Laparoscopic Revision After One Anastomosis Gastric Bypass: Four-Year Experience

Overview

This retrospective study from a high-volume bariatric center in Northern Italy reports on laparoscopic revisional surgeries following one anastomosis gastric bypass (OAGB) over four years. Various revision techniques were employed based on indications such as weight regain, bile reflux, and marginal ulcers, with outcomes assessed up to two years postoperatively.

Background

One anastomosis gastric bypass (OAGB) is a bariatric procedure involving a single gastrojejunal anastomosis and a biliopancreatic limb typically 150–200 cm distal to the ligament of Treitz. It offers technical simplicity compared to Roux-en-Y gastric bypass (RYGB) but carries a revision rate reported between 2% and 5%. Indications for revision include inadequate weight loss, recurrent weight gain, bile reflux, gastroesophageal reflux disease (GERD), marginal ulcers, and malnutrition. Surgical options for revision include conversion to RYGB, biliopancreatic limb lengthening or shortening, redo of the gastrojejunal anastomosis, pouch resizing, and restoration to normal anatomy.

Data Highlights

Key Findings

• Laparoscopic revisional surgery after OAGB is feasible and tailored according to the specific complication or indication.
• Biliopancreatic limb lengthening is effective for patients with recurrent weight gain or insufficient weight loss.
• Conversion to RYGB is the preferred approach for severe bile or gastroesophageal reflux and some marginal ulcers.
• Redo of the gastrojejunal anastomosis addresses anastomotic stenosis and marginal ulcers effectively.
• Resizing the gastric pouch is reserved for cases with a grossly enlarged pouch contributing to weight regain.
• Postoperative follow-up includes nutritional monitoring and symptom assessment at multiple intervals up to 12 months and beyond.

Clinical Implications

Surgeons managing OAGB patients should consider individualized revisional strategies based on the underlying cause of failure or complication. Understanding the anatomy and potential revision options allows for targeted interventions that optimize outcomes. Close postoperative monitoring is essential to detect complications early and ensure nutritional adequacy.

Conclusion

This four-year experience demonstrates that laparoscopic revisional surgery after OAGB can be safely performed with various tailored techniques yielding favorable short-term outcomes. A management algorithm based on indication and patient factors can guide surgical decision-making.

References

1. Rutledge et al. 1997 -- One Anastomosis Gastric Bypass Description
2. STROBE Statement -- Observational Study Reporting Guidelines