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Technical Variations and Considerations around OAGB in IFSO-APC and IFSO-MENAC Chapters, an Expert Survey

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Abstract

Objective

This study aimed to evaluate the technical variations of one-anastomosis gastric bypass (OAGB) among IFSO-APC and MENAC experts.

Background

The multitude of technical variations and patient selection challenges among metabolic and bariatric surgeons worldwide necessitates a heightened awareness of these issues. Understanding different perspectives and viewpoints can empower surgeons performing OAGB to adapt their techniques, leading to improved outcomes and reduced complications.

Methods

The scientific team of IFSO-APC, consisting of skilled bariatric and metabolic surgeons specializing in OAGB, conducted a confidential online survey. The survey aimed to assess technical variations and considerations related to OAGB within the IFSO-APC and IFSO-MENAC chapters. A total of 85 OAGB experts participated in the survey, providing their responses through a 35-question online format. The survey took place from January 1, 2024, to February 15, 2024.

Results

Most experts do not perform OAGB for children and adolescents younger than 18 years. Most experts create the gastric pouch over a 36–40-F bougie and prefer to create a gastrojejunostomy, at the posterior wall of the gastric pouch. An anti-reflux suture during OAGB is performed in all patients by 51.8% of experts. Most experts set a common limb length of > 4 m in revisional and conversional OAGBs to prevent nutritional complications.

Conclusion

The ongoing debate among metabolic and bariatric surgeons regarding the technical variations and patient selection in OAGB remains a significant point of discussion. This survey demonstrated the variations in technical aspects and patient selection for OAGB among MBS surgeons in the IFSO-APC and IFSO-MENAC chapters. Standardizing the OAGB technique is crucial to ensure optimal safety and efficacy in this procedure.

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Data Availability

The datasets generated during and/or analyzed during the current study is available from the corresponding author upon reasonable request.

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Acknowledgements

IFSO-APC/MENAC collaborators: Alaa Abbass, Mohamed Abouzeid, Tarek Abouzeid, Farooq Muhammad Afzal, Mohanad Al Ansari, Safauldeen Salim Albaaj, Bader AlHadhrami, Mohammad Alhaifi, Mustafa Allouch, Osamah A Alsanie, Sultan F Al Temyatt, Masoud Amini, Syed Tanseer Asghar, Sarfaraz Baig, Mounir Ben Chatouh, Daryl KA Chia, Angelica Delgado, Mohey Elbanna, Waleed Gado, Tikfu Gee, Sang-Moon Han, Seyed Mehdi Jalali, Gurvinder Singh Jammu, Manish D Khaitan, Alireza Khalaj, Ali A Khammas, Nesreen Khidir, Mousa Khoursheed, Guowei Kim, Nik Ritza Kosai, Minghsien Lee, JinLI Lv, Maazulhassan, Tarek Mahdy, Mumtaz Maher, Zhongqi Mo, Muhammad S Niam, Mani Niazi, Reynu Rajan, Karim Sabry, Sina Safamanesh, Masoud Sayadishahraki, Kong Han Ser, Alaa M Sewefy, Hany Shabbir Harazi, Ghulam Siddiq, Mohanarajah Silvarajah, Tienchou Soong, Xitai Sun, Safwan Taha, Mustafa M Taher, Michael L Talbot, Mohammad Talebpour, Chun Hai Tan, Daniel King Hung Tong, Burhan Ul Haq, Ala Wafa, Thejana K Wijeratne, Tahir Yunus, and Mohammad Zarin.

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Authors and Affiliations

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

    Mohammad Kermansaravi, Shahab Shahabi Shahmiri, Abdolreza Pazouki & Amir Hossein Davarpanah Jazi

  2. Adelaide Bariatric Centre, Flinders University of South Australia, Adelaide, Australia

    Lilian Kow

  3. Bariatric Surgery Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Khaled Gawdat

  4. Iranian Hospital, Al Wasl Road, Dubai, UAE

    Syed Imran Abbas

  5. Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia

    Ahmad Aly

  6. University of Melbourne, Melbourne, Australia

    Ahmad Aly

  7. Minimally Invasive and Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC), Jordan Hospital, Amman, Jordan

    Ahmad Bashir & Ashraf Haddad

  8. Mohak Bariatrics and Robotics Center, Indore, India

    Mohit Bhandari

  9. Makassed General Hospital, Beirut, Lebanon

    Mohamad Hayssam ElFawal

  10. Metabolic, Thoracic & General Surgery Unit III, Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan

    Atif Inam

  11. Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, Tokyo, Japan

    Kazunori Kasama

  12. Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea

    Sang Hyun Kim

  13. MGB-OAGB Club, Kular Research Institute, Bija, India

    Kuldeepak Singh Kular

  14. Sir H N Reliance Foundation Hospital, Mumbai, India

    Muffazal Lakdawala

  15. Al Sharq Hospital, Fujairah, UAE

    Laurent Abram Layani

  16. Medical Weight Loss Center, China Medical University Hsinchu Hospital, Zhubei, Taiwan

    Wei-Jei Lee

  17. Apollo Hospital, New Delhi, India

    Arun Prasad

  18. Aman Hospital, Doha, Qatar

    Bassem Safadi

  19. Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China

    Cunchuan Wang & Wah Yang

  20. The Wesley Hospital, Auchenflower, Queensland, Australia

    Reza Adib

  21. National University of Singapore, Singapore, Singapore

    Asim Shabbir

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  1. Mohammad Kermansaravi
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  2. Shahab Shahabi Shahmiri
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  3. Lilian Kow
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  21. Cunchuan Wang
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  22. Wah Yang
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  23. Reza Adib
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  24. Amir Hossein Davarpanah Jazi
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  25. Asim Shabbir
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IFSO-APC/MENAC collaborators

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Correspondence to Mohammad Kermansaravi or Amir Hossein Davarpanah Jazi.

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Key Points

1. Most experts create the gastric pouch as long as possible and at the level or below the crow’s foot.

2. Most of the experts create the gastric pouch over bougie and prefer to create a gastrojejunostomy, at the posterior wall of the gastric pouch.

3. Most experts do not measure total bowel length in primary OAGB but measure it in revisional and conversional OAGB.

4. Most experts set a common limb length of > 4 m in revisional and conversional OAGBs.

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Kermansaravi, M., Shahmiri, S.S., Kow, L. et al. Technical Variations and Considerations around OAGB in IFSO-APC and IFSO-MENAC Chapters, an Expert Survey. OBES SURG 34, 2054–2065 (2024). https://doi.org/10.1007/s11695-024-07239-9

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