Minimally Invasive & Bariatric Surgery, Gastrointestinal Bariatric and Metabolic Center (GBMC) -Jordan Hospital, Queen Noor St., 4th Circle, P.O BOX 3073, Amman, 11181, Jordan.
Clinical Affairs and Research, Mohak Bariatric and Robotics, Indore, India.
Obes Surg. 2021 Apr;31(4):1411-1421. doi: 10.1007/s11695-021-05249-5. Epub 2021 Jan 31.
One anastomosis gastric bypass (OAGB) has become one of the most commonly performed gastric bypass procedures in some countries.
To assess how surgeons viewed the OAGB, perceptions, indications, techniques, and outcomes, as well as the incidence of short- and long-term complications and how they were managed worldwide.
A questionnaire was sent to all IFSO members in all 5 chapters to study the pattern of practice and outcomes of OAGB.
Seven hundred and forty-two surgeons responded. The most commonly performed procedures were sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and OAGB. Preoperatively, 70% of the surgeons performed endoscopy routinely. In regards to weight loss, 83% (570 surgeons) responded that OAGB produces better weight loss than SG, and 49% (342 surgeons) responded that OAGB produces better weight loss than RYGB. The most common length of the biliopancreatic limb (BPL) utilized was 200 cm. Sixty-seven percent of surgeons did not measure the total length of the small bowel. In patients with reflux disease and history of smoking, 53% and 22% of surgeons respectively still offered OAGB as a treatment option. Postoperatively, leak was documented in 963 patients, and it was the leading cause for mortality. Leak management was conservative in 35%. Conversion to RYGB was performed in 31%. In 16% the anastomosis was reinforced, 6% of the patients were reversed, and other procedures were performed in 12%. Revision of OAGB for malnutrition/steatorrhea or severe bile reflux was reported at least once by 37% and 45% of surgeons, respectively (200 cm was the most commonly encountered biliopancreatic limb BPL in those revised for malnutrition). Most common strategy for revision was conversion to RYGB (43%), reversal to normal anatomy (32%), shortening of the BPL (20%), and conversion to SG (5%). Nevertheless, 5 out of 98 mortalities (5%) were due to liver failure/malnutrition.
There are infrequent but potentially severe specific complications including malnutrition, liver failure, and bile reflux that may require surgical correction after OAGB.
单吻合口胃旁路术（OAGB）已成为一些国家最常施行的胃旁路术式之一。
评估全球外科医生对 OAGB 的看法、手术适应证、手术技术和手术结果，以及短期和长期并发症的发生率和处理方法。
向 IFSO 所有 5 个分会的所有成员发送问卷，以研究 OAGB 的手术模式和结果。
742 名外科医生作出回应。最常施行的手术是袖状胃切除术（SG）、Roux-en-Y 胃旁路术（RYGB）和 OAGB。术前 70%的外科医生常规进行内镜检查。关于减重效果，83%（570 名外科医生）的外科医生认为 OAGB 比 SG 减重效果更好，49%（342 名外科医生）的外科医生认为 OAGB 比 RYGB 减重效果更好。最常用的胆胰支长度为 200cm。67%的外科医生不测量小肠总长度。对于有反流病和吸烟史的患者，53%和 22%的外科医生仍将 OAGB 作为治疗选择。术后有 963 例患者记录到吻合口漏，这是导致死亡率的主要原因。35%的患者采用保守方法处理吻合口漏。31%的患者改行 RYGB。16%的患者进行吻合口加固，6%的患者行反转术，12%的患者行其他手术。37%和 45%的外科医生至少报告过一次因营养不良/脂肪泻或严重胆汁反流而行 OAGB 翻修术（在因营养不良而行翻修术的患者中，最常见的胆胰支长度为 200cm）。最常见的翻修策略是改行 RYGB（43%）、恢复正常解剖结构（32%）、缩短胆胰支（20%）和改行 SG（5%）。尽管如此，98 例死亡病例中有 5 例（5%）是由于肝功能衰竭/营养不良引起的。
OAGB 术后可能需要手术矫正罕见但潜在严重的特定并发症，包括营养不良、肝功能衰竭和胆汁反流。
