Division of Minimally Invasive and Gastrointestinal Surgery, Medical College of Wisconsin (MCW), Milwaukee, Wisconsin.
El Paso Bariatric Surgery, El Paso, Texas.
Surg Obes Relat Dis. 2024 Dec;20(12):1351-1358. doi: 10.1016/j.soard.2024.08.035. Epub 2024 Sep 10.
One anastomosis gastric bypass (OAGB) is an American Society for Metabolic and Bariatric Surgery (ASMBS)-endorsed bariatric surgery. As utilization of OAGB increases, it is important that the safety profile of OAGB be rigorously assessed.
We studied the 30-day safety of OAGB compared to a similar gastro-jejunal anastomotic procedure, Roux-en-Y gastric bypass (RYGB).
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) participating bariatric centers in the United States.
A matched case-control study was conducted of patients who underwent primary gastric bypass surgery 2021-2022, identified in the MBSAQIP database. Each patient who underwent OAGB was matched to 4 controls who underwent RYGB on age (±10), sex, race, body mass index (BMI) (±5 kg/m), preoperative functional status, American Society of Anesthesiologists (ASA) classification, and 13 comorbidities. Univariate and multivariate regression analyses were performed.
A total of 1569 patients who underwent OAGB were matched to 6276 controls. Matched baseline characteristics were similar between groups. Operative time, length of stay (LOS), and overall complication rate were lower in the OAGB cohort (P < .001) with higher 30-day BMI loss percentage (P = .048). Specifically, OAGB was associated with a significantly lower bowel obstruction rate, as compared to RYGB (.1% versus 1.0%, P < .001). On logistic regression adjusting for all variables used in matching, OAGB was associated with a 27% decrease in overall complication rate (odds ratio [OR] .73, 95% confidence interval [CI] .62-.87, P < .001).
Although OAGB is minimally utilized, the 30-day safety profile appears favorable. As compared to RYGB, OAGB was associated with shorter operative time and LOS, and a lower complication rate, partially due to minimization of small bowel obstructions with a loop anatomy. Further evidence in the comparative long-term safety profile is still needed.
单吻合口胃旁路术（OAGB）是美国代谢与减重外科学会（ASMBS）认可的减重手术之一。随着 OAGB 的应用日益增多，严格评估 OAGB 的安全性显得尤为重要。
我们比较了 OAGB 与类似的胃空肠吻合术（RYGB）的 30 天安全性。
美国代谢与减重外科学会认证和质量改进计划（MBSAQIP）参与的减重中心。
在 MBSAQIP 数据库中，对 2021 年至 2022 年接受初次胃旁路手术的患者进行了一项 OAGB 与 RYGB 的病例对照研究。每位接受 OAGB 的患者与 4 位接受 RYGB 的患者进行年龄（±10）、性别、种族、体重指数（BMI）（±5kg/m）、术前功能状态、美国麻醉医师协会（ASA）分级和 13 种合并症相匹配。进行了单变量和多变量回归分析。
共有 1569 例接受 OAGB 的患者与 6276 例对照组患者相匹配。两组患者的基线特征相似。OAGB 组的手术时间、住院时间（LOS）和总体并发症发生率较低（P＜0.001），30 天 BMI 下降百分比较高（P=0.048）。具体而言，与 RYGB 相比，OAGB 的肠梗阻发生率显著降低（0.1%对 1.0%，P＜0.001）。在调整匹配中使用的所有变量的逻辑回归中，OAGB 与总体并发症发生率降低 27%相关（比值比[OR]0.73，95%置信区间[CI]0.62-0.87，P＜0.001）。
尽管 OAGB 的应用较少，但 30 天安全性似乎良好。与 RYGB 相比，OAGB 手术时间和 LOS 较短，并发症发生率较低，部分原因是Loop 解剖学减少了小肠梗阻。仍需要进一步的证据来评估比较长期的安全性。
