tichansky DS, et al. Experience with over 3000 open and laparoscopic bariatric procedures: multivariate analysis of factors related to leak and resultant mortality. Surg Endosc. 2004;18:193–7.CrossRefPubMed
46.
Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012;26(6):1509–15.CrossRefPubMed
47.
Johnson WH, Fernandez AZ, Farrell TM, et al. Surgical revision of loop (“mini”) gastric bypass procedure: multicenter review of complications and conversions to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2007;3(1):37–41.CrossRefPubMed
48.
Paroz A, Calmes JM, Giusti V, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass for morbid obesity: a continuous challenge in bariatric surgery. Ob Surg. 2006;16:1482–7.CrossRef
49.
Woodward GA, Morton JM. Stomal stenosis after gastric bypass. In: Deitel M, Gagner M, Dixon JB, Himpens J, editors. Handbook of obesity surgery. Toronto: FD-Communications; 2010. p. 102–7.
50.
Sataloff DM, Lieber CP, Seinige UL. Strictures following gastric stapling for morbid obesity: results of endoscopic dilatation. Am Surg. 1990;56(3):167–74.PubMed
51.
Coblijn UK, Goucham AB, Lagarde SM, et al. Development of ulcer disease after Roux-en-Y gastric bypass, incidence, risk factors and patient presentation: a systematic review. Obes Surg. 2014;24(2):299–309.CrossRefPubMed
52.
Fuchs KH, Maroske J, Fein M, et al. Variability in the composition of physiologic duodenogastric reflux. J Gastrointest Surg. 1999;3(4):389–95.CrossRefPubMed
53.
Atak I, Ozdil K, Yücel M, et al. The effect of laparoscopic cholecystectomy on the development of alkaline reflux gastritis and intestinal metaplasia. Hepato-Gastroenterology. 2012;59(113):59–61.PubMed
54.
55.
McQuaid KR, Laine L, Fennerty MB, et al. Systematic review: the role of bile acids in the pathogenesis of gastro-oesophageal reflux disease and related neoplasia. Aliment Pharmacol Ther. 2011;34(2):146–65.CrossRefPubMed
56.
57.
Chevallier JM, Trelles N, Arienzo R, et al. Endoscopic findings after laparoscopic omega loop gastric bypass. Obes Surg. 2011;21:956.CrossRef
58.
Tolone S, Cristiano S, Savarino E, et al. Effects of omega-loop bypass on esophagogastric junction function. Surg Obes Rel. 2016;12:62–9.CrossRef
59.
DuPree CE, Blair K, Steele SR, et al. Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease a national analysis. JAMA Surg. 2014;149(4):328–34.CrossRefPubMed
60.
Weiner RA, Theodoridou S, Weiner S. Failure of laparoscopic sleeve gastrectomy—further procedure? Obes Facts. 2011;4(suppl 1):42–6.PubMed
61.
Lee WJ, Lee YC, Ser KH, et al. Revisional surgery for laparoscopic minigastric bypass. Surg Obes Relat Dis. 2011;7(4):486–92.CrossRefPubMed
62.
Luque-de-Leon E, Carbajo MA. Conversion of one-anastomosis gastric bypass (OAGB) is rarely needed if standard operative techniques are performed. Obes Surg. 2016;26(7):1588–91.CrossRefPubMed
63.
Schafer LW, Larson DE, Melton III LJ, et al. The risk of gastric carcinoma after surgical treatment for benign ulcer disease. A population-based study in Olmsted County, Minnesota. N Engl J Med. 1983;309(20):1210–3.CrossRefPubMed
64.
Sitarz R, Maciejewski R, Polkowski WP, et al. Gastroenterostoma after Billroth antrectomy as a premalignant condition. World J Gastroenterol. 2012;18(25):3201–6.PubMedPubMedCentral
65.
Seoane A, Bessa X, Alameda F, et al. Role of Helicobacter pylori in stomach cancer after partial gastrectomy for benign ulcer disease. Rev Esp Enferm Dig. 2005;97(11):778–85.CrossRefPubMed
66.
Babor R, Booth M. Adenocarcinoma in the gastric pouch 26 years after loop gastric bypass. Obes Surg. 2006;16:935–8.CrossRefPubMed
67.
Scozzari G, Trapani R, Toppino M, et al. Esophagogastric cancer after bariatric surgery: systematic review of the literature. Surg Obes Relat Dis. 2013;9(1):133–42.CrossRefPubMed
68.
Wu CC, Lee WJ, Ser KH, et al. Gastric cancer after mini-gastric bypass surgery: a case report. Asian J Endosc Surg. 2013;6:303–6.CrossRefPubMed
69.
Taha AS, Angerson WJ, Morran CG. Reflux and Barrett’s oesophagitis after gastric surgery—long-term follow-up and implications for the roles of gastric acid and bile in oesophagitis. Aliment Pharmacol Ther. 2003;17(4):547–52.CrossRefPubMed
70.
Champion G, Richter JE, Vaezi MF, et al. Duodenogastroesophageal reflux: relationship to pH and importance in Barrett’s esophagus. Gastroenterology. 1994;107(3):747–54.CrossRefPubMed
71.
Chang JT, Katzka DA. Gastroesophageal reflux disease, Barrett’s esophagus, and esophageal adenocarcinoma. Arch Intern Med. 2004;164:1482–8.CrossRefPubMed
72.
Bernert CP, Ciangura C, Coupaye M, et al. Nutritional deficiency after gastric bypass: diagnosis, prevention and treatment. Diabetes Metab. 2007;33:13–24.CrossRef
73.
Hammer HF. Medical complications of bariatric surgery: focus on malabsortion and dumping syndrome. Digest Dis. 2012;30:182–6.CrossRef
74.
75.
de Luis DA, Pacheco D, Izaola O, et al. Micronutrient status in morbidly obese women before bariatric surgery. Surg Obes Rel Dis. 2013;9:323–7.CrossRef
76.
77.
78.
Bessler M, Daud A, Kim T, et al. Prospective randomized trial of banded versus non banded gastric bypass for the superobese: early results. Surg Obes Rel Dis. 2007;3(4):480–4.CrossRef
79.
Rawlins ML, Teel II D, Hedgcorth K, et al. Revision of Roux- en-Y gastric bypass to distal bypass for failed weight loss. Surg Obes Relat Dis. 2011;7:45–9.CrossRefPubMed
80.
Karra E, Yousseif A, Batterham RL. Mechanisms facilitating weight loss and resolution of type 2 diabetes following bariatric surgery. Trends Endocrin Met. 2010;21:337–44.CrossRef
81.
Deitel M. Mini-gastric (one-anastomosis) bypass becoming a mainstream operation. Bariatric News, issue 18, 2013;13.
82.
Carbajo MA, Luque-de-Leon E. Differentiating mini-gastric bypass/one-anastomosis gastric bypass from the single-anastomosis duodenoileal bypass procedures. Surg Obes Relat Dis. 2016;12(4):933–4.CrossRefPubMed
83.
84.
Metadata
Title
Laparoscopic One-Anastomosis Gastric Bypass: Technique, Results, and Long-Term Follow-Up in 1200 Patients
Authors
Miguel A. Carbajo
Enrique Luque-de-León
José M. Jiménez
Javier Ortiz-de-Solórzano
Manuel Pérez-Miranda
María J. Castro-Alija
Publication date
01-05-2017
Publisher
Springer US
Published in
Obesity Surgery / Issue 5/2017
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-016-2428-1

Other articles of this Issue 5/2017

Obesity Surgery 5/2017 Go to the issue

Video Submission

Laparoscopic Conversion of Omega Loop Gastric Bypass into Roux-en-Y Gastric Bypass

Brief Communication

Prevalence of Anemia in Subjects Randomized into Roux-en-Y Gastric Bypass or Sleeve Gastrectomy

Original Contributions

Investigating Factors Involved in Post Laparoscopic Sleeve Gastrectomy (LSG) Neuropathy

Original Contributions

Gastrointestinal Quality of Life Improves Significantly After Sleeve Gastrectomy and Roux-en-Y Gastric Bypass—a Prospective Cross-Sectional Study Within a 2-Year Follow-up

Video Submission

Endoscopic Suturing for Massively Bleeding Marginal Ulcer 10 days Post Roux-en-Y Gastric Bypass

Original Contributions

Improvement of Health-Related Quality of Life After Roux-en-Y Gastric Bypass Related to Weight Loss