Clinical Scorecard: One-Anastomosis Gastric Bypass (OAGB) 2025: A Comprehensive Review and Meta-Analysis of Indications and Outcomes After Five Years
At a Glance
Category
Detail
Condition
Severe obesity and related metabolic comorbidities
Key Mechanisms
Single anastomosis gastric bypass surgery reducing stomach size and altering nutrient absorption to promote weight loss and metabolic improvements
Target Population
Adults (≥18 years) with severe obesity undergoing metabolic and bariatric surgery
Care Setting
Specialized bariatric surgical centers with long-term follow-up capabilities
Key Highlights
OAGB is one of the three most commonly performed primary metabolic and bariatric procedures worldwide.
Long-term weight loss and metabolic improvements, including significant HbA1c reduction and higher 5-year T2DM remission rates compared to RYGB and SG, are reported.
Long-term complications such as bile reflux, malnutrition, vitamin D and iron deficiencies, and marginal ulcers remain concerns, with some patients requiring revisional surgery.
Guideline-Based Recommendations
Diagnosis
Patient selection should be based on severe obesity and metabolic comorbidities with comprehensive preoperative evaluation.
Diagnosis of complications such as GERD and nutritional deficiencies requires ongoing clinical and laboratory assessment.
Management
OAGB is endorsed as a safe and effective primary and revisional bariatric procedure by IFSO (2021) and ASMBS (2023).
Surgical technique and patient selection should aim to minimize long-term complications.
Management of postoperative nutritional deficiencies and reflux symptoms is essential.
Monitoring & Follow-up
Long-term follow-up of at least 5 years is recommended to assess weight loss, metabolic outcomes, and complications.
Regular monitoring for nutritional deficiencies (vitamin D, iron) and gastrointestinal symptoms is necessary.
Surveillance for marginal ulcers and bile reflux should be included in postoperative care.
Risks
Potential for bile reflux and gastroesophageal reflux disease requiring conversion to RYGB.
Risk of malnutrition and micronutrient deficiencies necessitating supplementation and monitoring.
Possibility of marginal ulcers and diarrhea impacting quality of life.
Patient & Prescribing Data
Adults with severe obesity undergoing OAGB as primary or revisional metabolic and bariatric surgery
OAGB provides effective long-term weight loss and metabolic control with a 28% higher 5-year T2DM remission rate compared to other bariatric procedures; however, vigilance for long-term complications is required.
Clinical Best Practices
Use standardized patient selection criteria focusing on severe obesity and metabolic comorbidities.
Ensure comprehensive preoperative counseling regarding benefits and potential long-term risks.
Implement rigorous long-term follow-up protocols including nutritional assessment and management.
Monitor and manage reflux symptoms proactively to reduce need for revisional surgery.
Adopt multidisciplinary approach involving surgeons, dietitians, and endocrinologists for optimal outcomes.
