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Meta-analysis finds revisional OAGB/MGB is feasible and effective

Mon, 11/02/2020 - 12:09
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Revisional One Anastomosis/Mini-Gastric Bypass (OAGB/MGB) procedures after failed restrictive bariatric surgery (eg gastric lap band) is feasible and effective, according to a meta-analysis from 26 studies including 1,771 patients. The findings were reported in the paper, ‘One Anastomosis/Mini-Gastric Bypass (OAGB/MGB) as Revisional Surgery Following Primary Restrictive Bariatric Procedures: a Systematic Review and Meta-Analysis’, published in Obesity Surgery.

The international team of authors from Iran, Italy and Spain, noted that the current revisional bariatric surgery rates range from 9.8% for laparoscopic sleeve gastrectomy (LSG) to 26% for laparoscopic adjustable gastric banding (LAGB). Although the popularity of OAGB/MGB is growing, there are few studies that have examined the validity of the procedure as revisional procedure. Therefore, the authors conducted a literature review study looking at the outcomes of OAGB/MGB following failed LAGB, LSG and vertical banded gastroplasty (VBG).

Unsurprisingly, the authors reported that weight regain and weight loss failure were the most frequent causes of revisional OAGB/MGB, additional causes included abdominal pain/dyspepsia, port infection, device-related complications or intolerance to restriction (eg band migration, slippage and port infection), recurrence of T2DM, GERD, dysphagia and oesophageal disorders. The most common biliopancreatic limb (BPL) length in OAGB/MGB was 200cm (36% of the studies), with BPL lengths varying from 150 to 350cm.

Overall, they found the mean initial BMI was 45.70 kg/m2, reduced to 31.5, 31.4 and 30.5 kg/m2 at one-, three- and five-year follow-ups after revisional surgery. Revisional OAGB/MGB resulted in greater BMI loss after LAGB compared to LSG or VBG and the authors suggest this is due to lesser weight loss after LAGB vs. LSG or VBG.

In addition, remission of T2DM after revisional surgery at the follow-up intervals was 65.2±24.4, 65.4±36.1 and 78.1±14.2, respectively. Remission of hypertension was 68.4 ± 27.1, 49.9 ± 25, and 74.7 ± 16.2%, respectively. For remission of dyslipidaemia, revisional surgery was also found to successful and the rates were recorded at 61.5±0, 45.8±49.2 and 85.50±14.8, respectively. Obstructive sleep apnoea was 80.00±0, 60.00±14.1 and 86.00±5.7, respectively. For GERD, 81.7% of the patients with GERD improved or had remission following OAGB/MGB, although 7.4% of the patients developed de novo GERD following OABG.

The most common problem after revisional OAGB/MGB was leakage (n=29/1,771, 1.6%) and bleeding (n=23/1,771, 1.2%). Other complications included hematoma and abscess, reoperation (n=2/1,771, 0.1%) strangulated hernia at the trocar port, late incisional hernia, colonic necrosis, bowel obstruction, respiratory failure, anastomotic stricture, hypoalbuminemia, intractable bile reflux, small bowel ileus, pneumonia, GJ stoma fistula, hematemesis, port site infection and ulceration.

Regarding BPL length, they noted that this is still very much under debate, but they surmised that it is better to measure the entire small intestine and use a maximum one-third of it for gastrojejunostomy to prevent malnutrition, although they acknowledge that further studies are needed to identify the optimal length for primary and revisional OAGB/MGB.

“Regardless of the BPL length, conversion to OAGB/MGB induces further weight loss after LSG, VGB, and especially LAGB,” the authors concluded. “The rate of remission of classic obesity-related diseases after this procedure is satisfactory, and its postoperative complications are comparable to those of primary OAGB/MGB.”

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