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Randomized Controlled Trial of One Anastomosis Gastric Bypass Versus Roux-En-Y Gastric Bypass for Obesity: Comparison of the YOMEGA and Taiwan Studies

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Abstract

Background

The YOMEGA study (Y-study) was a randomized trial comparing one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB). Here, we aim to compare the Y-study and our pioneer trial from Taiwan (T-study).

Methods

Data from the Y-study and the T-study were collected and compared.

Results

The Y-study recruited 234 patients with a mean body mass index (BMI) of 43.9 and age of 43.5 years. The T-study recruited 80 patients with a similar mean BMI of 44.3 and mean age of 31.4 years. The studies had similar findings including (1) OAGB is easier and possibly safer procedure than RYGB. Both studies showed that OAGB had a shorter operation time than RYGB, but a lower surgical complication rate was only demonstrated in T-study. (2) Both procedures have similar weight loss but OAGB features better glycemic control than RYGB. Weight loss at 2 years after surgery was similar between two procedures, but OAGB reduced HbA1c to a greater degree than RYGB at 2 years in Y-study (− 2.3% vs. − 1.3%; p = 0.025). The resolution of the metabolic syndrome was 100% for both groups in the T-study. (3) OAGB carried a higher risk of malnutrition. OAGB had more malabsorptive problems with a lower hemoglobin level than RYGB at 2 years after surgery. Adverse malnutrition events occurred in nine (7.8%) OAGB patients in the Y-study. Four (3.4%) patients of OAGB received revision surgery in Y-study but none in T-study. (4) Bile reflux was noted in OAGB patients but did not influence quality of life or revision rate. Y-study found that bile in the gastric pouch was present in 16% of patients in the OAGB group versus none in the RYGB, but no inter-group difference in quality of life was detected. There was a trend for RYGB patients to experience more abdominal pain than OAGB.

Conclusions

Both studies showed that OAGB is a technically easier procedure and features better glycemic control than RYGB, but has a mal-absorptive effect. However, the bile reflux and abdominal pain controversies persisted.

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References

  1. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.

    Article  CAS  PubMed  Google Scholar 

  2. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.

    Article  PubMed  Google Scholar 

  3. Lee WJ, Huang MT, Wang W, et al. Bariatric surgery: Asia-pacific perspective. Obes Surg. 2005;15:751–7.

    Article  PubMed  Google Scholar 

  4. Scopinaro N. The IFSO and obesity surgery through the world. Obes Surg. 1998;8:3–8.

    Article  CAS  PubMed  Google Scholar 

  5. Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg. 2009;19(12):1605–11.

    Article  PubMed  Google Scholar 

  6. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25:1822–32.

    Article  CAS  PubMed  Google Scholar 

  7. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoliminal procedure: IFSO worldwide survey 2014. Obes Surg. 2017;27:2279–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001;11(3):276–80.

    Article  CAS  PubMed  Google Scholar 

  9. Lee WJ, Yu PJ, Wang W, et al. Laparoscopic roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity. Ann Surg. 2005;242:20–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini- gastric bypass: short- and long-term outcome. Obes Surg. 2012;22:697–703.

    Article  PubMed  Google Scholar 

  11. 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;11:321–6.

    Article  PubMed  Google Scholar 

  12. Lee WJ, Lin YH. Single-anastomosis gastric bypass (SAGB): appraisal of clinical evidence. Obes Surg. 2014;24:1749–56.

    Article  PubMed  Google Scholar 

  13. 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 multicenter, randomized, open-label, non-inferiority trial. Lancet. 2019;393:1299–309.

    Article  PubMed  Google Scholar 

  14. Mahawar KK. Findings of YOMEGA trial need to be interpreted with caution (led to edit). Obes Surg. 2019; April 23 on line

  15. Lee WJ, Huang MT, Wang W, et al. Effects of obesity surgery on metabolic syndrome. Arch Surg. 2004;139(10):1088–92.

    Article  PubMed  Google Scholar 

  16. Wang FG, Yan WM, Yan M, et al. Outcomes of mini-vs roux-en-Y gastric bypass: a meta-analysis and systematic review. Int J Surg. 2018;56:7–14.

    Article  PubMed  Google Scholar 

  17. Quan Y, Huang A, Ye M, et al. Efficacy of laparoscopic mini gastric bypass for obesity and type 2 diabetes mellitus: a systematic review and meta-analysis. Gastroenterol Res Pract. 2015;2015:152852. 13 pages

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bhandari M, Nautiyal HK, Kosta S, et al. Comparison of one anastomosis gastric bypass (OAGB) and roux-en-Y gastric bypass (RYGB) for treatment of obesity: a five-year study. Surg Obes Relat Dis. 2019; May 25 on line first

  19. Jammu GS, Sharma R. A 7-year clinical audit of 1107 cases comparing sleeve gastrectomy, roux-en-Y gastric bypass, and mini-gastric bypass, to determine an effective and safe bariatric and metabolic procedure. Obes Surg. 2016;26(5):926–32.

    Article  PubMed  Google Scholar 

  20. Ruiz-Tovar J, Carbajo MA, Jimenez JM, et al. Long-term follow-up after sleeve gastrectomy versus roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a prospective randomized comparative study of weight loss and remission of co-morbidities. Surg Endos. 2019;33(2):401–10.

    Article  Google Scholar 

  21. Stenberg E, Szabo E, Agren G, et al. Closure of mesenteric defects in laparoscopic gastric bypass: a multicenter, randomized, parallel, open-label trial. Lancet. 2016;387(10026):1397–404.

    Article  PubMed  Google Scholar 

  22. Chowbey P, Baijal M, Kantharia NS, et al. Mesenteric defect closure decreases the incidence of internal hernia following laparoscopic roux-en-Y gastric bypass: a retrospective cohort study. Obes Surg. 2016;26(9):2029–34.

    Article  PubMed  Google Scholar 

  23. Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg. 2004;199:543–51.

    Article  PubMed  Google Scholar 

  24. Nguyen NT, Paya M, Stevens M, et al. The relationship between hospital volume and outcome in bariatric surgery at academic medical center. Ann Surg. 2004;240:586–94.

    PubMed  PubMed Central  Google Scholar 

  25. Buchwald H, Estok R, Fahrback K, et al. Trends in mortality in bariatric surgery a systematic review and meta analysis. Surgery. 2007;142:621–32.

    Article  PubMed  Google Scholar 

  26. The longitudinal assessment of bariatric surgery consortium. Peri-operative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361:445–54.

    Article  Google Scholar 

  27. Almalki O, Lee WJ, Chong K, et al. Laparoscopic gastric bypass for the treatment of type 2 diabetes: a comparison of roux-en-Y versus single anastomosis gastric bypass. Surg Obes Relat Dis. 2018;14(4):509–16.

    Article  PubMed  Google Scholar 

  28. Homan J, Boerboom A, Aarts E, et al. A longer biliopancreatic limb in roux-en-Y gastric bypass improves weight loss in the first year after surgery: results of a randomized controlled trial. Obes Surg. 2018;28(12):3744–55.

    Article  PubMed  Google Scholar 

  29. Murad Jr AJ, Cohen RV, de Godoy EP, et al. A prospective single-arm trial of modified long biliopancreatic and short alimentary limbs roux-en-Y gastric bypass in type 2 diabetes patients with morbid obesity. Obes Surg. 2018;28(3):599–605.

    Article  PubMed  Google Scholar 

  30. Boerboom A, Homan J, Arts E, et al. A long biliopancreatic and short alimentary limb results in more weight loss in revisional RYGB surgery. Outcomes of the randomized controlled ELEGANCE REDO trial. Surg Obes Relat Dis. 2019;15(1):60–72.

    Article  PubMed  Google Scholar 

  31. Miyachi T, Nagao M, Shikashi S, et al. Biliopancreatic limb plays an important role in metabolic improvement after duodenal-jejunal bypass in a rat model of diabetes. Surgery. 2016;159(5):1360–71.

    Article  PubMed  Google Scholar 

  32. Molinaro A, Wahlstrom A, Marschall HU. Role of bile acids in metabolic control. Trends Endocrinol Metab. 2018;29(1):31–41.

    Article  CAS  PubMed  Google Scholar 

  33. Ise I, Tanaka N, Imoto H, et al. Changes in enterohepatic circulation after duodenal-jejunal bypass and reabsorption of bile acids in the bilio-pancreatic limb. Obes Surg. 2019 (Febuary 25 on-line first;29:1901–10.

    Article  PubMed  Google Scholar 

  34. Mika A, Kaska L, Proczko-Stepaniak M, et al. Evidence that the length of bile loop determines serum bile acid concentration and glycemic control after bariatric surgery. Obes Surg. 2018;28(11):3405–14.

    Article  PubMed  Google Scholar 

  35. Zorrilla-Nunez LF, Campbell A, Giambartolomei G, et al. The importance of the biliopancreatic limb length in gastric bypass: a systematic review. Surg Obes Relat Dis. 2019;15(1):43–50.

    Article  PubMed  Google Scholar 

  36. Mingrone G, Panunz S, De Gaetamo A, et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-center, randomized controlled trials. Lancet. 2015;386:964–73.

    Article  PubMed  Google Scholar 

  37. Sethi M, Chau E, Youn A, et al. Long-term outcomes after biliopancreatic diversion with and without duodenal switch:2-, 5-, 10-year data. Surg Obes Relat Dis. 2016;12(9):1697–705.

    Article  PubMed  Google Scholar 

  38. Lee W, Wang W, Lee YC, et al. Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg. 2008;18:294–9.

    Article  PubMed  Google Scholar 

  39. Chen JC, Shen CY, Lee WJ, et al. Protein deficiency after gastric bypass: the role of common limb length in revision surgery. Surg Obes Relat Dis. 2019;15(3):441–6.

    Article  PubMed  Google Scholar 

  40. Chen CY, Lee WJ, Lee HM, et al. Laparoscopic conversion of gastric bypass complication to sleeve gastrectomy: technique and early results. Obes Surg. 2016;26:2014–21.

    Article  PubMed  Google Scholar 

  41. Lee WJ, Lee YC, Ser KH, et al. Revisional surgery for laparoscopic minigastric bypass. Surg Obes Relat Dis. 2011;7(4):486–91.

    Article  PubMed  Google Scholar 

  42. 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;22:1827–34.

    Article  PubMed  Google Scholar 

  43. Alkhalifah N, Lee WJ, Tan CH, et al. 15-year experience of laparoscopic single anastomosis (mini-)gastric bypass: comparison with other bariatric procedures. Surg Endosc. 2018;32(6):3024–31.

    Article  PubMed  Google Scholar 

  44. Gormsen J, Burcharth J, Gogenur I, et al. Prevalence and risk factors for chronic abdominal pain after roux-en-Y gastric bypass surgery: a cohort study. Ann Surg. 2019; April 1 on line first

  45. Higa K, Ho T, Tercero F, et al. Laparoscopic roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–25.

    Article  PubMed  Google Scholar 

  46. Angrisani L, Cutolo PP, Formisano G, et al. Laparoscopic adjustable gastric banding versus roux-en-Y gastric bypass: 10-year results of a prospective, randomized trial. Surg Obes Relat Dis. 2013;9(3):405–16.

    Article  PubMed  Google Scholar 

  47. Edholm D, Sevensson F, Naslund I, et al. Long-term results 11 years after primary gastric bypass in 384 patients. Surg Obes Relat Dis. 2013;9(5):708–13.

    Article  PubMed  Google Scholar 

  48. Obeid NR, Malick W, Concors SJ, et al. Long-term outcomes after roux-en-Y gastric bypass:10- to 13-year data. Surg Obes Relat Dis. 2016;12(1):11–22.

    Article  PubMed  Google Scholar 

  49. Mehaffey JH, Turrentine FE, Miller MS, et al. Roux-en-Y gastric bypass 10-year follow-up: the found poupulation. Surg Obes Relat Dis. 2016;12(4):778–83.

    Article  Google Scholar 

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Funding

This work was supported by a grant obtained from Ming-Sheng General Hospital (2014-A-01).

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Authors and Affiliations

  1. Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Taoyuan, Taiwan, Republic of China

    Wei-Jei Lee, Kong-Han Ser & Jung-Chien Chen

  2. Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia

    Owaid M. Almalki

  3. Department of International Business, Chien Hsin University of Science and Technology, Taoyuan City, Taiwan

    Yi-Chih Lee

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  1. Wei-Jei Lee
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Correspondence to Wei-Jei Lee.

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Lee, WJ., Almalki, O.M., Ser, KH. et al. Randomized Controlled Trial of One Anastomosis Gastric Bypass Versus Roux-En-Y Gastric Bypass for Obesity: Comparison of the YOMEGA and Taiwan Studies. OBES SURG 29, 3047–3053 (2019). https://doi.org/10.1007/s11695-019-04065-2

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