Skip to main content
SpringerLink
Log in

Effect of anti-reflux suture on gastroesophageal reflux symptoms after one anastomosis gastric bypass: a randomized controlled trial

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Purpose

Gastroesophageal reflux disease (GERD) is an issue after one anastomosis gastric bypass (OAGB) and modification of OAGB with adding an anti-reflux system may decrease the incidence of postoperative GERD. This study aimed to compare the efficacy of the anti-reflux mechanism to treat preoperative GERD and prevent de novo GERD.

Methods

A prospective randomized clinical trial study was conducted on patients with a body mass index of 40 and more from August 2020 to February 2022. Patients undergoing one anastomosis gastric bypass with and without anti-reflux sutures (groups A and B, respectively). These patients had follow-ups for one year after the surgery. GERD symptoms were assessed in all the patients using the GERD symptom questionnaire.

Results

The mean age was 39.5 ± 9.8 years and 40.7 ± 10.2 years in groups A and B respectively. GERD symptoms remission occurred in 76.5% and 68.4% of patients in groups A and B, respectively. The incidence of de novo GERD symptoms was lower in group A, compared to group B (6.2% and 16.1% in groups A and B respectively), without any statistically significant difference (p-value: 0.239).

Conclusion

GERD symptoms and de novo GERD after OAGB seems to be under-reported after OAGB. This study suggests that applying an anti-reflux suture can decrease de novo GERD symptoms.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

References

  1. Nam SY, Choi IJ, Ryu KH, Park BJ, Kim HB, Nam BH (2010) Abdominal visceral adipose tissue volume is associated with increased risk of erosive esophagitis in men and women. Gastroenterology 139(6):1902–11.e2

    Article  PubMed  Google Scholar 

  2. Kindel TL, Oleynikov D (2016) The improvement of gastroesophageal reflux disease and barrett’s after bariatric surgery. Obes Surg 26(4):718–720

    Article  PubMed  Google Scholar 

  3. Chiappetta S, Lainas P, Kassir R, Valizadeh R, Bosco A, Kermansaravi M (2022) Gastroesophageal reflux disease as an indication of revisional bariatric surgery-indication and results-a systematic review and metanalysis. Obes Surg 32(9):3156–3171

    Article  PubMed  Google Scholar 

  4. De Luca M, Piatto G, Merola G, Himpens J, Chevallier JM, Carbajo MA et al (2021) IFSO update position statement on one anastomosis gastric bypass (OAGB). Obes Surg 31(7):3251–3278

    Article  PubMed  Google Scholar 

  5. Rutledge R (2001) The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg 11(3):276–280

    Article  CAS  PubMed  Google Scholar 

  6. Mahawar KK, Jennings N, Brown J, Gupta A, Balupuri S, Small PK (2013) “Mini” gastric bypass: systematic review of a controversial procedure. Obes Surg 23(11):1890–1898

    Article  PubMed  Google Scholar 

  7. Carbajo M, García-Caballero M, Toledano M, Osorio D, García-Lanza C, Carmona JA (2005) One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg 15(3):398–404

    Article  PubMed  Google Scholar 

  8. Carbajo MA, Luque-de-León E, Jiménez JM, Ortiz-de-Solórzano J, Pérez-Miranda M, Castro-Alija MJ (2017) Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 patients. Obes Surg 27(5):1153–1167

    Article  PubMed  Google Scholar 

  9. Seetharamaiah S, Tantia O, Goyal G, Chaudhuri T, Khanna S, Singh JP et al (2017) LSG vs OAGB-1 year follow-up data-a randomized control trial. Obes Surg 27(4):948–954

    Article  PubMed  Google Scholar 

  10. Singh B, Saikaustubh Y, Singla V, Kumar A, Ahuja V, Gupta Y et al (2023) One anastomosis gastric bypass (OAGB) vs roux en y gastric bypass (RYGB) for remission of T2DM in patients with morbid obesity: a randomized controlled trial. Obes surg 33(4):1218–1227

    Article  PubMed  Google Scholar 

  11. Kermansaravi M, Shahmiri SS, Davarpanah Jazi AH, Valizadeh R, Weiner RA, Chiappetta S (2021) Reversal to normal anatomy after one-anastomosis/mini gastric bypass, indications and results: a systematic review and meta-analysis. Surg.Obes Relat Dis 17(8):1489–1496

    Article  PubMed  Google Scholar 

  12. Mahawar KK, Himpens J, Shikora SA, Chevallier JM, Lakdawala M, De Luca M et al (2018) The first consensus statement on one anastomosis/mini gastric bypass (OAGB/MGB) using a modified delphi approach. Obes Surg 28(2):303–312

    Article  PubMed  Google Scholar 

  13. Gyawali CP, Kahrilas PJ, Savarino E, Zerbib F, Mion F, Smout A et al (2018) Modern diagnosis of GERD: the lyon consensus. Gut 67(7):1351–1362

    Article  PubMed  Google Scholar 

  14. Schulz KF, Altman DG, Moher D (2011) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg 9(8):672–677

    Article  PubMed  Google Scholar 

  15. Kermansaravi M, Mahawar KK, Davarpanah Jazi AH, Eghbali F, Kabir A, Pazouki A (2020) Revisional surgery after one anastomosis/mini gastric bypass: a narrative review. J Res Med Sci 25:62

    Article  PubMed  PubMed Central  Google Scholar 

  16. Franzén T, Tibbling L (2014) Is the severity of gastroesophageal reflux dependent on hiatus hernia size? World J Gastroenterol 20(6):1582–1584

    Article  PubMed  PubMed Central  Google Scholar 

  17. Jones R, Junghard O, Dent J, Vakil N, Halling K, Wernersson B et al (2009) Development of the gerdq, a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care. Aliment Pharmacol Ther 30(10):1030–1038

    Article  CAS  PubMed  Google Scholar 

  18. Kermansaravi M, Kabir A, Mousavimaleki A, Pazouki A (2020) Association between hiatal hernia and gastroesophageal reflux symptoms after one-anastomosis/mini gastric bypass. Surg Obes Relat Dis 16(7):863–867

    Article  PubMed  Google Scholar 

  19. Kermansaravi M, Shahmiri SS, Khalaj A, Jalali SM, Amini M, Alamdari NM et al (2022) The first web-based iranian national obesity and metabolic surgery database (INOSD). Obes Surg 32(6):2083–2086

    Article  PubMed  Google Scholar 

  20. Suzuki H, Matsuzaki J, Okada S, Hirata K, Fukuhara S, Hibi T (2013) Validation of the gerdq questionnaire for the management of gastro-oesophageal reflux disease in Japan. United Euro Gastroenterol J 1(3):175–183

    Article  Google Scholar 

  21. Chiappetta S, Stier C, Ghanem OM, Dayyeh BKA, Boškoski I, Prager G et al (2023) Perioperative interventions to prevent gastroesophageal reflux disease and marginal ulcers after bariatric surgery - an international experts’ survey. Obes Surg 33(5):1449–1462

    Article  PubMed  Google Scholar 

  22. Greenberg JA, Palacardo F, Edelmuth RCL, Egan CE, Lee YJ, Schnoll-Sussman FH et al (2023) Comparative outcomes of anti-reflux surgery in obese patients with gastroesophageal reflux disease(1). J Gastrointest Surg 27(3):502–510

    Article  PubMed  Google Scholar 

  23. Chahal-Kummen M, Våge V, Kristinsson JA, Mala T (2023) Chronic abdominal pain and quality of life after roux-en-y gastric bypass and sleeve gastrectomy - a cross-cohort analysis of two prospective longitudinal observational studies. Surg Obes Relat Dis 19(8):819–829

    Article  PubMed  Google Scholar 

  24. Peterli R, Wölnerhanssen BK, Peters T, Vetter D, Kröll D, Borbély Y et al (2018) Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA 319(3):255–265

    Article  PubMed  PubMed Central  Google Scholar 

  25. DuPree CE, Blair K, Steele SR, Martin MJ (2014) Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease : a national analysis. JAMA Surg 149(4):328–334

    Article  PubMed  Google Scholar 

  26. Patel P, Hobbs P, Rogers BD, Bennett M, Eckhouse SR, Eagon JC et al (2022) Reflux symptoms increase following sleeve gastrectomy despite triage of symptomatic patients to roux-en-y gastric bypass. J clin gastroenterol 58(1):24–30

    Article  Google Scholar 

  27. Kermansaravi M, Parmar C, Chiappetta S, Shahabi S, Abbass A, Abbas SI et al (2022) Patient selection in one anastomosis/mini gastric bypass-an expert modified delphi consensus. Obes Surg 32(8):2512–2524

    Article  PubMed  Google Scholar 

  28. Slagter N, Hopman J, Altenburg AG, de Heide LJM, Jutte EH, Kaijser MA et al (2021) Applying an anti-reflux suture in the one anastomosis gastric bypass to prevent biliary reflux: a long-term observational study. Obes Surg 31(5):2144–2152

    Article  PubMed  Google Scholar 

  29. De Luca M, Tie T, Ooi G, Higa K, Himpens J, Carbajo MA et al (2018) Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSO position statement. Obes Surg 28(5):1188–1206

    Article  PubMed  Google Scholar 

  30. Bruzzi M, Chevallier JM, Czernichow S (2017) One-anastomosis gastric bypass: why biliary reflux remains controversial? Obes Surg 27(2):545–547

    Article  PubMed  Google Scholar 

  31. Saarinen T, Pietiläinen KH, Loimaala A, Ihalainen T, Sammalkorpi H, Penttilä A et al (2020) Bile reflux is a common finding in the gastric pouch after one anastomosis gastric bypass. Obes Surg 30(3):875–881

    Article  PubMed  Google Scholar 

  32. Apers J, Wijkmans R, Totte E, Emous M (2018) Implementation of mini gastric bypass in the netherlands: early and midterm results from a high-volume unit. Surg Endosc 32(9):3949–3955

    Article  CAS  PubMed  Google Scholar 

  33. Carandina S, Soprani A, Zulian V, Cady J (2021) Long-term results of one anastomosis gastric bypass: a single center experience with a minimum follow-up of 10 years. Obes Surg 31(8):3468–3475

    Article  PubMed  Google Scholar 

  34. Musella M, Susa A, Greco F, De Luca M, Manno E, Di Stefano C et al (2014) The laparoscopic mini-gastric bypass: the italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc 28(1):156–163

    Article  CAS  PubMed  Google Scholar 

  35. Nehmeh WA, Baratte C, Rives-Lange C, Martineau C, Boullenois H, Krivan S et al (2021) Acid reflux is common in patients with gastroesophageal reflux disease after one-anastomosis gastric bypass. Obes Surg 31(11):4717–4723

    Article  PubMed  Google Scholar 

  36. Felsenreich DM, Zach ML, Vock N, Jedamzik J, Eichelter J, Mairinger M et al (2023) Esophageal function and non-acid reflux evaluated by impedance-24 h-pH-metry, high-resolution manometry, and gastroscopy after one-anastomosis gastric bypass-outcomes of a prospective mid-term study. Surg endosc 37(5):3832–3841

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Musella M, Vitiello A, Berardi G, Velotti N, Pesce M, Sarnelli G (2021) Evaluation of reflux following sleeve gastrectomy and one anastomosis gastric bypass: 1-year results from a randomized open-label controlled trial. Surg Endosc 35(12):6777–6785

    Article  PubMed  Google Scholar 

  38. Doulami G, Triantafyllou S, Albanopoulos K, Natoudi M, Zografos G, Theodorou D (2018) Acid and nonacid gastroesophageal reflux after single anastomosis gastric bypass an objective assessment using 24-hour multichannel intraluminal impedance-pH metry. Surg Obes Relat Dis 14(4):484–488

    Article  PubMed  Google Scholar 

  39. Eskandaros MS, Abbass A, Zaid MH, Darwish AA (2021) Laparoscopic one anastomosis gastric bypass versus laparoscopic roux-en-y gastric bypass effects on pre-existing mild-to-moderate gastroesophageal reflux disease in patients with obesity: a randomized controlled study. Obes Surg 31(11):4673–4681

    Article  PubMed  Google Scholar 

  40. Borbély Y, Kröll D, Nett PC, Moreno P, Tutuian R, Lenglinger J (2018) Radiologic, endoscopic, and functional patterns in patients with symptomatic gastroesophageal reflux disease after roux-en-y gastric bypass. Surg obes relat dis 14(6):764–768

    Article  PubMed  Google Scholar 

  41. Kermansaravi M, DavarpanahJazi AH, ShahabiShahmiri S, Carbajo M, Vitiello A, Parmar CD et al (2021) Areas of non-consensus around one anastomosis/mini gastric bypass (OAGB/MGB): a narrative review. Obes Surg 31(6):2453–2463

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Minimally Invasive Surgery Research Center, School of Medicine, Hazrat-E Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran

    Mohammad Kermansaravi, Reza Ebrahimi, Ali Mousavimaleki, Barmak Gholizadeh & Shahab ShahabiShahmiri

  2. Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran

    Mohammad Kermansaravi & Shahab ShahabiShahmiri

  3. Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran

    Masoumeh Shahsavan

  4. Urmia University of Medical Sciences, Urmia, Iran

    Rohollah Valizadeh

  5. Centre of Excellence for the Study and Treatment of Obesity and Diabetes, Valladolid, Spain

    Miguel A. Carbajo

Authors
  1. Mohammad Kermansaravi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masoumeh Shahsavan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Reza Ebrahimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ali Mousavimaleki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barmak Gholizadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rohollah Valizadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shahab ShahabiShahmiri
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Miguel A. Carbajo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohammad Kermansaravi.

Ethics declarations

Disclosure

Drs Mohammad Kermansaravi, Masoumeh Shahsavan, Reza Ebrahimi, Ali Mousavimaleki, Barmak Gholizadeh, Rohollah Valizadeh, Shahab ShahabiShahmiri and Miguel A Carbajo have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kermansaravi, M., Shahsavan, M., Ebrahimi, R. et al. Effect of anti-reflux suture on gastroesophageal reflux symptoms after one anastomosis gastric bypass: a randomized controlled trial. Surg Endosc 38, 2562–2570 (2024). https://doi.org/10.1007/s00464-024-10792-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-024-10792-0

Keywords

Search

Navigation