Comparative Outcomes of Revisional RYGB vs OAGB After Failed Sleeve Gastrectomy

Overview

This randomized controlled trial compared revisional Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB) following failed laparoscopic sleeve gastrectomy (LSG) over 2 years. Both procedures demonstrated effective weight loss and improvement in associated medical problems, with differences in complication profiles and nutritional outcomes.

Background

Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric procedure but has variable rates of weight regain and failure, leading to revision surgeries. Roux-en-Y gastric bypass (RYGB) is the most common revisional procedure after LSG, while one-anastomosis gastric bypass (OAGB) is less common but gaining popularity. Data comparing these two revisional procedures post-LSG are limited, especially from randomized controlled trials. This study aimed to fill that gap by evaluating weight loss, complications, nutritional status, and resolution of comorbidities over a 2-year follow-up.

Data Highlights

Key Findings

• Both revisional RYGB and OAGB resulted in significant weight loss at 6 months, 1 year, and 2 years post-surgery.
• RYGB remains the most commonly performed revisional procedure after failed LSG, but OAGB showed comparable or superior weight loss outcomes in some measures.
• GERD grade B or higher was an exclusion criterion; postoperative reflux symptoms were monitored and assessed using the Los Angeles classification.
• Both procedures improved associated medical problems such as diabetes and hypertension over 2 years.
• Nutritional deficiencies were monitored with laboratory tests; supplementation with multivitamins, calcium, and iron was standard for all patients.
• Complication rates and types differed between RYGB and OAGB, with detailed perioperative and postoperative monitoring including imaging and endoscopy as indicated.

Clinical Implications

Clinicians should consider both RYGB and OAGB as effective revisional options after failed LSG, with careful patient selection based on individual risk profiles and comorbidities. Nutritional monitoring and supplementation are essential post-revision to prevent deficiencies. The choice of procedure may be influenced by the patient’s reflux status and surgeon expertise.

Conclusion

Revisional RYGB and OAGB after failed sleeve gastrectomy both provide effective weight loss and improvement in comorbidities over 2 years, with distinct profiles in complications and nutritional outcomes. This randomized trial supports the use of either procedure tailored to patient needs.

References

1. Alexandria University Medical Research Institute Ethics Committee 2018-2020 -- Study protocol and registration
2. Los Angeles Classification 1996 -- GERD grading system
3. Bariatric Surgery Literature 2014-2018 -- Trends in LSG and revision procedures