Effect of one anastomosis gastric bypass on liver function tests: A comparison between 150 cm and 200 cm biliopancreatic limbs.

CONTEXT: Some studies have shown that one anastomosis gastric bypass (OAGB) results in the derangement of liver function tests (LFTs). We wanted to study this in our patients. AIMS: The aims are to study the effect of OAGB on LFTs and to compare the effect of a biliopancreatic limb (BPL) of 150 cm (OAGB-150) to a BPL of 200 cm (OAGB-200). SETTINGS AND DESIGN: The study was a retrospective cohort study conducted at a university hospital. MATERIALS AND METHODS: Information was obtained from our prospectively maintained database and hospital's computerised records. STATISTICAL ANALYSIS: A P < 0.05 was regarded statistically significant; however, given the number of variables examined, findings should be regarded as exploratory. RESULTS: A total of 405 patients underwent an OAGB-200 (n = 234) or OAGB-150 (n = 171) in our unit between October 2012 and July 2018. There were significant improvements in gamma-glutamyl transpeptidase (GGT) levels at 1 and 2 years after OAGB-200 and significant worsening in the levels of alkaline phosphatase (ALP) and albumin at 1 and 2 years. There was a significant improvement in GGT levels at 1 and 2 years after OAGB-150 and in alanine transaminase levels at 1 year. There was a significant worsening in ALP and albumin levels at both follow-up points in this group. OAGB-150 group had a significantly lower bilirubin level at 1 year and significantly fewer abnormal ALP values at 2 years in comparison with OAGB-200 patients. CONCLUSIONS: This exploratory study demonstrates the overall safety of OAGB with regard to its effect on LFTs, with no remarkable difference between OAGB-150 and OAGB-200.

Comparison of mini-gastric bypass with sleeve gastrectomy in a mainly super-obese patient group: first results.

INTRODUCTION: Whereas sleeve gastrectomy (SG) in its beginnings was mainly performed to treat super-obesity, it has become as popular as gastric bypass in the treatment of obesity of any class. In contrast to this, the persisting problems of early staple line leaks and poor long-term results of SG regarding weight loss and new onset of gastroesophageal reflux have become increasingly obvious. The mini-gastric bypass (MGB) with its low complication rates and possibly better long-term results may be a good alternative to SG, especially in super-obesity. METHODS: In this context, two groups of mostly super-obese patients (SG and MGB) of a single bariatric center were retrospectively analyzed and compared for perioperative and early postoperative outcomes. RESULTS: Between August 2007 and March 2015, 169 patients underwent MGB, while 118 patients were operated by SG. Both groups were comparable for BMI at baseline (MGB = 54.1 kg/m2 vs. SG = 54.6 kg/m2, p = 0.657). Mean operation time (81.7 vs. 112.1 min, p < 0.0001) as well as hospital stay was lower in the MGB-group (4.5 vs. 7.2 days, p < 0.0001). Perioperative (30 days) mortality was 0 % in MGB versus 0.8 % in SG (one patient). Perioperative complication rate was also lower in the MGB-group (3.0 vs. 9.3 %, p = 0.449). %EWL was significantly better after 1 year in MGB: 66.2 % (±13.9 %) versus 57.3 % (±19.0 %) in SG (p < 0.0001), as well as BMI which was 34.9 kg/m2 (±4.8 kg/m2) in MGB versus 38.5 kg/m2 (±8.6 kg/m2) in SG (p = 0.001). CONCLUSIONS: MGB achieved superior weight loss at 1 year and had a lower 30-day complication rate in comparison with SG for super-obese patients. Thus, MGB might be superior to SG regarding the treatment of super-obesity.

Management of super-super obese patients: comparison between one anastomosis (mini) gastric bypass and Roux-en-Y gastric bypass.

BACKGROUND: Gastric bypass can be technically challenging in super-super obese patients. Both Roux-en-Y gastric bypass (RYGB) and one anastomosis (mini) gastric bypass (OAGB/MGB) have been described in these patients, but direct comparisons are lacking. The purpose of this study was to compare the early outcomes with these two procedures in patients with body mass index (BMI) of ≥60 kg/m2 in our unit. METHODS: We identified all super-super obese patients who underwent either OAGB/MGB or RYGB from our prospectively maintained database. Information was also obtained from the case notes and from hospital computerized records. We obtained data regarding patient demographics, operative details, complications, and weight loss, in both groups, and compared them using standard statistical methods. RESULTS: This study compares our results with 19 OAGB/MGB and 47 RYGB super-super obese patients performed in our unit between October 2012 and June 2015. OAGB/MGB group patients had a significantly higher weight and body mass index. There was no mortality or major complication in either group. There were two late complications in the OAGB/MGB group compared to six in the RYGB group. One patient in the OAGB/MGB group needed conversion to RYGB for persistent reflux symptoms. OAGB/MGB patients achieved a significantly higher EWL of 70.4% at 2 years compared to 57.1% in the RYGB group. The difference between TWL of 44.4 and 33.4%, respectively, was also significant at 2 years. TWL of 43.0 and 29.3%, respectively, in OAGB/MGB and RYGB groups at 18 months was also significantly different, but the difference in EWL at 18 months did not reach significance. CONCLUSION: One anastomosis (mini) gastric bypass yields superior weight loss at 18 and 24 months in comparison with Roux-en-Y gastric bypass in patients with BMI of ≥60 kg/m2. Findings need confirmation in larger randomized studies.

Metabolic consequences of the incorporation of a Roux limb in an omega loop (mini) gastric bypass: evaluation by a glucose tolerance test at mid-term follow-up.

BACKGROUND: In the technique used in our department, Roux-en-Y gastric bypass (RYGB) anatomically only differs from the mini- or omega loop gastric bypass (OLGB) by the incorporation of an isolated alimentary limb, called the Roux limb. The metabolic consequences of the incorporation of a Roux limb are unknown. OBJECTIVES: To evaluate differences in glucose and insulin dynamics between RYGB and OLGB in normoglycemic patients, by submitting them to a glucose challenge after stabilization of their weight. METHODS: Nondiabetic patients who had undergone OLGB 4 years earlier were matched with nondiabetic patients who had undergone RYGB around the same time and with healthy controls. Participants underwent oral (OGTT) and intravenous glucose tolerance test (IVGTT). Endpoints of the study were: progression of plasma glucose and insulin, changes in their concentration [calculated by area under the curve (AUC)] at OGTT and IVGTT, incretin effect and incidence of hypoglycemia. RESULTS: Each of the three groups comprised 14 participants. At OGTT, plasma glucose and insulin incremental values were comparable after OLGB and RYGB, and substantially higher than in controls. Overall glucose concentration, however, did not vary across the three groups. Thirty-minute and overall insulin plasma concentration, indicators of early and total insulin secretion, respectively, was significantly higher in both bypass groups than in controls, and was greatest in OLGB. Severe hypoglycemia occurred in one out of two patients in both bypass groups. At IVGTT, no differences were registered across the three groups and no participant experienced hypoglycemia. The incretin effect was higher after OLGB than after RYGB, but the difference was not statistically significant. CONCLUSIONS: The incorporation of a Roux limb in a loop gastric bypass appears to create a statistically nonsignificant tendency toward reducing insulin hypersecretion observed at OGTT after OLGB, and consequently toward tapering the incretin effect.

Malnutrition Following One-Anastomosis Gastric Bypass: a Systematic Review.

Severe malnutrition following one-anastomosis gastric bypass (OAGB) remains a concern. Fifty studies involving 49,991 patients were included in this review. In-hospital treatment for severe malnutrition was needed for 0.9% (n = 446) of patients. Biliopancreatic limb (BPL) length was 150 cm in five (1.1%) patients, > 150 cm in 151 (33.9%), and not reported in 290 (65%) patients. OAGB was revised to normal anatomy in 126 (28.2%), sleeve gastrectomy in 46 (10.3%), Roux-en-Y gastric bypass in 41 (9.2%), and shortening of BPL length in 17 (3.8%) patients. One hundred fifty-one (33.8%) patients responded to treatment; ten (2.2%) did not respond and was not reported in 285 (63.9%) patients. Eight (0.02%) deaths were reported. Standardisation of the OAGB technique along with robust prospective data collection is required to understand this serious problem.

Surgical Management of Gastro-oesophageal Reflux Disease After One Anastomosis Gastric Bypass - a Systematic Review.

Gastro-oesophageal reflux disease (GORD) after one anastomosis gastric bypass (OAGB) remains a concern. We reviewed the current literature on revisional surgery after OAGB for GORD. MEDLINE, EMBASE, and PubMed databases were searched. We identified 21 studies, appraising 13,658 OAGB patients. A total of 230 (1.6%) patients underwent revisional surgery for GORD. Revision to Roux-en-Y configuration was performed in 211 (91.7%) patients. Six (2.6%) patients had a Braun entero-enterostomy added to the OAGB. Thirteen (5.6%) patients underwent excluded stomach fundoplication (ESF). Reflux symptoms resolved in 112 (48.6%) patients, persisted in 13 (5.6%) patients, and were not reported in 105 (45.6%) patients. Revisional surgery after OAGB for GORD appears to be rare, and when required, conversion to Roux-en-Y configuration is the commonest choice.

Revisional bariatric surgery to single-anastomosis gastric bypass: a large multi-institutional series.

BACKGROUND: Reoperation is often required after bariatric procedures. Single-anastomosis gastric bypass (SAGB) is increasingly utilized as a primary bariatric procedure. Few series document SAGB as a revisional bariatric procedure. OBJECTIVES: To describe our short-term experience with revisional SAGB, focusing on weight loss and reflux symptom outcomes. SETTING: Three hospitals in Australia with both private and public (government funded) patients. METHODS: We reviewed all revisional SAGB cases from 2012 to 2019 at. Complications were considered significant if they were Clavien-Dindo grade 3a or higher. A phone survey was conducted to assess weight loss outcomes, patient satisfaction, reflux symptoms, and other complications. RESULTS: We identified 254 patients who had a revisional bariatric procedure to SAGB (21 previous sleeve gastrectomies and 233 previous adjustable bands), with a mean follow-up of 22 ± 15.6 months (range, 1-55 mo). The mean percentage of excess weight loss was 77% (183 patients, 72%), and the number of patients with follow-ups at 1 and 4 years was 184 (73%) and 35 patients (14%). Within 30 days, there were 29 patients (11%) who required reinterventions (21 endoscopies, 1 interventional radiology procedure, and 7 reoperations) with no deaths. Beyond 30 days, 27 patients (11%) required rerevision to Roux-en-Y gastric bypass for reflux symptoms and 10 (4%) required a laparotomy or laparoscopy for another reason (e.g., bowel obstruction). At a median follow-up of 36.6 months, 87 patients (34%) completed a phone survey, 45 (52%) of whom were taking proton pump inhibitors and 66 patients (76%) of whom were satisfied with their experience. CONCLUSION: In our series, revision to SAGB was safe, with low short-term morbidity and favorable weight loss outcomes. However, beyond 1 year, a large proportion of patients experienced severe reflux symptoms and required rerevision.

Effect of One Anastomosis Gastric Bypass on Haematinics, Vitamin D and Parathyroid Hormone Levels: a Comparison Between 150 and 200 cm Bilio-Pancreatic Limbs.

INTRODUCTION: There is little data on the effect of one anastomosis gastric bypass (OAGB) on haematinics, vitamin D and parathyroid hormone levels. It is further unclear if an OAGB with a bilio-pancreatic limb (BPL) of 150 cm (OAGB-150) would deliver better outcomes than that with a BPL of 200 cm (OAGB-200). MATERIALS AND METHODS: We investigated our records to obtain information on patients who underwent an OAGB-200 or OAGB-150 until 31st July 2018 in our unit. RESULTS: A total of 405 patients underwent either an OAGB-200 (n = 234) or OAGB-150 (n = 171). The mean age was 46 ± 10.98 years and 276 (68.1%) were females. The mean preoperative weight and the body mass index (BMI) were 139 ± 29.96 kg and 49 ± 8.14 kg/m2 respectively. With OAGB-200, there was a significant increase in anaemia rates at 1 and 2 years compared to preoperative levels with a significant fall in haemoglobin levels. After OAGB-150, there was a significant fall in haemoglobin levels at 1 and 2 years but the increase in anaemia rate was only significant at 2 years. There was a significant increase in PTH levels and the number of abnormal values at 1 and 2 years with OAGB-200. With OAGB-150, PTH changes were significant at 2 years only. CONCLUSION: We found that both OAGB-200 and OAGB-150 are associated with a significant increase in anaemia and secondary hyperparathyroidism. Our findings should prompt the evaluation of supplementation protocols with higher dosages than we recommend for iron, folate and calcium. Consideration should also be given to evaluating shorter BPL lengths than 150 cm with OAGB.

Chyloperitoneum secondary to internal herniation complicating omega-loop gastric bypass.

Chyloperitoneum is a potential complication of omega-loop gastric bypass caused by internal herniation. Chronic compression of the mesentery leads to chylous extravasation that can mimic peritonitis.

Indications, Operative Techniques, and Outcomes for Revisional Operation Following Mini-Gastric Bypass-One Anastomosis Gastric Bypass: a Systematic Review.

In addition to being a relatively reversible and less complex operation, mini-gastric bypass-one anastomosis gastric bypass (MGB-OAGB) has demonstrated comparable weight loss and metabolic improvement rates with Roux-en-Y gastric bypass (RYGB). However, surgical strategies for managing its failures and late complications were poorly defined. This article aims to review the indications, operative techniques, and outcomes for revisional surgery following MGB-OAGB. A systematic review was performed using the PubMed database from 1997 to 2019. Of 179 included patients, 89 underwent revision to RYGB; 52 to sleeve gastrectomy (SG); 32 reversal to original anatomy; and 6 underwent partial revision with gastro-gastrostomy alone. Most common indications were severe malnutrition, chronic bile reflux, intractable marginal ulcerations, and insufficient weight loss. Postoperative complication rates ranged from 5 to 35%.

One Anastomosis Gastric Bypass Performed with a 150-cm Biliopancreatic Limb Delivers Weight Loss Outcomes Similar to Those with a 200-cm Biliopancreatic Limb at 18 -24 Months.

BACKGROUND: It has been suggested that shortening the biliopancreatic limb (BPL) length with one anastomosis gastric bypass (OAGB) to 150 cm would reduce the revision rates for malnutrition. But, it remains unclear if this would not compromise the efficacy of this procedure. METHODS: We examined our prospectively maintained database to compare the outcomes of patients who had their OAGB performed with a 150-cm BPL with those performed with a 200-cm BPL. RESULTS: Medium-term weight loss data at 18-24 months was available for 343/398 (86.1% follow-up) patients. Of these, 225 had undergone OAGB-200 and 118 had undergone OAGB-150. The mean preoperative weight and body mass index were 141.6 ± 32.8 kg and 49.76 ± 8.6 kg/m2, respectively, in the OAGB-200 group compared with 133.7 ± 24.5 kg and 47.83 ± 7.2 kg/m2, respectively, in the OAGB-150 group. There was no significant difference in albumin and haemoglobin levels in the two groups at 18-month follow-up. The mean excess weight loss was 75.0% ± 20.1 in the OAGB-200 group and 74.0% ± 22.0 in the OAGB-150 group (p = 0.6714). A total of 89.7% (n = 202) patients achieved an excess weight loss (EWL) of ≥ 50.0% in the OAGB-200 group compared with 85.5% (n = 103) in the OAGB-150 group (p value = 0.4754). The mean total weight loss was 36.1% ± 9.2 in the OAGB-200 group compared with 34.0% ± 9.8 in the OAGB-150 group (p value = 0.0598). CONCLUSIONS: OAGB performed with a BPL of 150 cm delivers weight loss outcomes similar to that seen with a BPL of 200 cm.

Initial outcomes of one anastomosis gastric bypass at a single institution.

INTRODUCTION: One anastomosis gastric bypass (OAGB) is an emerging bariatric procedure, which has been reported to be safe and effective. This study aims to evaluate the short-term outcome of OAGB and its midterm effects on weight loss and remission of type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: A retrospective review of patients who had undergone OAGB between January 2013 and January 2017 in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, is presented here. Patients' perioperative characteristics, biochemical profile (fasting blood glucose, HbA1c and iron profile) and details on subsequent weight loss in terms of body mass index (BMI) and excess weight loss percentage (EWL%) along with early and late postoperative complications were evaluated. RESULTS: Out of the 47 patients who underwent OAGB, 42 were included in this study and completed the 2-year follow-up. Average operative time was 107±21.3 minutes and average length of hospital stay was 2.5±0.53 days. Mean preoperative BMI was 47.6±9.1 kg/m2, and at 1 and 2 years of follow-up, it was 30.5±7.4 and 27.1±5.1, respectively. No mortality, anastomotic leak or bleeding were reported. Most common midterm complication was iron deficiency anemia (n=7/42). Remission of T2DM at 6 months was 80%. Patients with preoperative T2DM for less than 10 years showed better remission (P<0.001). CONCLUSION: Our analysis suggests that OAGB is a safe and effective weight loss procedure that carries low perioperative risk and acceptable nutritional complications in the midterm, with a notable remission of T2DM. Preoperative duration of T2DM plays a major role in achieving remission after OAGB.

Perioperative Practices Concerning One Anastomosis (Mini) Gastric Bypass: A Survey of 210 Surgeons.

BACKGROUND: There is currently little evidence available on the perioperative practices concerning one anastomosis/mini gastric bypass (OAGB/MGB) and no published consensus amongst experts. Even the published papers are not clear on these aspects. The purpose of this study was to understand various perioperative practices concerning OAGB/MGB. METHODS: Bariatric surgeons from around the world were invited to participate in a questionnaire-based survey. Only surgeons performing this procedure were included. RESULTS: Two hundred and ten surgeons from 39 countries with a cumulative experience of 68,442 procedures took the survey. Surgeons described a large number of absolute (n = 55) and relative contraindications (n = 59) to this procedure in their practice. Approximately 71.0% (n = 148/208), 70.0% (n = 147/208) and 65.0% (n = 137/209), respectively, routinely perform a preoperative endoscopy, screening for Helicobacter pylori and ultrasound scan of the abdomen. A minority (35.0%, n = 74/208) of the surgeons used a constant bilio-pancreatic limb (BPL) length for all the patients with remaining preferring to tailor the limb length to the patient and approximately half (49.0%, n = 101/206) routinely approximate diaphragmatic crura in patients with hiatus hernia. Some 48.5% (n = 101/208) and 40.0% (n = 53/205) surgeons, respectively, do not recommend routine iron and calcium supplementation. CONCLUSION: This survey is the first attempt to understand a range of perioperative practices with OAGB/MGB. The findings will help in identifying areas for future research and allow consensus building amongst experts with preparation of guidelines for future practice.

One Anastomosis (Mini) Gastric Bypass Is Now an Established Bariatric Procedure: a Systematic Review of 12,807 Patients.

The One Anastomosis (Mini) Gastric Bypass is rapidly gaining acceptance. This review reports cumulative results of 12,807 procedures in obese patients with a mean age of 41.18 years and BMI of 46.6 kg/m2. The overall mortality was 0.10% and the leak rate was 0.96%. The follow-up duration ranged from 6 months to 12 years. A marginal ulceration rate of 2.7% and an anaemia rate of 7.0% were reported. Approximately 2.0% of patients reported postoperative gastro-oesophageal reflux and 0.71% developed malnutrition. Excess weight loss at 6, 12, 24 and 60 months was 60.68, 72.56, 78.2 and 76.6% respectively. Type 2 diabetes mellitus and hypertension resolved in 83.7 and 66.94% respectively. We conclude that there is now sufficient evidence to include MGB-OAGB as a mainstream bariatric procedure.

Omega-loop gastric bypass is more effective for weight loss but negatively impacts liver enzymes: a registry-based comprehensive first-year analysis.

BACKGROUND: The impact of omega-loop gastric bypass (OLGB) on weight loss and liver enzymes remains inconclusive. OBJECTIVE: The aim of this study was to compare the impact of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and OLGB on weight loss and liver enzyme levels. SETTING: National Bariatric Surgery Registry. METHODS: The study included 10,675 cases of SG, 1590 cases of RYGB, and 469 cases of OLGB that had available baseline and 1-year (12 ± 2 mo) follow-up data. RESULTS: The highest percentage of excess weight loss was achieved by the OLGB group (84.5% ± 26.7%), followed by the SG (78.5% ± 26.0%) and RYGB (72.0% ± 26.5%) groups (P<.05). The data show that 10% of OLGB cases, 5.2% of RYGB cases, and 1.9% of SG cases (P<.001) had increases in alanine aminotransferase levels, from a normal baseline mean of 23.9 ± 7.5 U/L to an abnormal mean of 64.8.7 ± 66.0 U/L, at follow-up. Similar trends were observed for aspartate aminotransferase and alkaline phosphatase. A regression analysis showed that OLGB was a predictive risk factor for normal baseline alanine aminotransferase levels becoming abnormal postoperatively compared with SG (odds ratio [OR] = 5.65) or RYGB (OR = 2.08) (P<.001). Similarly, OLGB was a predictive risk factor for baseline aspartate aminotransferase and alkaline phosphatase levels becoming abnormal postoperatively. Female sex was the only other meaningful predictive risk of alanine aminotransferase (OR = 2.45) and aspartate aminotransferase (OR = 1.82) becoming abnormal postoperatively. CONCLUSION: This study confirmed the strengths of OLGB weight loss outcomes but also demonstrated its negative impact on liver enzymes. Thus, patients and caregivers should be informed of the risks, and close follow-up is warranted.

The First Consensus Statement on One Anastomosis/Mini Gastric Bypass (OAGB/MGB) Using a Modified Delphi Approach.

BACKGROUND: An increasing number of surgeons worldwide are now performing one anastomosis/mini gastric bypass (OAGB/MGB). Lack of a published consensus amongst experts may be hindering progress and affecting outcomes. This paper reports results from the first modified Delphi consensus building exercise on this procedure. METHODS: A committee of 16 recognised opinion-makers in bariatric surgery with special interest in OAGB/MGB was constituted. The committee invited 101 OAGB/MGB experts from 39 countries to vote on 55 statements in areas of controversy or variation associated with this procedure. An agreement amongst ≥ 70.0% of the experts was considered to indicate a consensus. RESULTS: A consensus was achieved for 48 of the 55 proposed statements after two rounds of voting. There was no consensus for seven statements. Remarkably, 100.0% of the experts felt that OAGB/MGB was an "acceptable mainstream surgical option" and 96.0% felt that it could no longer be regarded as a new or experimental procedure. Approximately 96.0 and 91.0% of the experts felt that OAGB/MGB did not increase the risk of gastric and oesophageal cancers, respectively. Approximately 94.0% of the experts felt that the construction of the gastric pouch should start in the horizontal portion of the lesser curvature. There was a consensus of 82, 84, and 85% for routinely supplementing iron, vitamin B12, and vitamin D, respectively. CONCLUSION: OAGB/MGB experts achieved consensus on a number of aspects concerning this procedure but several areas of disagreements persist emphasising the need for more studies in the future.

Outcomes of Omega Loop Gastric Bypass, 6-Years Experience of 1520 Cases.

BACKGROUND: Omega loop gastric bypass (OLGB) has been viewed with skepticism after the failure of the "old Mason loop." During the past 15 years, a growing number of authors worldwide approved that OLGB is a safe and effective procedure, which appears clearly from the operative outcome and long-term follow-up of consecutive cohort studies of patients who underwent OLGB. The aim of this study is to evaluate the outcomes of OLGB at the bariatric center of our university hospital between 2009 and 2015. METHODS: The data of 1520 patients who underwent OLGB from November 2009 to December 2015 at our center were reviewed. Mean age was 37.15 years, mean preoperative BMI was 46.8 ± 6.6 kg/m2, mean preoperative weight was 127.4 ± 25.3 kg, and 62.7% were women. Diabetes mellitus (DM) affected 683 (44.9%) of the 1520 patients, whereas 773 of the 1520 patients (50.9%) presented with hypertension. The mean operative time was 35 min. RESULTS: The 1-year postoperative BMI mean decreased to 29.6 ± 3.1 kg/m2, and at the 3-year follow-up, it was 27.5 ± 3.4 kg/m2. The mean of weight decreased to 81.3 ± 16.7 kg and to 78.9 ± 16.9 kg at the 1-year and the 3-year follow-up, respectively. Mortality rate was 0.1%. Overall complications were 9.3%; 0.8% required reoperations. Early complications were encountered in 50 patients (3.3%), and the late complications rate was (6.1%). CONCLUSIONS: In this study, greater excess weight loss was observed with OLGB which appeared to be a short, simple, low-risk, effective, and durable bariatric procedure.

Vitamin D3 Loading Is Superior to Conventional Supplementation After Weight Loss Surgery in Vitamin D-Deficient Morbidly Obese Patients: a Double-Blind Randomized Placebo-Controlled Trial.

BACKGROUND: Bariatric patients often suffer from vitamin D deficiency (VDD), and both, morbid obesity and VDD, are related to non-alcoholic fatty liver disease. However, limited data are available regarding best strategies for treating VDD, particularly, in bariatric patients undergoing omega-loop gastric bypass (OLGB). Therefore, we examined the efficacy and safety of a forced vitamin D dosing regimen and intervention effects in liver fibrotic patients. METHODS: In this double-blind, randomized, placebo-controlled trial, 50 vitamin D-deficient patients undergoing OLGB were randomly assigned to receive, in the first month postoperatively, oral vitamin D3 (≤3 doses of 100,000 IU; intervention group) or placebo as loading dose (control group) with subsequent maintenance dose (3420 IU/day) in both groups until 6-month visit. RESULTS: Compared with control group, higher increase of 25(OH)D (67.9 (21.1) vs. 55.7 nmol/L (21.1); p = 0.049) with lower prevalence of secondary hyperparathyroidism (10 vs. 24 %; p = 0.045) was observed in intervention group. No (serious) adverse events related to study medication were found. The loading dose regimen was more effective in increasing 25(OH)D in patients with significant liver fibrosis while this was not the case for conventional supplementation (placebo with maintenance dose) (71.5 (20.5) vs. 22.5 nmol/L (13.8); p = 0.022; n = 14). CONCLUSIONS: Our findings indicate that a high vitamin D3 loading dose, in the first month postoperatively, with subsequent maintenance dose is effective and safe in achieving higher vitamin D concentrations in OLGB patients. Unexpectedly, it is more effective in patients with significant liver fibrosis which is of potentially high clinical relevance and requires further investigation.

Laparoscopic Conversion of Omega Loop Gastric Bypass into Roux-en-Y Gastric Bypass.

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Laparoscopic Conversion of One Anastomosis Gastric Bypass to a Standard Roux-en-Y Gastric Bypass.

INTRODUCTION: One anastomosis gastric bypass (OAGB) demonstrated results similar to traditional Roux-en-Y procedures [1-3], in terms of weight loss and resolution of obesity-related comorbidities. The main controversy regarding OAGB is the concern for an association between biliary alkaline gastritis and esophageal or gastric cancer raised by some studies [4]. METHODS: We present the case of a 51-year-old woman with a BMI of 41 kg/m2 who underwent a laparoscopic OAGB in 2014. One year later, she consulted for recurrent heartburns. An upper GI endoscopy showed pouchitis and bile reflux in the esophagus. Medical treatment of gastroesophageal reflux disease was ineffective. We decided to convert the OAGB to a Roux-en-Y gastric bypass (RYGB). RESULTS: In this video, we show how to revise an OAGB to treat chronic bile reflux, by converting the procedure to a standard RYGB. The intervention starts by restoring the normal anatomy of the small bowel, with the resection of the gastrojejunal anastomosis, which was located at 250-cm du Treitz's ligament. Then, the gastric pouch is created. A standard Roux-en-Y gastric bypass is performed. CONCLUSIONS: The resection of the gastrojejunal anastomosis allows fashioning the Roux-en-Y limb with the classical measures. This technique allows a conversion to a standard RYGB and is effective in treating the biliary reflux.