Anti-Reflux One-Anastomosis Gastric Bypass (OAGB)—(Spanish BAGUA): Step-By-Step Technique, Rationale and Bowel Lengths

  • Miguel A. Carbajo
  • Enrique Luque-de-León
  • Juan F. Valdez-Hashimoto
  • Jaime Ruiz-Tovar


The One-Anastomosis Gastric Bypass (OAGB) is a technical modification of the Mini-Gastric Bypass (MGB) which was developed in the year 2002. Although both procedures have the common principles of performing only one anastomosis and avoiding an alimentary (Roux) limb, OAGB includes some different technical and conceptual proposals which among others, essentially include: (1) Complete measurement of the entire small bowel (SB) to determine extent of bypassed biliopancreatic limb and common channel; lengths of these segments are not fixed but assigned according to body mass index, SB length and other metabolic variables, which lead OAGB into having a more malabsorptive profile, (2) Explicit dissection of the angle of His and a very long and narrow gastric pouch constructed over a 36-Fr calibration tube, (3) Creation of an “anti-reflux mechanism” by an 8–10 cm latero-lateral continuous suture between the (selected) SB and gastric pouch, which is reinforced by fixation of the apex of the SB to the excluded stomach, (4) Width of the latero-lateral gastro-ileal anastomosis (~2.5 cm) is wider than in Roux-Y Gastric Bypass, but not as wide as in MGB. Implementation of all these measures has turned OAGB into a more robust operation which minimizes the possibility of reflux or marginal ulcer and leads to better medium- and long-term results in terms of weight loss and metabolic benefits.


Morbid obesity Bariatric surgery Metabolic surgery Obesity surgery Gastric bypass One-anastomosis gastric bypass (OAGB) Mini-gastric bypass (MGB) Laparoscopic gastric bypass Diabetes mellitus Malabsorptive 



Body mass index




Common Channel


Esophago-gastric junction




Gastroesophageal reflux disease


Mini-gastric bypass


One-anastomosis gastric bypass


Right Lower Quadrant


Roux-en-Y gastric bypass


Small bowel


Surgical Table


Weight loss


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Miguel A. Carbajo
    • 1
  • Enrique Luque-de-León
    • 1
    • 2
  • Juan F. Valdez-Hashimoto
    • 3
  • Jaime Ruiz-Tovar
    • 1
    • 4
  1. 1.Center of Excellence for the Study and Treatment of Obesity and DiabetesValladolidSpain
  2. 2.Center of Excellence for the Study and Treatment of Obesity and Diabetes—Latinamerican Affiliated Subsidiary/The American British Cowdray Medical Center, I.A.P./Hospital de Especialidades, Centro Médico Nacional (IMSS)México CityMexico
  3. 3.General and Bariatric SurgeonCancúnMexico
  4. 4.Universidad Autónoma de MadridMadridSpain

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