The Effect of Revisional One Anastomosis Gastric Bypass After Sleeve Gastrectomy on Gastroesophageal Reflux Disease, Compared with Revisional Roux-en-Y Gastric Bypass: Symptoms and Quality of Life Outcomes

May 11, 2023Obesity surgery

Revisional One Anastomosis vs Roux-en-Y Gastric Bypass after Sleeve Surgery: Impact on Acid Reflux Symptoms and Quality of Life

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Abstract

At 32.4 months follow-up, GERD resolution was 77.4% for one anastomosis gastric bypass (OAGB) compared to 91.9% for Roux-en-Y gastric bypass (RYGB).

Seventy-eight patients who previously underwent sleeve gastrectomy (SG) were converted to either OAGB (n=31) or RYGB (n=47).
Significant differences were observed between groups in age, body mass index, time since surgery, and prevalence of sleep apnea.
There was no significant difference in the use of proton pump inhibitors, quality of life scores related to GERD, or endoscopic findings between the two groups.
Major complication rates were 0% for OAGB and 8.5% for RYGB, though this difference was not statistically significant.
Both procedures resulted in substantial weight loss, with OAGB achieving an average of 22% weight loss compared to 4.4% for RYGB.

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BACKGROUND: Gastroesophageal reflux disease (GERD) is common after sleeve gastrectomy (SG). We aimed to evaluate the effect of revisional one anastomosis gastric bypass (OAGB) on GERD, compared with revisional Roux-en-Y gastric bypass (RYGB) METHODS: A retrospective single-center study of a prospectively maintained patient registry (2018-2022). All patients with GERD undergoing OAGB and RYGB after SG were retrieved and included in the study.

RESULTS: Seventy-eight SG patients had conversion to OAGB (n=31) and RYGB (n=47). Baseline characteristics were similar except age (43.8±11.5 vs. 50.3±13.4 years; p=0.03), body mass index (39.9±8.8 vs. 30.6±6 kg/m; p<0.001), time interval (8±2.7 vs. 6.4±3.4 years; p=0.01), and sleep apnea (29% vs 8.5%; p=0.01), respectively. There was no significant difference between groups in number of patients consuming proton pump inhibitors (70.1% vs. 72.3%; p=0.66), GERD-health-related quality of life (HRQL) score (9.6±7.2 vs. 13.1±8; p=0.06), and pathological endoscopic findings (48.4% vs. 46.8%; p=0.89). Major complication rates were 0% vs. 8.5% (p=0.09). At 32.4 months follow-up, total weight loss was 22%±12.9 and 4.4%±14.6 (p<0.001), GERD resolution 77.4% and 91.9% (p=0.03), HRQL scoring improved to 1.7±4.5 and 1.7±2.7; p=0.94 for OAGB and RYGB, respectively. 2

CONCLUSIONS: SG conversion to RYGB provides better chances for definitive treatment of GERD. OAGB results in good symptom resolution and improved quality of life and may be considered for post-SG GERD treatment. The most appropriate solution should be individualized to each patient.

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The Effect of Revisional One Anastomosis Gastric Bypass After Sleeve Gastrectomy on Gastroesophageal Reflux Disease, Compared with Revisional Roux-en-Y Gastric Bypass: Symptoms and Quality of Life Outcomes

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