Roux-en-Y to One Anastomosis Gastric Bypass Conversion: Description of a Novel Technique.

Introduction: Roux-en-Y gastric bypass (RYGB) remains among the most widely performed bariatric procedures. A significant decline in its indication has been observed due to weight regain and reappearance of comorbidities. Moreover, the lack of effective therapeutic alternatives after failure justifies why other techniques are more frequently chosen. We present a novel technique to convert a failed RYGB into a one anastomosis gastric bypass (OAGB). Case Presentation: A 43-year-old male patient with a body mass index (BMI) of 47 kg/m2 and several comorbidities was submitted to RYGB. Initially his surgery was successful, but after 7 years he visited the bariatric and metabolic surgery clinic with reappearance of all comorbidities, and the same BMI as before having bariatric surgery. After proper evaluation and preparation, conversion to OAGB was decided. After anatomy identification, the alimentary limb was transected 20 cm distal to the gastrojejunal anastomosis, and a new anastomosis with the common channel (CC) was created, to form a new long afferent biliopancreatic limb and a new short efferent CC. Results: The surgical procedure and postoperative course were uneventful. One year after the procedure the patient's BMI was 36 kg/m2. He has been able to stop all medications and therapies related to previous comorbidities. To date, the patient has good dietary and supplementation adherence resulting in no nutritional deficiencies, or gastrointestinal symptoms. Conclusion: This new surgical technique is safe and feasible. Short-term results have shown reasonable weight loss (WL), and especially remission of comorbidities with an improved quality of life.

Assessment of body composition in obese patients undergoing one anastomosis gastric bypass: cross-sectional study.

Bariatric surgery is the most effective long-term treatment to obesity, and it is necessary to assess changes in body composition and to be able to establish better follow-up of patients. Cross-sectional, observational study in patients undergoing One Anastomosis Gastric Bypass (OAGB) bariatric surgery. We analysed changes in weight and body composition during the first postoperative year. 405 patients (68.9% women. 31.1% men), mean age 44 years, mean weight 110.02 kg, Body Mass Index (BMI) 39.76 kg/m2, height 1.66 m. The variables analyzed were substantially decreased compared to the preoperative values one year after surgery in every case: weight (110.02 ± 22.03 kg vs. 69.36 ± 13.60 kg), BMI (39.76 ± 6.65 vs. 24.52 ± 3. 76), fat free mass (61.12 ± 12.43 kg vs. 53.61 ± 11.61 kg), fat mass (50.44 ± 14.36 kg vs. 15.74 ± 6.74 kg), bone mass (58.06 ± 11.85 kg vs. 50.92 ± 11.06 kg) and water (45.08 ± 9.99 kg vs. 37.39 ± 9.23 kg), P < 0.001. The results show noticeable improvements in weight reduction and changes in body composition, and will contribute to develop a thorough understanding of both of them, contributing also to perform a better patients' follow-up.

Long-Term Weight Loss Results, Remission of Comorbidities and Nutritional Deficiencies of Sleeve Gastrectomy (SG), Roux-En-Y Gastric Bypass (RYGB) and One-Anastomosis Gastric Bypass (OAGB) on Type 2 Diabetic (T2D) Patients.

This study aimed to compare the long-term weight loss results, remission of comorbidities and nutritional deficiencies of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) and One-Anastomosis gastric bypass (OAGB) on type 2 diabetic (T2D) patients. PATIENTS AND METHODS: A retrospective analysis of all the morbidly obese and diabetic patients undergoing SG, RYGB, and OAGB as primary bariatric procedures between February 2010 and June 2015 was performed. Anthropometric parameters, remission of comorbidities, nutritional deficiencies and supplementation requirements at 1, 2 and 5 years' follow-up were monitored. Patients lost to follow-up 5 years after surgery were excluded from the analysis. RESULTS: 358 patients were included. The follow-up rate was 84.8%. Finally, 83 SG, 152 RYGB, and 123 OAGB patients were included in the analysis. OAGB obtained significantly greater weight loss and remission of dyslipidemia than the other techniques. There was a trend towards greater T2D and hypertension remission rate after OAGB, while fasting glucose and glycated hemoglobin levels were significantly lower after OAGB. There were no significant differences in hemoglobin or protein levels between groups. SG obtained lower iron deficiencies than the other techniques, while there were no significant differences in other nutritional deficiencies between groups. CONCLUSION: OAGB obtained greater weight loss and remission of dyslipidemia than RYGB or SG. Excluding lower iron deficiency rates after SG, there were no significant differences in the development of nutritional deficiencies between groups.

Implications of Professional Occupation Related to Obesity in Patients Undergoing Bariatric Surgery.

Obesity is an epidemic with severe consequences on the professional development of patients. Bariatric surgery has proven to be a safe treatment with effective results in weight control. The aim of this study is to assess the implications of professional occupation in relation to the development of obesity and weight changes after bariatric surgery. We analyzed 500 obese patients (77.8% women, 22.2% men) who underwent one anastomosis gastric bypass surgery at the Centre of Excellence for the Study and Treatment of Obesity and Diabetes (2014-2019), assessing the influence of professional occupation on body composition and evolution of weight loss up to two years after surgery. Preoperative obesity type III and IV was higher in men than in women (45.9-19.8% vs. 43.7-9.5%; respectively). Prevalent clinical history in women was depression (46.7%), varicose veins (35.6%), and thyroid disease (9.7%), while in men it was respiratory failure (98.2%), high blood pressure (56.8%), hepatic steatosis (82%). Postoperative weight loss was effective in every professional field, reaching normal weight values from 12 months after surgery.

Changes in Lipid Profile, Body Weight Variables and Cardiovascular Risk in Obese Patients Undergoing One-Anastomosis Gastric Bypass.

Morbid obesity has a direct impact on the development of cardiovascular disease. One-anastomosis gastric bypass (OAGB) is an effective surgical technique for the control of body weight and the reduction of cardiovascular risk. This work examines the change in weight loss, lipid profile and cardiovascular risk in 100 patients (71 women, 29 men), mean age 42.61 ± 11.33 years at 3, 6, 9, 12, 18 and 24 months after OAGB. At 24 months post-surgery, mean body weight was significantly reduced compared to pre-operative values (116.75 ± 22.19 kg vs. 69.66 ± 13.07 kg), as were mean total cholesterol (201.86 ± 44.60 mg/dL vs. 172.99 ± 32.26 mg/dL), LDL (Low-Density Lipoprotein) cholesterol (126.90 ± 39.81 mg/dL vs. 96.28 ± 26.99 mg/dL), triglycerides (138.05 ± 78.45 mg/dL vs. 76.04 ± 30.34 mg/dL) and cardiovascular risk (total cholesterol/HDL (High-Density Lipoprotein) cholesterol: 4.32 ± 1.24 vs. 2.93 ± 0.71), while the mean HDL cholesterol concentration was significantly higher (49.09 ± 14.16 mg/dL vs. 61.98 ± 14.86 mg/dL) (all p < 0.001). In conclusion, OAGB surgery led to significant reductions in body weight, a significant improvement in the lipid profile, and a reduction in cardiovascular risk.

Enfermedad por reflujo gastroesofágico en un paciente con un IMC 30kg/m2 y gastroplastia vertical endoscópica previa: indicación para un bypass gástrico de una anastomosis / Gastroesophageal reflux disease in a patient with BMI 30kg/m2 and previous endoscopic vertical gastroplasty: Indication for a one anastomosis gastric bypass

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Long-term follow-up after sleeve gastrectomy versus Roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a prospective randomized comparative study of weight loss and remission of comorbidities.

BACKGROUND: One-Anastomosis Gastric Bypass (OAGB) has exponentially increased in the last decade, as it is associated with very low complications, mortality, readmissions and reoperations rates, and shows excellent short- and long-term benefits of weight loss and resolution of comorbidities. The aim of this study was to compare the effect of SG, RYGB, and OAGB, on short- and long-term weight loss and comorbidities resolution. METHODS: A prospective randomized clinical study of all morbidly obese patients undergoing SG, RYGB, and OAGB, as primary bariatric procedures, was performed. Patients were randomly assigned into 3 groups: those patients undergoing SG, those ones undergoing RYGB and those ones undergoing OAGB. BMI, excess BMI loss (EBMIL) and remission of type 2 diabetes (T2DM), hypertension (HT), and dyslipidemia (DL) were assessed. RESULTS: 600 patients were included in the study, 200 in each group. Follow-up rate at 5 years postoperatively was 91% in SG group, 92% in RYGB, and 90% in OAGB. OAGB achieves significantly greater EBMIL than RYGB and SG at 1, 2, and 5 years (p < 0.001, respectively). At 5 years, OAGB achieves significantly greater remission of T2DM (p = 0.027), HT (p = 0.006), and DL (p < 0.001) than RYGB and SG. RYGB did not show significant superiority than SG in short- and long-term remission of T2DM and HT, but achieves greater remission of DL (p < 0.001). CONCLUSION: OAGB achieves superior mid- and long-term weight loss than RYGB and SG. There are no significant differences in weight loss between SG and RYGB at 1, 2, and 5 years. OAGB achieves better short- and long-term resolution rates of DM, HT, and DL than SG and RYGB. RYGB and SG obtain similar T2DM and HT remissions, but RYGB reaches significantly greater rates of DL remission. ClinicalTrials.gov Identifier: NCT03467646.

12-year old adolescent with super morbid obesity, treated with laparoscopic one anastomosis gastric bypass (LOAGB/BAGUA): A case report after 5-year follow-up / Adolescente de 12 años portador de obesidad super-mórbida, tratado mediante bypass gástrico de una anastomosis (bagua) y monotorizado durante cinco años: caso clínico

The prevalence of morbid obesity among adolescents has being on the increased in the recent decades specifically in developed countries around the world. In Europe, Spain has the highest prevalence of obese adolescents with more than 18% of the population of children and adolescents. There is evidence that the only effective and permanent treatment for morbid obesity and the comorbidities is surgical treatment, however there exists many controversies about which treatment is the best for obese adolescents. We report a case of a 12 year old patient with super obesity (58.5 kg/m2 of BMI) and metabolic syndrome who underwent LOAGB/BAGUA and monitored during the last 5 year. The patient after five years follow-up maintains a 22.4 kg/m2 of BMI. We consider that LOAGB/BAGUA could be an effective and safe procedure as a treatment of obesity and comorbidities as well, for adolescent patients (AU)

La prevalencia de la obesidad mórbida en adolescentes se ha incrementado en las últimas décadas alrededor del mundo y países desarrollados. En Europa, España ocupa el primer lugar de obesidad en adolescentes, con más de un 18% de la población infantil y juvenil. Existe evidencia de que el único tratamiento efectivo y permanente para la resolución de la obesidad y sus comorbilidades es el tratamiento quirúrgico, aunque existen controversias sobre cuál sería el procedimiento óptimo para los adolescentes. Reportamos el caso de un paciente de 12 años de edad con superobesidad y síndrome metabólico (IMC de 58.5 kg/m2 ) que se sometió a bypass gástrico tipo BAGUA y que se ha sido monitorizando durante los últimos 5 años, presentando un IMC actual de 22.4 kg/m2 . Consideramos que el método BAGUA se puede ofrecer como un procedimiento seguro y efectivo para la resolución de la obesidad y sus comorbilidades, incluso en la adolescencia (AU)