Management of super–super obese patients: comparison between one anastomosis (mini) gastric bypass and Roux-en-Y gastric bypass

Dec 17, 2016Surgical endoscopy

Comparing two types of weight-loss surgery in extremely obese patients: one anastomosis (mini) gastric bypass versus Roux-en-Y gastric bypass

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Abstract

OAGB/MGB patients achieved a 70.4% excess weight loss at 2 years compared to 57.1% in the RYGB group.

OAGB/MGB patients had a higher average weight and body mass index than RYGB patients.
No mortality or major complications occurred in either surgical group.
Late complications were reported as two in the OAGB/MGB group and six in the RYGB group.
One patient in the OAGB/MGB group required a conversion to RYGB due to persistent reflux symptoms.
Total weight loss was significantly greater in the OAGB/MGB group at both 18 months (43.0% vs. 29.3%) and 24 months (44.4% vs. 33.4%).
The difference in excess weight loss between the two groups at 18 months did not reach significance.

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BACKGROUND: Gastric bypass can be technically challenging in super-super obese patients. Both Roux-en-Y gastric bypass (RYGB) and one anastomosis (mini) gastric bypass (OAGB/MGB) have been described in these patients, but direct comparisons are lacking. The purpose of this study was to compare the early outcomes with these two procedures in patients with body mass index (BMI) of ≥60 kg/min our unit. 2

METHODS: We identified all super-super obese patients who underwent either OAGB/MGB or RYGB from our prospectively maintained database. Information was also obtained from the case notes and from hospital computerized records. We obtained data regarding patient demographics, operative details, complications, and weight loss, in both groups, and compared them using standard statistical methods.

RESULTS: This study compares our results with 19 OAGB/MGB and 47 RYGB super-super obese patients performed in our unit between October 2012 and June 2015. OAGB/MGB group patients had a significantly higher weight and body mass index. There was no mortality or major complication in either group. There were two late complications in the OAGB/MGB group compared to six in the RYGB group. One patient in the OAGB/MGB group needed conversion to RYGB for persistent reflux symptoms. OAGB/MGB patients achieved a significantly higher EWL of 70.4% at 2 years compared to 57.1% in the RYGB group. The difference between TWL of 44.4 and 33.4%, respectively, was also significant at 2 years. TWL of 43.0 and 29.3%, respectively, in OAGB/MGB and RYGB groups at 18 months was also significantly different, but the difference in EWL at 18 months did not reach significance.

CONCLUSION: One anastomosis (mini) gastric bypass yields superior weight loss at 18 and 24 months in comparison with Roux-en-Y gastric bypass in patients with BMI of ≥60 kg/m. Findings need confirmation in larger randomized studies. 2

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Management of super–super obese patients: comparison between one anastomosis (mini) gastric bypass and Roux-en-Y gastric bypass

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