Clinical Scorecard: Midterm Outcome Comparisons of Roux-en-Y Gastric Bypass, Diverted One-Anastomosis Gastric Bypass, and One-Anastomosis Gastric Bypass

At a Glance

Key Highlights

• Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB) are effective bariatric procedures with metabolic benefits.
• OAGB offers a simpler surgical approach with potentially greater malabsorptive effects due to a longer biliopancreatic limb.
• Diverted OAGB (D-OAGB) modifies OAGB by adding Roux-en-Y diversion to reduce bile reflux and marginal ulcers.

Guideline-Based Recommendations

Diagnosis

• Patient eligibility for bariatric surgery should follow International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) guidelines.
• GERD diagnosis postoperatively is based on typical symptoms and/or ongoing use of proton pump inhibitors beyond 3 months.

Management

• Selection of bariatric procedure (RYGB, OAGB, or D-OAGB) should be individualized after patient-surgeon discussion of benefits and risks.
• Surgical techniques include creation of gastric pouch and intestinal limb lengths specific to each procedure.
• Intraoperative methylene blue test is recommended to detect anastomotic leakage.

Monitoring & Follow-up

• Follow-up includes assessment of weight loss at 3, 6 months, and beyond using total weight loss percentage (TWL%) and excess weight loss percentage (EWL%).
• Monitor improvement of obesity-related conditions by reduction or cessation of medications for hypertension, diabetes, and dyslipidemia.
• Evaluate GERD symptoms and treatment status postoperatively to assess improvement or persistence.

Risks

• Biliary reflux is a known complication of OAGB, potentially requiring surgical revision.
• D-OAGB aims to reduce bile reflux risk by creating a Roux-en-Y configuration.
• Perioperative adverse events should be monitored and managed accordingly.

Patient & Prescribing Data

Patients undergoing bariatric bypass surgeries (RYGB, OAGB, D-OAGB) with at least 2 years follow-up

Weight loss and metabolic improvements are achieved with all procedures; D-OAGB may reduce bile reflux complications compared to OAGB.

Clinical Best Practices

• Ensure thorough preoperative multidisciplinary evaluation and informed consent discussing procedure-specific risks and benefits.
• Use standardized surgical techniques with appropriate limb lengths and anastomosis methods to optimize outcomes.
• Employ intraoperative leak testing to reduce postoperative complications.
• Conduct regular postoperative follow-up to monitor weight loss, metabolic improvements, and GERD symptoms.
• Consider D-OAGB as an alternative to OAGB to minimize bile reflux while maintaining weight loss efficacy.

References

• Obesity pandemic and bariatric surgery overview
• IFSO guidelines for bariatric surgery eligibility
• Original description of OAGB by Rutledge
• D-OAGB surgical technique and rationale
• GERD diagnosis and management guidelines