Laparoscopic OAGB is an effective revisional option after failed open VGB

Laparoscopic one anastomosis gastric bypass (OAGB) is an effective revisional surgery after failed open vertical banded gastroplasty (VBG) in terms of weight loss and metabolic outcomes, according to researchers from Mansoura University, Mansoura, Egypt. However, the non-negligible risk of bile reflux (8.5%), coupled with its potential long-term oncological risks, necessitates careful patient selection, long-term follow-up, and consideration of alternative procedures in high-risk individuals.

Open VBG was first described by Mason in 1982 and was a widely used technique resulting in alimentary restriction and loss of weight while avoiding the bypass of any part of the digestive tract and its potential malabsorptive effects. Nevertheless, the procedure lead tomany long-term complications including regurgitation, vomiting, intolerance to solid food due to gastric pouch outlet stricture or a narrow band and  dilatation of the gastric pouch, resulting in increased food intake and weight regain. The researcher noted that more than 50% of the cases required revisional surgery due to regain of weight and/or complications.

With the growing popularity of OAGB, the researchers assessed the perioperative outcomes and long-term results of revising open VBG to OAGB. Between February 2014 and February 2020, 75 patients underwent revisional laparoscopic OAGB after failed open VBG, and four were excluded, so data analysis was performed on 71 patients.

The most common indications for revision included weight regain (52.1%), inadequate weight loss (26.8%) and severe gastroesophageal reflux (19.7%). The BMI before revisional surgery was 41.8 ± 3.7 kg/m2.

The baseline weight of the patients before revisional surgery was 115.5 ± 11.2 kg. The EBWL % at 12 months was 68.2 ± 9.4% and at 24 and 36 months was 65.9 ± 2.5% and 59.6 ± 7.4%, respectively. The BMI before revision was 41.8 ± 3.7 kg/m2, which decreased to 30.4 ± 5.3 kg/m2 at 12 months after surgery, and at 24 and 36 months was 30.8 ± 6.5 kg/m2 and 31.9 ± 4.2 kg/m2.

Six (8.5%) patients developed early postoperative complications, postoperative bleeding occurred in one patient and was managed conservatively by two units of blood transfusion. Two patients developed postoperative leakage, and upper GI endoscopy was performed for both of them. There was no conversion to open procedure, and no mortality was recorded. Hospital stay was 5.3 ± 2.6 days .

Regarding late complications, bile reflux occurred in six patients (8.5%) who were diagnosed clinically and by endoscopic findings; four of them were controlled by medical treatment, and two required surgical intervention in the form of side-to-side enteroenterostomy. Two patients (2.8%) developed gastric ulcer and were managed by medical treatment. Anastomotic stricture was encountered in one patient (1.4%) and was managed by upper GI endoscopy and balloon dilatation. Malnutrition was observed in six cases (8.5%) and was managed by medical treatment. Three patients (4.2%) developed port-site incisional hernia, and they were managed by mesh repair.

There was one case of mortality (1.4%) that was not associated with the procedure.

After 12 months of revisional surgery, resolution of T2DM and HTN was 85.7% and 80%, respectively. Resolution of other comorbidities also occurred.

The study authors said that further prospective, randomised controlled trials with longer follow-up periods are essential to clarify the true incidence of bile reflux and its long-term consequences, including the risk of gastrointestinal malignancies.

The findings were reported in the paper, ‘Laparoscopic One Anastomosis Gastric Bypass as a Revisional Procedure After Failed Vertical Banded Gastroplasty: Our Center Experience’, published in the Journal of Obesity. To access this paper, please click here