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Comparison of the Bile Reflux Frequency in One Anastomosis Gastric Bypass and Roux-en-Y Gastric Bypass: a Cohort Study

  • Behrouz Keleidari
  • Mohsen MahmoudiehEmail author
  • Amir Hosein Davarpanah Jazi
  • Hamid Melali
  • Farid Nasr Esfahani
  • Mohammad Minakari
  • Mojgan Mokhtari
Original Contributions
  • 100 Downloads

Abstract

Introduction

One of the most acceptable procedures in bariatric surgery is laparoscopic gastric bypass. Laparoscopic Roux-en-Y gastric bypass (RYGB) is a common technique used in bariatric surgery. Recently, one anastomosis gastric bypass (OAGB) has been suggested as a simple, fast, and effective technique for obesity treatment. This study aims to compare the frequency of histologically proven bile reflux in OAGB and RYGB among patients with morbid obesity.

Methods

This prospective cohort study was performed from 2015 to 2017 in the Department of Bariatric Surgery of Isfahan University of Medical Sciences, Isfahan, Iran. Patients who had undergone RYGB or OAGB surgery were enrolled. Patients who had undergone revisional surgery were excluded. Data on demographics, symptoms, fasting blood sugar, lipid profile, endoscopic, and histologic findings (based on the Sydney bile reflux index) of bile reflux and postoperative complications were collected and compared for the two techniques.

Results

A total of 122 obese patients (22 males) who had undergone RYGB or OAGB surgery were included. The Sydney bile reflux index showed no statistically significant difference between RYGB and OAGB groups. Similarly, no statistically significant difference was found in the self-reported history of bile reflux–related symptoms, bile reflux markers in esophagogastroduodenoscopy, and postoperative complications between groups.

Conclusions

OAGB and RYGB appear to be equal with respect to postoperative complications, bile reflux frequency, bile reflux index, and the Sydney system score.

Keywords

Roux-en-Y gastric bypass Omega gastric bypass One anastomosis gastric bypass Bile reflux Morbid obesity 

Notes

Acknowledgements

We would like to express our very great appreciation to Dr. Shervin Badihian for his valuable comments and suggestions during several stages of this research.

Compliance with Ethical Standards

This study was approved by the Ethical research committee of Isfahan University of Medical Sciences, and all participants provided written voluntary informed consent

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.CrossRefGoogle Scholar
  2. 2.
    Khoursheed MA, Al-Bader IA, Al-asfar FS, et al. Revision of failed bariatric procedures to Roux-en-Y gastric bypass (RYGB). Obes Surg. 2011;21(8):1157–60.CrossRefGoogle Scholar
  3. 3.
    Disse E, Pasquer A, Espalieu P, et al. Greater weight loss with the omega loop bypass compared to the Roux-en-Y gastric bypass: a comparative study. Obes Surg. 2014;24(6):841–6.CrossRefGoogle Scholar
  4. 4.
    Taha O, editor Malabsorption and fecal fat execretion of omega loop gastric bypass vs Roux-en-Y. Obesity Surgery; 2016;23: Springer 233 Spring St, New York, NY 10013 USA.Google Scholar
  5. 5.
    Kruschitz R, Luger M, Kienbacher C, et al. The effect of Roux-en-Y vs. omega-loop gastric bypass on liver, metabolic parameters, and weight loss. Obes Surg. 2016;26(9):2204–12.CrossRefGoogle Scholar
  6. 6.
    Scott JD. Comment on: Roux-en-Y gastric bypass for the treatment of severe complications after omega-loop gastric bypass. Surg Obes Relat Dis. 2017;13(6):994–6.  https://doi.org/10.1016/j.soard.2017.01.033.CrossRefGoogle Scholar
  7. 7.
    Facchiano E, Leuratti L, Veltri M, et al. Laparoscopic conversion of one anastomosis gastric bypass to Roux-en-Y gastric bypass for chronic bile reflux. Obes Surg. 2016;26(3):701–3.  https://doi.org/10.1007/s11695-015-2017-8.CrossRefGoogle Scholar
  8. 8.
    Kruschitz R, Luger M, Schindler K, et al. Concerning the manuscript “the effect of Roux-en-Y vs omega-loop gastric bypass on liver, metabolic parameters and weight loss”. Obes Surg. 2017;27(5):1341–2.CrossRefGoogle Scholar
  9. 9.
    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.CrossRefGoogle Scholar
  10. 10.
    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.  https://doi.org/10.1007/s11695-012-0618-z.CrossRefGoogle Scholar
  11. 11.
    Poghosyan T, Caille C, Moszkowicz D, et al. Roux-en-Y gastric bypass for the treatment of severe complications after omega-loop gastric bypass. Surg Obes Relat Dis. 2017;13(6):988–94.CrossRefGoogle Scholar
  12. 12.
    Kassir R, Alamri T, Lointier P. Laparoscopic conversion of omega loop gastric bypass into Roux-en-Y gastric bypass. Obes Surg. 2017;27(5):1392–3.CrossRefGoogle Scholar
  13. 13.
    Hussain A, El-Hasani S. The effect of Roux-en-Y vs. omega loop gastric bypass on liver, metabolic parameters, and weight loss. Obes Surg. 2017;27(3):820.CrossRefGoogle Scholar
  14. 14.
    Deylgat B, D’Hondt M, Pottel H, et al. Indications, safety, and feasibility of conversion of failed bariatric surgery to Roux-en-Y gastric bypass: a retrospective comparative study with primary laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2012;26(7):1997–2002.  https://doi.org/10.1007/s00464-011-2140-0.CrossRefGoogle Scholar
  15. 15.
    Jacobsen HJ, Nergard BJ, Leifsson BG, et al. Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg. 2014;101(4):417–23.  https://doi.org/10.1002/bjs.9388.CrossRefGoogle Scholar
  16. 16.
    Mahawar KK, Carr WR, Balupuri S, et al. Controversy surrounding ‘mini’gastric bypass. Obes Surg. 2014;24(2):324–33.CrossRefGoogle Scholar
  17. 17.
    De Luca M, Tie T, Ooi G, et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSO position statement. Obes Surg. 2018, 2018:1–19.Google Scholar
  18. 18.
    Chakhtoura G, Zinzindohoué 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.CrossRefGoogle Scholar
  19. 19.
    Rasmussen J, Fuller W, Ali M. Marginal ulceration after laparoscopic gastric bypass: an analysis of predisposing factors in 260 patients. Surg Endosc. 2007;21(7):1090–4.CrossRefGoogle Scholar
  20. 20.
    Price AB. The Sydney system: histological division. J Gastroenterol Hepatol. 1991;6(3):209–22.CrossRefGoogle Scholar
  21. 21.
    Stolte M, Meining A. The updated Sydney system: classification and grading of gastritis as the basis of diagnosis and treatment. Can J Gastroenterol Hepatol. 2001;15(9):591–8.Google Scholar
  22. 22.
    Sobala GM, O’Connor HJ, Dewar EP, et al. Bile reflux and intestinal metaplasia in gastric mucosa. J Clin Pathol. 1993;46(3):235–40.CrossRefGoogle Scholar
  23. 23.
    Bruzzi M, Rau C, Voron T, et al. Single anastomosis or mini-gastric bypass: long-term results and quality of life after a 5-year follow-up. Surg Obes Relat Dis. 2015;11(2):321–6.CrossRefGoogle Scholar
  24. 24.
    Wang F-G, Yu Z-P, Yan W-M, et al. Comparison of safety and effectiveness between laparoscopic mini-gastric bypass and laparoscopic sleeve gastrectomy: a meta-analysis and systematic review. Medicine. 2017;96(50):e8924.CrossRefGoogle Scholar
  25. 25.
    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.CrossRefGoogle Scholar
  26. 26.
    Lee W-J, Ser K-H, Lee Y-C, 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.CrossRefGoogle Scholar
  27. 27.
    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.CrossRefGoogle Scholar
  28. 28.
    Nimeri A, Al Shaban T, Maasher A. Laparoscopic conversion of one anastomosis gastric bypass/mini gastric bypass to Roux-en-Y gastric bypass for bile reflux gastritis. Surg Obes Relat Dis. 2017;13(1):119–21.CrossRefGoogle Scholar
  29. 29.
    Swartz DE, Mobley E, Felix EL. Bile reflux after Roux-en-Y gastric bypass: an unrecognized cause of postoperative pain. Surg Obes Relat Dis. 2009;5(1):27–30.CrossRefGoogle Scholar
  30. 30.
    Kumar N, Thompson CC. Remnant gastropathy due to bile reflux after Roux-en-Y gastric bypass: a unique cause of abdominal pain and successful treatment with ursodiol. Surg Endosc. 2017;31(12):5399–402.CrossRefGoogle Scholar
  31. 31.
    La Vella E, Hovorka Z, Yarbrough DE, et al. Bile reflux of the remnant stomach following Roux-en-Y gastric bypass: an etiology of chronic abdominal pain treated with remnant gastrectomy. Surg Obes Relat Dis. 2017;13(8):1278–83.CrossRefGoogle Scholar
  32. 32.
    Mahawar K, Reed A, Graham Y. Marginal ulcers after one anastomosis (mini) gastric bypass: a survey of surgeons. Clin Obes. 2017;7(3):151–6.CrossRefGoogle Scholar
  33. 33.
    Saarinen T, Räsänen J, Salo J, et al. Bile reflux scintigraphy after mini-gastric bypass. Obes Surg. 2017;27(8):2083–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Minimally Invasive Surgery Research CenterIsfahan University of Medical SciencesIsfahanIran
  2. 2.Department of Minimally Invasive SurgeryAl Zahra HospitalIsfahanIran
  3. 3.Student Research CommitteeSchool of Medicine, Isfahan University of Medical SciencesIsfahanIran
  4. 4.Department of GastroenterologyIsfahan University of Medical SciencesIsfahanIran
  5. 5.Department of PathologyIsfahan University of Medical SciencesIsfahanIran

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