Skip to main content
Log in

Revision/Conversion Surgeries After One Anastomosis Gastric Bypass—An Experts’ Modified Delphi Consensus

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

There is a lack of evidence for treatment of some conditions including complication management, suboptimal initial weight loss, recurrent weight gain, or worsening of a significant obesity complication after one anastomosis gastric bypass (OAGB). This study was designed to respond to the existing lack of agreement and to provide a valuable resource for clinicians by employing an expert-modified Delphi consensus method.

Methods

Forty-eight recognized bariatric surgeons from 28 countries participated in the modified Delphi consensus to vote on 64 statements in two rounds. An agreement/disagreement among ≥ 70.0% of the experts was regarded to indicate a consensus.

Results

A consensus was achieved for 46 statements. For recurrent weight gain or worsening of a significant obesity complication after OAGB, more than 85% of experts reached a consensus that elongation of the biliopancreatic limb (BPL) is an acceptable option and the total bowel length measurement is mandatory during BPL elongation to preserve at least 300–400 cm of common channel limb length to avoid nutritional deficiencies. Also, more than 85% of experts reached a consensus on conversion to Roux-en-Y gastric bypass (RYGB) with or without pouch downsizing as an acceptable option for the treatment of persistent bile reflux after OAGB and recommend detecting and repairing any size of hiatal hernia during conversion to RYGB.

Conclusion

While the experts reached a consensus on several aspects regarding revision/conversion surgeries after OAGB, there are still lingering areas of disagreement. This highlights the importance of conducting further studies in the future to address these unresolved issues.

Graphical Abstract

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

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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

Instant access to the full article PDF.

Similar content being viewed by others

Data Availability

The data that support the findings of this study are available on request from the corresponding authors, [SC, MK].

References

  1. Ramos AC, Chevallier JM, Mahawar K, et al. IFSO (International Federation for Surgery of Obesity and Metabolic Disorders) Consensus conference statement on one-anastomosis gastric bypass (OAGB-MGB): results of a modified Delphi study. Obes Surg. 2020;30(5):1625–34.

    PubMed  Google Scholar 

  2. De Luca M, Tie T, Ooi G, et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSO position statement. Obes Surg. 2018;28(5):1188–206.

    PubMed  Google Scholar 

  3. ASMBS Endorsed Procedures and FDA Approved Devices. 2022. [cited 2024 January 11]; Available from: https://asmbs.org/resources/endorsed-procedures-and-devices.

  4. Kermansaravi M, Parmar C, Chiappetta S, et al. Patient selection in one anastomosis/mini gastric bypass-an expert modified Delphi consensus. Obes Surg. 2022;32(8):2512–24.

    PubMed  Google Scholar 

  5. Angrisani L, Santonicola A, Iovino P. Bariatric surgery survey 2018: similarities and disparities among the 5 IFSO chapters. Obes Surg. 2021;31(5):1937–48.

    PubMed  PubMed Central  Google Scholar 

  6. Parmar CD, Gan J, Stier C, et al. One anastomosis/mini gastric bypass (OAGB-MGB) as revisional bariatric surgery after failed primary adjustable gastric band (LAGB) and sleeve gastrectomy (SG): a systematic review of 1075 patients. Int J Surg (London, England). 2020;81:32–8.

    Google Scholar 

  7. Kermansaravi M, Shahmiri SS, DavarpanahJazi AH, et al. One anastomosis/mini-gastric bypass (OAGB/MGB) as revisional surgery following primary restrictive bariatric procedures: a systematic review and meta-analysis. Obes Surg. 2021;31(1):370–83.

    PubMed  Google Scholar 

  8. Ponce de Leon-Ballesteros G, Pouwels S, Romero-Velez G, Aminian A, Angrisani L, Bhandari M, Brown W, Copaescu C, De Luca M, Fobi M, Ghanem OM, Hasenberg T, Herrera MF, Herrera-Kok JH, Himpens J, Kow L, Kroh M, Kurian M, Musella M, Narwaria M, Noel P, Pantoja JP, Ponce J, Prager G, Ramos A, Ribeiro R, Ruiz-Ucar E, Salminen P, Shikora S, Small P, Stier C, Taha S, Taskin EH, Torres A, Vaz C, Vilallonga R, Verboonen S, Zerrweck C, Zundel N, Parmar C. Metabolic and bariatric surgery in patients with obesity class V (BMI > 60kg/m2): a modified delphi study. Obes Surg. 2024;34(3):790–813. https://doi.org/10.1007/s11695-023-06990-9.

  9. Hussain A, Van den Bossche M, Kerrigan DD, et al. Retrospective cohort study of 925 OAGB procedures. The UK MGB/OAGB collaborative group. Int J Surg (London, England). 2019;69:13–8.

    CAS  Google Scholar 

  10. De Luca M, Piatto G, Merola G, et al. IFSO update position statement on one anastomosis gastric bypass (OAGB). Obes Surg. 2021;31(7):3251–78.

    PubMed  Google Scholar 

  11. Chiappetta S, Weiner R. Evidence of the mini-/one-anastomosis-gastric-bypass for being a standard procedure in obesity and metabolic surgery. Chirurg. 2018;89(8):589–96.

    CAS  PubMed  Google Scholar 

  12. Kermansaravi M, DavarpanahJazi AH, ShahabiShahmiri S, et al. Areas of non-consensus around one anastomosis/mini gastric bypass (OAGB/MGB): a narrative review. Obes Surg. 2021;31(6):2453–63.

    PubMed  Google Scholar 

  13. Mahawar KK, Himpens J, Shikora SA, et al. The first consensus statement on one anastomosis/mini gastric bypass (OAGB/MGB) using a modified Delphi approach. Obes Surg. 2018;28(2):303–12.

    PubMed  Google Scholar 

  14. Mahawar KK, Omar I, Singhal R, et al. The first modified Delphi consensus statement on sleeve gastrectomy. Surg Endosc. 2021;35(12):7027–33.

    PubMed  Google Scholar 

  15. Kermansaravi M, Parmar C, Chiappetta S, et al. Best practice approach for redo-surgeries after sleeve gastrectomy, an expert’s modified Delphi consensus. Surg Endosc. 2023;37(3):1617–28.

    PubMed  Google Scholar 

  16. Keleidari B, Dehkordi MM, Shahraki MS, et al. Bile reflux after one anastomosis gastric bypass surgery: a review study. Ann Med Surg (Lond). 2021;64:102248.

    PubMed  Google Scholar 

  17. Salminen P, Kow L, Aminian A, et al. IFSO consensus on definitions and clinical practice guidelines for obesity management-an international Delphi study. Obes Surg. 2024;34(1):30–42.

    PubMed  Google Scholar 

  18. El Ansari W, Elhag W. Weight regain and insufficient weight loss after bariatric surgery: definitions, prevalence, mechanisms, predictors, prevention and management strategies, and knowledge gaps-a scoping review. Obes Surg. 2021;31(4):1755–66.

    PubMed  PubMed Central  Google Scholar 

  19. Gero D, Vannijvel M, Okkema S, et al. Defining global benchmarks in elective secondary bariatric surgery comprising conversional, revisional, and reversal procedures. Ann Surg. 2021;274(5):821–8.

    PubMed  Google Scholar 

  20. Elhag W, El Ansari W. Effectiveness and safety of liraglutide in managing inadequate weight loss and weight regain after primary and revisional bariatric surgery: anthropometric and cardiometabolic outcomes. Obes Surg. 2022;32(4):1005–15.

    PubMed  Google Scholar 

  21. Jensen AB, Renström F, Aczél S, et al. Efficacy of the glucagon-like peptide-1 receptor agonists liraglutide and semaglutide for the treatment of weight regain after bariatric surgery: a retrospective observational study. Obes Surg. 2023;33(4):1017–25.

    PubMed  PubMed Central  Google Scholar 

  22. Yan W, Bai R, Yan M, et al. Preoperative fasting plasma C-peptide levels as predictors of remission of type 2 diabetes mellitus after bariatric surgery: a systematic review and meta-analysis. J Invest Surg. 2017;30(6):383–93.

    PubMed  Google Scholar 

  23. Chen Y, Zeng G, Tan J, et al. Impact of roux-en Y gastric bypass surgery on prognostic factors of type 2 diabetes mellitus: meta-analysis and systematic review. Diabetes Metab Res Rev. 2015;31(7):653–62.

    CAS  PubMed  Google Scholar 

  24. Ferro S, Zulian V, De Palma M, Sartori A, Andreica A, Nedelcu M, Carandina S. Resizing of the gastric pouch for weight regain after laparoscopic Roux-en-Y gastric bypass and one-anastomosis gastric bypass: is it a valid option? J Clin Med. 2022;11(21):6238. https://doi.org/10.3390/jcm11216238.

  25. Phisitkul P, Akoh CC, Rungprai C, et al. Optimizing arthroscopy for osteochondral lesions of the talus: the effect of ankle positions and distraction during anterior and posterior arthroscopy in a Cadaveric Model. Arthroscopy. 2017;33(12):2238–45.

    PubMed  Google Scholar 

  26. Faul A, Chevallier JM, Poghosyan T. Dilated gastric pouch resizing for weight loss failure after one anastomosis gastric bypass. Obes Surg. 2019;29(10):3406–9.

    PubMed  Google Scholar 

  27. Abu Dayyeh BK, Lautz DB, Thompson CC. Gastrojejunal stoma diameter predicts weight regain after Roux-en-Y gastric bypass. Clin Gastroenterol Hepatol. 2011;9(3):228–33.

    PubMed  Google Scholar 

  28. Patel LY, Lapin B, Brown CS, et al. Outcomes following 50 consecutive endoscopic gastrojejunal revisions for weight gain following Roux-en-Y gastric bypass: a comparison of endoscopic suturing techniques for stoma reduction. Surg Endosc. 2017;31(6):2667–77.

    PubMed  Google Scholar 

  29. Salman MA, Salman A, Assal MM, et al. One anastomosis gastric bypass (OAGB) with a 150-cm biliopancreatic limb (BPL) versus a 200-cm BPL, a systematic review and meta-analysis. Obes Surg. 2023;33(6):1846–56.

    PubMed  PubMed Central  Google Scholar 

  30. Slagter N, de Heide LJM, Jutte EH, et al. Tailoring limb length based on total small bowel length in one anastomosis gastric bypass surgery (TAILOR study): study protocol for a randomized controlled trial. Trials. 2022;23(1):526.

    PubMed  PubMed Central  Google Scholar 

  31. Eagleston J, Nimeri A. Optimal small bowel limb lengths of Roux-en-Y gastric bypass. Curr Obes Rep. 2023;12(3):345–54.

    PubMed  Google Scholar 

  32. Soong TC, Almalki OM, Lee WJ, et al. Measuring the small bowel length may decrease the incidence of malnutrition after laparoscopic one-anastomosis gastric bypass with tailored bypass limb. Surg Obes Relat Dis. 2019;15(10):1712–8.

    PubMed  Google Scholar 

  33. Kassir R, Giudicelli X, Lointier P, Breton C, Blanc P. Omega loop gastroileal bypass (OLGIBP/SAGI) versus one anastomosis gastric bypass (OAGB): medium-term results. Obes Surg. 2021;31(4):1597–602.

    PubMed  Google Scholar 

  34. De Luca M, Himpens J, Angrisani L, et al. A new concept in bariatric surgery. Single anastomosis gastro-ileal (SAGI): Technical details and preliminary results. Obes Surg. 2017;27(1):143–7.

    PubMed  Google Scholar 

  35. Musella M, Vitiello A, Susa A, et al. Revisional surgery after one anastomosis/minigastric bypass: an Italian multi-institutional survey. Obes Surg. 2022;32(2):256–65.

    PubMed  PubMed Central  Google Scholar 

  36. Cazzo E, Jimenez LS, Valerini FG. Weight loss and vomiting 1 year after banded versus non-banded one anastomosis gastric bypass: a prospective randomized trial. Obes Surg. 2020;30(5):1719–25.

    PubMed  Google Scholar 

  37. Cazzo E, Valerini FG, Chaim FHM. Early weight loss outcomes and glucose metabolism parameters after banded versus non-banded one anastomosis gastric bypass: a prospective randomized trial. Arq Gastroenterol. 2019;56(1):15–21.

    PubMed  Google Scholar 

  38. Parmar C, Pouwels S. Oesophageal and gastric cancer after bariatric surgery: an up-to-date systematic scoping review of literature of 324 cases. Obes Surg. 2022;32(12):3854–62.

    PubMed  Google Scholar 

  39. Davarpanah Jazi AH, Shahabi S, Sheikhbahaei E, et al. A systematic review and meta-analysis on GERD after OAGB: rate, treatments, and success. Expert Rev Gastroenterol Hepatol. 2023;17(12):1321–32.

    CAS  PubMed  Google Scholar 

  40. Kassir R, Petrucciani N, Debs T. Conversion of one anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB) for biliary reflux resistant to medical treatment: lessons learned from a retrospective series of 2780 consecutive patients undergoing OAGB. Obes Surg. 2020;30(6):2093–8.

    PubMed  Google Scholar 

  41. Kermansaravi M, Abbas A, Pishgahroudsari M, et al. Short-term outcomes of the conversion of one anastomosis gastric bypass to Roux-en-Y gastric bypass in symptomatic reflux patients without revising the size of the gastric pouch. J Minim Access Surg. 2021;17(3):318–21.

    PubMed  Google Scholar 

  42. Rheinwalt KP, Schipper S, Plamper A, et al. Roux-en-Y versus one anastomosis gastric bypass as redo-operations following sleeve gastrectomy: a retrospective study. World J Surg. 2022;46(4):855–64.

    PubMed  Google Scholar 

  43. Verras GI, Mulita F, Pouwels S, Parmar C, Drakos N, Bouchagier K, Kaplanis C, Skroubis G. Outcomes at 10-year follow-up after Roux-en-Y gastric bypass, biliopancreatic diversion, and sleeve gastrectomy. J Clin Med. 2023;12(15):4973. https://doi.org/10.3390/jcm12154973.

  44. Parmar CD, Mahawar KK. One anastomosis (Mini) gastric bypass is now an established bariatric procedure: a systematic review of 12,807 patients. Obes Surg. 2018;28(9):2956–67.

    PubMed  Google Scholar 

  45. Almerie MQ, Darrien JH, Javed S, et al. Braun procedure is effective in treating bile reflux following one anastomosis gastric bypass: a case series. Obes Surg. 2021;31(8):3880–2.

    PubMed  Google Scholar 

  46. Werapitiya SB, Ruwanpura SP, Coulson TR. Laparoscopic fundoplication using the excluded stomach as a novel management option for refractory bile reflux following one anastomosis gastric bypass (OAGB). Obes Surg. 2022;32(2):561–6.

    PubMed  Google Scholar 

  47. Ospanov O, Yeleuov G, Buchwald JN, et al. A randomized controlled trial of acid and bile reflux esophagitis prevention by modified fundoplication of the excluded stomach in one-anastomosis gastric bypass: 1-year results of the FundoRing trial. Obes Surg. 2023;33(7):1974–83.

    PubMed  Google Scholar 

  48. Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet (London, England). 2019;393(10178):1299–309.

    PubMed  Google Scholar 

  49. Stier C, Parmar C, Koschker A-C, Bokhari M, Stier R, Chiappetta S. Computed tomography-3D-volumetry: a valuable adjunctive diagnostic tool after bariatric surgery. Minim Invasive Surg. 2020;4:18. https://doi.org/10.20517/2574-1225.2019.75.

  50. Sakran N, Haj B, Pouwels S, et al. Standardization of the one-anastomosis gastric bypass procedure for morbid obesity: technical aspects and early outcomes. Surg Laparosc Endosc Percutaneous Techn. 2023;33(2):162–70.

    Google Scholar 

  51. Deitel M. Essentials of mini-one anastomosis gastric bypass. Springer; 2018.

    Google Scholar 

  52. Poljo A, Pentsch A, Raab S, et al. Incidence of dumping syndrome after sleeve gastrectomy, Roux-en-Y gastric bypass and one-anastomosis gastric bypass. J Metab Bariatric Surg. 2021;10(1):23–31.

    Google Scholar 

  53. Robert M, Poghosyan T, Maucort-Boulch D, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass at 5 years (YOMEGA): a prospective, open-label, non-inferiority, randomised extension study. Lancet Diabetes Endocrinol. 2024;12(4):267–76.

    PubMed  Google Scholar 

  54. Charalampos T, Maria N, Vrakopoulou VGZ, et al. Tailored one anastomosis gastric bypass: 3-year outcomes of 94 patients. Obes Surg. 2019;29(2):542–51.

    PubMed  Google Scholar 

  55. Rheinwalt KP, Plamper A, Rückbeil MV, et al. One anastomosis gastric bypass-mini-gastric bypass (OAGB-MGB) versus Roux-en-Y gastric bypass (RYGB)-a mid-term cohort study with 612 patients. Obes Surg. 2020;30(4):1230–40.

    PubMed  Google Scholar 

  56. Zarshenas N, Tapsell LC, Batterham M, et al. Changes in anthropometric measures, nutritional indices and gastrointestinal symptoms following one anastomosis gastric bypass (OAGB) compared with Roux-en-y gastric bypass (RYGB). Obes Surg. 2021;31(6):2619–31.

    PubMed  PubMed Central  Google Scholar 

  57. Andrade L, Chiote I, Santos-Cruz A, et al. Protein intake, adherence to vitamin-mineral supplementation, and dumping syndrome in patients undergoing one anastomosis gastric bypass. Obes Surg. 2021;31(8):3557–64.

    PubMed  Google Scholar 

  58. Vargas EJ, Abu Dayyeh BK, Storm AC, et al. Endoscopic management of dumping syndrome after Roux-en-Y gastric bypass: a large international series and proposed management strategy. Gastrointest Endosc. 2020;92(1):91–6.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Mohammad Kermansaravi or Sonja Chiappetta.

Ethics declarations

Ethics Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

Informed consent does not apply.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

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

Key Points

• Elongation of the BPL is an acceptable option for recurrent weight gain or worsening of a significant obesity complication after OAGB.

• Preservation of at least 300–400 cm of common channel limb length is necessary to decrease nutritional deficiencies.

• Increasing the CC (shortening the BPL), conversion to RYGB with shorter BPL, or complete reversal of OAGB are acceptable options for severe nutritional complications resistant to nutritional supports.

• Conversion to Roux-en-Y gastric bypass (RYGB) with or without pouch downsizing is the only acceptable option for the treatment of persistent bile reflux after OAGB.

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., Chiappetta, S., Parmar, C. et al. Revision/Conversion Surgeries After One Anastomosis Gastric Bypass—An Experts’ Modified Delphi Consensus. OBES SURG 34, 2399–2410 (2024). https://doi.org/10.1007/s11695-024-07345-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-024-07345-8

Keywords

Navigation