Revisional Roux-en-Y gastric bypass versus revisional one-anastomosis gastric bypass after failed sleeve gastrectomy: a randomized controlled trial

Hany, M.; Zidan, A.; Elmongui, E.; Torensma, B. (2022)

Article / Letter to editor

Background High rates of revision surgery have been reported for laparoscopic sleeve gastrectomy (LSG), with weight regain (WR) as the most frequently reported cause. Roux-en-Y gastric bypass (RYGB) is the most commonly performed revision procedure, whereas one-anastomosis gastric bypass (OAGB) is a less popular approach.Methods A single-blinded randomized controlled trial was conducted. One hundred seventy-six patients were enrolled and randomized. After loss to follow-up, 80 patients for RYGB and 80 patients for OAGB were analyzed, with a 2-year follow-up. Patients with grade B or higher gastroesophageal reflux disease (GERD) were excluded. Early and late postoperative complications were recorded. Body mass index (BMI), percentage of excess BMI loss (%EBMIL), nutritional laboratory test results, and the resolution of associated medical problems were assessed after revision surgery.Results After 2 years, both groups achieved significantly lower BMI than their post-LSG nadir BMI (p < 0.001). The %EBMIL changes showed significantly faster weight loss in the OAGB group than in the RYGB at the 6-month follow-up (mean difference: 8.5%, 95% confidence interval [CI]: 0.2 to 16.9%). However, at 1-year and 2-year follow-ups, the differences were statistically insignificant (p > 0.05). Early and late complications were similar between two groups. Both groups showed improvement or resolution of associated medical problems, with no statistically significant differences after 2 years (p = 1.00).Conclusion Both revisional RYGB and OAGB have comparable significant weight loss effects when performed for WR after LSG. After a 2-year follow-up, both procedures were safe, with no significant differences in the occurrence of complications and nutritional deficits.

• Laparoscopic sleeve gastrectomy
• Weight regain
• Revisional bariatric surgery
• Roux-en-Y gastric bypass (RYGB)
• One-anastomosis gastric bypass (OAGB)

• All authors: Hany, M.; Zidan, A.; Elmongui, E.; Torensma, B.
• Date: 2022-09-13
• Journal: Obesity Surgery
• Volume: 32
• Pages: 3491 - 3503
• DOI: doi:10.1007/s11695-022-06266-8
• Link: https://link.springer.com/article/10.1007/s11695-022-06266-8