Obesity Surgery

, Volume 27, Issue 8, pp 1952–1960 | Cite as

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

  • Osama Taha
  • Mahmoud Abdelaal
  • Mohamed Abozeid
  • Awny Askalany
  • Mohamed Alaa
Original Contributions



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.


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.


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%).


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.


Omega loop gastric bypass Mini gastric bypass Obesity 


Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Sjostrom L, Gummesson A, Sjostrom CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish obese subjects study): a prospective, controlled intervention trial. Lancet Oncol. 2009;10(7):653–62.CrossRefPubMedGoogle Scholar
  2. 2.
    Haslam DW, James WP. Obesity Lancet. 2005;366(9492):1197–209.CrossRefPubMedGoogle Scholar
  3. 3.
    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142(7):547–59.CrossRefPubMedGoogle Scholar
  4. 4.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.CrossRefPubMedGoogle Scholar
  5. 5.
    Chevallier JM, Paita M, Rodde-Dunet MH, et al. Predictive factors of outcome after gastric banding: a nationwide survey on the role of center activity and patients’ behavior. Ann Surg. 2007;246(6):1034–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Miras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev Gastroenterol Hepatol. 2013;10(10):575–84.CrossRefPubMedGoogle Scholar
  7. 7.
    Griffen Jr WO, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg. 1977;186(4):500–9.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA. 2005;294(15):1909–17.CrossRefPubMedGoogle Scholar
  9. 9.
    DeMaria EJ, Pate V, Warthen M, et al. Baseline data from American Society for Metabolic and Bariatric Surgery—designated Bariatric Surgery Centers of Excellence using the bariatric outcomes longitudinal database. Surg Obes Relat Dis. 2010;6(4):347–55.CrossRefPubMedGoogle Scholar
  10. 10.
    Saber AA, Elgamal MH, McLeod MK. Bariatric surgery: the past, present, and future. Obes Surg. 2008;18(1):121–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242(1):20–8.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Reddy RM, Riker A, Marra D, et al. Open Roux-en-Y gastric bypass for the morbidly obese in the era of laparoscopy. Am J Surg. 2002;184(6):611–5. discussion 5-6CrossRefPubMedGoogle Scholar
  13. 13.
    Christou N, Efthimiou E. Five-year outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in a comprehensive bariatric surgery program in Canada. Can J Surg. 2009;52(6):E249–58.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Rutledge R. The mini-gastric bypass: experience with the first 1, 274 cases. Obes Surg. 2001;11(3):276–80.CrossRefPubMedGoogle Scholar
  15. 15.
    Rutledge R, Walsh TR. Continued excellent results with the mini-gastric bypass: six-year study in 2,410 patients. Obes Surg. 2005;15(9):1304–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Peraglie C. Laparoscopic mini-gastric bypass (LMGB) in the super-super obese: outcomes in 16 patients. Obes Surg. 2008;18(9):1126–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22(5):697–703.CrossRefPubMedGoogle Scholar
  18. 18.
    Chevallier JM, Chakhtoura G, Zinzindohoue F. Laparoscopic mini-gastric bypass. J Chir (Paris). 2009;146(1):60–4.CrossRefGoogle Scholar
  19. 19.
    Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Lee WJ, Ser KH, Lee YC, et al. Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience. Obes Surg. 2012;22(12):1827–34.CrossRefPubMedGoogle Scholar
  21. 21.
    Fisher BL, Buchwald H, Clark W, et al. Mini-gastric bypass controversy. Obes Surg. 2001;11(6):773–7.PubMedGoogle Scholar
  22. 22.
    Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr. 1992; 55(2 Suppl):615S–9S.Google Scholar
  23. 23.
    American Diabetes A. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2008;31(Suppl 1):S55–60.CrossRefGoogle Scholar
  24. 24.
    Kilpatrick ES, Bloomgarden ZT, Zimmet PZ. International expert committee report on the role of the A1C assay in the diagnosis of diabetes: response to the international expert committee. Diabetes Care. 2009;32(12):e159. author reply e60CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    American Diabetes A. Standards of medical care in diabetes—2012. Diabetes Care. 2012;35(Suppl 1):S11–63.Google Scholar
  26. 26.
    Musella M, Susa A, Greco F, et al. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc. 2014;28(1):156–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Chevallier JM, Arman GA, Guenzi M, et al. One thousand single anastomosis (omega loop) gastric bypasses to treat morbid obesity in a 7-year period: outcomes show few complications and good efficacy. Obes Surg. 2015;25(6):951–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Kular KS, Manchanda N, Cheema GK. Seven years of mini-gastric bypass in type II diabetes patients with a body mass index <35 kg/m(2). Obes Surg. 2016;26(7):1457–62.CrossRefPubMedGoogle Scholar
  29. 29.
    Ugale S, Gupta N, Modi KD, et al. Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes—a retrospective cohort study. J Diabetes Metab Disord. 2014;13(1):89.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Lee MH, Lee WJ, Chong K, et al. Predictors of long-term diabetes remission after metabolic surgery. J Gastrointest Surg. 2015;19(6):1015–21.CrossRefPubMedGoogle Scholar
  31. 31.
    Lee WJ, Chong K, Chen SC, et al. Preoperative prediction of type 2 diabetes remission after gastric bypass surgery: a comparison of DiaRem scores and ABCD scores. Obes Surg. 2016;26(10):2418–24.CrossRefPubMedGoogle Scholar
  32. 32.
    WHO,  Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. 2006.Google Scholar
  33. 33.
    Chuang J, Zeller MH, Inge T, et al. Bariatric surgery for severe obesity in two adolescents with type 1 diabetes. Pediatrics. 2013;132(4):e1031–4.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Rottenstreich A, Keidar A, Yuval JB, et al. Outcome of bariatric surgery in patients with type 1 diabetes mellitus: our experience and review of the literature. Surg Endosc. 2016;30(12):5428–33.CrossRefPubMedGoogle Scholar
  35. 35.
    Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):515–29.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17(2):212–5.CrossRefPubMedGoogle Scholar
  37. 37.
    Mahawar KK, Kumar P, Carr WR, et al. Current status of mini-gastric bypass. J Minim Access Surg. 2016;12(4):305–10.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Mahawar KK, Jennings N, Brown J, et al. “Mini” gastric bypass: systematic review of a controversial procedure. Obes Surg. 2013;23(11):1890–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Kular KS, Manchanda N, Rutledge R. A 6-year experience with 1,054 mini-gastric bypasses-first study from Indian subcontinent. Obes Surg. 2014;24(9):1430–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Guenzi M, Arman G, Rau C, et al. Remission of type 2 diabetes after omega loop gastric bypass for morbid obesity. Surg Endosc. 2015;29(9):2669–74.CrossRefPubMedGoogle Scholar
  41. 41.
    Carbajo M, Garcia-Caballero M, Toledano M, et al. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg. 2005;15(3):398–404.CrossRefPubMedGoogle Scholar
  42. 42.
    Chakhtoura G, Zinzindohoue F, Ghanem Y, et al. Primary results of laparoscopic mini-gastric bypass in a French obesity-surgery specialized university hospital. Obes Surg. 2008;18(9):1130–3.CrossRefPubMedGoogle Scholar
  43. 43.
    Ahmed AR, Rickards G, Coniglio D, et al. Laparoscopic Roux-en-Y gastric bypass and its early effect on blood pressure. Obes Surg. 2009;19(7):845–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Sugerman HJ, Wolfe LG, Sica DA, et al. Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg. 2003;237(6):751–6. discussion 7-8PubMedPubMedCentralGoogle Scholar
  45. 45.
    Robert M, Belanger P, Hould FS, et al. Should metabolic surgery be offered in morbidly obese patients with type I diabetes? Surg Obes Relat Dis. 2015;11(4):798–805.CrossRefPubMedGoogle Scholar
  46. 46.
    Maraka S, Kudva YC, Kellogg TA, et al. Bariatric surgery and diabetes: implications of type 1 versus insulin-requiring type 2. Obesity (Silver Spring). 2015;23(3):552–7.CrossRefGoogle Scholar
  47. 47.
    Lannoo M, Dillemans B, Van Nieuwenhove Y, et al. Bariatric surgery induces weight loss but does not improve glycemic control in patients with type 1 diabetes. Diabetes Care. 2014;37(8):e173–4.CrossRefPubMedGoogle Scholar
  48. 48.
    Brethauer SA, Aminian A, Rosenthal RJ, et al. Bariatric surgery improves the metabolic profile of morbidly obese patients with type 1 diabetes. Diabetes Care. 2014;37(3):e51–2.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Middelbeek RJ, James-Todd T, Patti ME, et al. Short-term insulin requirements following gastric bypass surgery in severely obese women with type 1 diabetes. Obes Surg. 2014;24(9):1442–6.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Mason EE, Ito C. Gastric bypass in obesity. Surg Clin North Am. 1967;47(6):1345–51.CrossRefPubMedGoogle Scholar
  51. 51.
    Tolone S, Cristiano S, Savarino E, et al. Effects of omega-loop bypass on esophagogastric junction function. Surg Obes Relat Dis. 2016;12(1):62–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Wang W, Wei PL, Lee YC, et al. Short-term results of laparoscopic mini-gastric bypass. Obes Surg. 2005;15(5):648–54.CrossRefPubMedGoogle Scholar
  53. 53.
    Higa KD, Boone KB, Ho T, et al. Laparoscopic Roux-en-Y gastric bypass for morbid obesity: technique and preliminary results of our first 400 patients. Arch Surg. 2000;135(9):1029–33. discussion 33-4CrossRefPubMedGoogle Scholar
  54. 54.
    Sobolewski AP, Deshmukh RM, Brunson BL, et al. Venous hemodynamic changes during laparoscopic cholecystectomy. J Laparoendosc Surg. 1995;5(6):363–9.CrossRefPubMedGoogle Scholar
  55. 55.
    Jorgensen JO, Gillies RB, Lalak NJ, et al. Lower limb venous hemodynamics during laparoscopy: an animal study. Surg Laparosc Endosc. 1994;4(1):32–5.PubMedGoogle Scholar
  56. 56.
    Wazz G, Branicki F, Taji H, et al. Influence of pneumoperitoneum on the deep venous system during laparoscopy. JSLS. 2000;4(4):291–5.PubMedPubMedCentralGoogle Scholar
  57. 57.
    Scholten DJ, Hoedema RM, Scholten SE. A comparison of two different prophylactic dose regimens of low molecular weight heparin in bariatric surgery. Obes Surg. 2002;12(1):19–24.CrossRefPubMedGoogle Scholar
  58. 58.
    Macgregor AM. Prophylaxis of venous thromboembolism in bariatric patients. Obes Surg. 2000;10(1):14.CrossRefPubMedGoogle Scholar
  59. 59.
    Miller MT, Rovito PF. An approach to venous thromboembolism prophylaxis in laparoscopic Roux-en-Y gastric bypass surgery. Obes Surg. 2004;14(6):731–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Piazza L, Ferrara F, Leanza S, et al. Laparoscopic mini-gastric bypass: short-term single-institute experience. Updat Surg. 2011;63(4):239–42.CrossRefGoogle Scholar
  61. 61.
    Gagner M, Deitel M, Erickson AL, et al. Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obes Surg. 2013;23(12):2013–7.CrossRefPubMedGoogle Scholar
  62. 62.
    Marshall JS, Srivastava A, Gupta SK, et al. Roux-en-Y gastric bypass leak complications. Arch Surg. 2003;138(5):520–3. discussion 3-4CrossRefPubMedGoogle Scholar
  63. 63.
    Carucci LR, Turner MA, Conklin RC, et al. Roux-en-Y gastric bypass surgery for morbid obesity: evaluation of postoperative extraluminal leaks with upper gastrointestinal series. Radiology. 2006;238(1):119–27.CrossRefPubMedGoogle Scholar
  64. 64.
    Zingg U, McQuinn A, DiValentino D, et al. Revisional vs. primary Roux-en-Y gastric bypass—a case-matched analysis: less weight loss in revisions. Obes Surg. 2010;20(12):1627–32.CrossRefPubMedGoogle Scholar
  65. 65.
    Helling TS. The lethality of obstructing hematoma at the jejunojejunostomy following Roux-en-Y gastric bypass. Obes Surg. 2005;15(2):290–1. author reply 2-3CrossRefPubMedGoogle Scholar
  66. 66.
    Eckhauser A, Torquati A, Youssef Y, et al. Internal hernia: postoperative complication of Roux-en-Y gastric bypass surgery. Am Surg. 2006;72(7):581–4. discussion 4-5PubMedGoogle Scholar
  67. 67.
    Naef M, Mouton WG, Wagner HE. Small-bowel volvulus in late pregnancy due to internal hernia after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2010;20(12):1737–9.CrossRefPubMedGoogle Scholar
  68. 68.
    Gazzalle A, Braun D, Cavazzola LT, et al. Late intestinal obstruction due to an intestinal volvulus in a pregnant patient with a previous Roux-en-Y gastric bypass. Obes Surg. 2010;20(12):1740–2.CrossRefPubMedGoogle Scholar
  69. 69.
    Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons bariatric surgery center network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg. 2011;254(3):410–20. discussion 20-2CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Pournaras DJ, Aasheim ET, Sovik TT, et al. Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders. Br J Surg. 2012;99(1):100–3.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Plastic and Obesity Surgery DepartmentAssiut University HospitalAssiutEgypt
  2. 2.Overweight ClinicsCairoEgypt
  3. 3.Bariatric Unit, Plastic Surgery DepartmentAssiut University HospitalAssiutEgypt
  4. 4.General Surgery Department, Ain Shams University HospitalAin Shams UniversityCairoEgypt

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