Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) for Biliary Reflux Resistant to Medical Treatment: Lessons Learned from a Retrospective Series of 2780 Consecutive Patients Undergoing OAGB

Feb 14, 2020Obesity surgery

Changing one type of stomach bypass to another to treat bile reflux that doesn't improve with medicine: Insights from 2,780 patients

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Abstract

A total of 32 patients (1.2%) underwent conversion from one anastomosis gastric bypass to Roux-en-Y gastric bypass for biliary reflux.

Biliary reflux resistant to medical treatment occurs in 0.6-10% of patients after one anastomosis gastric bypass.
The mean time from one anastomosis gastric bypass to conversion was 30.3 months.
Postoperative complications were observed in 12.5% of patients after conversion to Roux-en-Y gastric bypass.
At 24 months follow-up, the mean weight of patients was 74.3 kg and the mean body mass index was 27.2 kg/m².
Biliary reflux symptoms were relieved in 93.8% of patients after the conversion procedure.

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BACKGROUND: Biliary reflux resistant to medical treatment has an incidence of 0.6-10% after one anastomosis gastric bypass (OAGB) and may be a reason for revisional surgery. The aim of this study is to report the results of a single-institution series of patients who underwent conversion from OAGB to Roux-en-Y gastric bypass (RYGB) for biliary reflux.

METHODS: Data of OAGB patients converted to RYGB between May 2010 and December 2017 were prospectively collected and retrospectively analyzed. The afferent limb was sectioned proximally to the gastrojejunal anastomosis. A jejuno-jejunal latero-lateral anastomosis was performed between the biliary and alimentary limb. The final RYGB had an alimentary limb of 100 cm and a biliary limb of 150 cm.

RESULTS: During the study period, 2780 patients underwent OAGB. A total of 32 patients (1.2%) underwent conversion from OAGB to RYGB for biliary reflux, at a mean of 30.3 months from OAGB. Mean weight before RYGB was 70.6 kg, and mean body mass index BMI was 26 kg/m. Four patients experienced postoperative complications (12.5%). Patients' mean weight was 74.3 kg at 24 months follow-up, with BMI of 27.2 kg/m. Conversion to RYGB relieved symptoms of biliary reflux in all patients but 2 (93.8%). 2 2

CONCLUSIONS: Biliary reflux although rare can complicate OAGB. RYGB is a safe and feasible technique of revision in this case. A shorter length of the afferent limb during the initial operation facilitates the revision.

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Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) for Biliary Reflux Resistant to Medical Treatment: Lessons Learned from a Retrospective Series of 2780 Consecutive Patients Undergoing OAGB

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