Comparison of mid-term effectiveness and safety of one-anastomosis gastric bypass and sleeve gastrectomy in patients with super obesity (BMI ≥ 50 kg/m2)

Oct 24, 2021Surgery today

Mid-term safety and effectiveness of single-connection gastric bypass versus stomach sleeve surgery in patients with extreme obesity (BMI ≥ 50)

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Abstract

In a cohort of 557 patients, one-anastomosis gastric bypass (OAGB) resulted in 36.5% total weight loss compared to 33.2% for sleeve gastrectomy (SG) within three years post-surgery.

OAGB showed greater weight loss than SG over three years, with a ΔBMI of 20.1 kg/m for OAGB versus 18.1 kg/m for SG.
Resolution rates for diabetes, hypertension, and dyslipidemia were similar between OAGB and SG.
OAGB was associated with longer operative times and hospital stays compared to SG.
The incidence of complications requiring readmission or reoperation was significantly higher in the OAGB group than in the SG group.
No significant differences in postoperative weight loss or comorbidity resolution were found between OAGB-160 and OAGB-200 groups, except for protein-calorie malnutrition, which was only seen in the OAGB-200 group.

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PURPOSES: There is no consensus regarding the optimal bariatric procedure in patients with super obesity [body mass index (BMI) ≥ 50 kg/m]. This study compared the outcomes of one-anastomosis gastric bypass (OAGB) with those of sleeve gastrectomy (SG) in these patients. 2

METHODS: This retrospective study was conducted based on the prospectively maintained data in a cohort of 557 patients with super obesity, who underwent either SG (n = 348) or OAGB with a 200-cm BPL (n = 154) or a 160-cm BPL (n = 55) by the same surgical team from March 2013 to 2017.

RESULTS: Patients undergoing OAGB had greater weight loss in comparison to those managed by SG during the first, second, and third years of follow-up. Comparing the OAGB and SG groups within 3 years after surgery, the total weight loss was 36.5 vs. 33.2% (P < 0.001) and the ΔBMI was 20.1 vs. 18.1 kg/m(P < 0.001), respectively. The resolution of diabetes mellitus, hypertension and dyslipidemia were similar after the two procedures. The operative time and length of hospital stay were longer in the OAGB group, and incidence of complications, requiring either readmission or reoperation, was significantly higher after OAGB, in comparison to SG. There was no significant difference in the postoperative weight loss results, resolution of comorbidities, or the incidence of complications between the OAGB-160 and OAGB-200 groups, with the exception of protein-calorie malnutrition requiring revision surgery, which was exclusively observed in the OAGB-200 group. 2

CONCLUSION: Although OAGB provides superior mid-term weight loss, SG remains the first option for patients with super obesity, due to the safer surgical profile and comparable metabolic improvement.

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Comparison of mid-term effectiveness and safety of one-anastomosis gastric bypass and sleeve gastrectomy in patients with super obesity (BMI ≥ 50 kg/m2)

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