RESUMO
Introduction: The one-anastomosis gastric bypass (OAGB), first published by Dr Rutledge in 1997 is now a well-established procedure in the bariatric-metabolic armamentarium. This procedure based on a (single) loop gastro-jejunal anastomosis (the biliopancreatic limb or BPL) with a long narrow gastric pouch combines restriction with hypo-absorption. The biliopancreatic limb and in particular its length is held responsible for the degree of the hypo-absorptive effect but the most appropriate or "optimal" length of the BPL remains debatable. Methods: The following text is based on a comprehensive and meticulous selection of the most recent literature in Cochrane, Pubmed and Google Scholar using the search terms "biliopancreatic limb", "biliopancreatic limb in one anastomosis gastric bypass" in an attempt to define not only the most common used biliopancreatic limb length but also to find out If there is an "ideal" limb length not only to optimize the outcomes of the OAGB in terms of weight loss and resolution of obesity-related diseases but also to reduce the potential side-effects in particular nutritional deficiencies. Results: Until today there is no consensus about the "standard" or "ideal" length of the biliopancreatic limb in OAGB, a fixed length of 200 cm is still the most common used procedure although many reports and studies are in favour of shorter limb lengths adjusted to the BMI or the total small bowel length. Conclusion: The "ideal" or "optimal" biliopancreatic limb length in OAGB still needs to be defined. There are different options and all of them have their credits, the question remains if a consensus can be reached regarding the best strategy to obtain the best outcome.
RESUMO
BACKGROUND: There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS: We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS: Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS: BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.