Midterm Outcomes of RYGB, D-OAGB, and OAGB in Bariatric Surgery

Overview

This retrospective study compared midterm outcomes of Roux-en-Y gastric bypass (RYGB), diverted one-anastomosis gastric bypass (D-OAGB), and one-anastomosis gastric bypass (OAGB) in patients undergoing bariatric surgery. Weight loss, perioperative adverse events, GERD outcomes, and improvement in obesity-related conditions were evaluated over a minimum 2-year follow-up.

Background

Obesity is a global pandemic with significant health impacts, and metabolic/bariatric surgery remains the most effective treatment for obesity and related comorbidities. RYGB and sleeve gastrectomy are considered gold standard procedures, with RYGB showing superior metabolic benefits due to its bypass component. OAGB, introduced in 2001, has gained popularity for its simplicity and effective weight loss, but concerns about biliary reflux have limited its use. D-OAGB is a novel modification designed to reduce bile reflux by incorporating a Roux-en-Y diversion while maintaining procedural simplicity.

Data Highlights

The study included patients undergoing RYGB, OAGB, or D-OAGB with at least 2 years of follow-up. Weight loss was assessed by total weight loss percentage (TWL%) and excess weight loss percentage (EWL%) at 3, 6 months, and subsequent intervals. Improvement in hypertension, diabetes, and dyslipidemia was defined by medication reduction or cessation. GERD diagnosis was based on symptoms and proton pump inhibitor use beyond 3 months postoperatively.

Key Findings

• RYGB showed a biliopancreatic limb (BPL) length of 45 cm and alimentary limb (AL) length of 120 cm, while OAGB and D-OAGB had a BPL of 200 cm.
• D-OAGB incorporated an additional 60 cm alimentary limb and entero-enterostomy to create a Roux-en-Y configuration, reducing bile reflux risk.
• All procedures demonstrated effective weight loss at midterm follow-up, with TWL% and EWL% assessed at multiple postoperative intervals.
• GERD symptoms and bile reflux were a concern with OAGB but were mitigated in D-OAGB due to the diversion technique.
• Improvement in obesity-related conditions such as hypertension, diabetes, and dyslipidemia was observed across all groups, with medication reduction or cessation as criteria.

Clinical Implications

D-OAGB offers a promising alternative to traditional OAGB by reducing bile reflux through Roux-en-Y diversion while maintaining procedural simplicity. Surgeons may consider D-OAGB for patients at risk of bile reflux or marginal ulcers associated with OAGB. Careful patient selection and counseling remain essential, with attention to limb lengths and surgical technique to optimize metabolic outcomes and minimize complications.

Conclusion

Midterm outcomes suggest that D-OAGB combines the metabolic benefits of OAGB with reduced bile reflux risk, offering a viable surgical option alongside RYGB and OAGB. Further prospective studies are warranted to confirm long-term efficacy and safety.

References

1. Rutledge 2001 -- One anastomosis gastric bypass description
2. IFSO 2018 -- Recognition of OAGB as mainstream bariatric technique
3. Study Authors 2021 -- Midterm Outcome Comparisons of RYGB, D-OAGB, and OAGB