Conte Luigi Eduardo, Sensi Bruno, Griguolo Giulia, Orsi Michela, Cutrupi Francesco, Serio Francesca, Conti Giulia, Campanelli Michela, Benavoli Domenico, Gentileschi Paolo
University of Rome "Tor Vergata", Rome, Italy.
Unità di Chirurgia Generale Ospedale San Giovanni Decollato-Andosilla, Civita Castellana, Viterbo, Italy.
Updates Surg. 2025 Aug 2. doi: 10.1007/s13304-025-02329-4.
One anastomosis gastric bypass (OAGB) is gaining popularity among bariatric procedures. However, data on the number and outcomes of revisional surgeries is scarce. This study included patients undergoing OAGB revision in a high-volume centre between January 2020 and October 2024. The study evaluates the indication for revision, the type of procedure performed, and the success of revisional surgery, assessed by symptom resolution or percent excess weight loss (%EWL) > 40% at 2 years. OAGB was performed on 3280 patients, of which 52 (1.6%) necessitated surgical revision for late complications as well as 18 patients who had their primary OAGB elsewhere. A total of 68 patients (47 females, 21 males) underwent OAGB revision. The mean time to revision after primary OAGB was 28 months. Indications for revision in the 68 patients were recurrent weight gain (51.5%, 0.73% of the total), severe bile reflux (29.4%, 0.52% of the total), marginal ulcers (7.4%, 0.12% of the total), excessive malabsorption (5.9%, 0.06% of the total), and stenosis (5.9%, 0.12% of the total). Revisional procedures in the 68 patients included biliary-pancreatic limb lengthening (47%), conversion to RYGB (29.4%), redo gastro-jejunal anastomosis (13.3%), biliary-pancreatic limb shortening (5.9%), and pouch resizing (4.4%). There were no major postoperative complications and 5.8% minor complications, all managed conservatively. At 20 months, 98.5% of revisional surgeries were successful, with complete symptom resolution for reflux, anastomotic ulcers and stenosis. The mean of %EWL in the recurrent weight gain group was 33.7%, 57.4% and 84% at 3 months, 1 year and 2 years. OAGB appears to be a safe procedure with a low revision rate. When necessary, surgical revision procedures can be tailored and have a high success rates and low morbidity. A management algorithm has been developed and proposed.
单吻合口胃旁路术（OAGB）在减肥手术中越来越受欢迎。然而，关于翻修手术的数量和结果的数据却很稀少。本研究纳入了2020年1月至2024年10月期间在一家大型中心接受OAGB翻修的患者。该研究评估了翻修的指征、所进行的手术类型以及翻修手术的成功率，通过症状缓解或2年时超重减轻百分比（%EWL）>40%来评估。对3280例患者实施了OAGB，其中52例（1.6%）因晚期并发症需要进行手术翻修，另有18例在其他地方接受了初次OAGB手术。共有68例患者（47例女性，21例男性）接受了OAGB翻修。初次OAGB后至翻修的平均时间为28个月。68例患者的翻修指征包括体重反复增加（51.5%，占总数的0.73%）、严重胆汁反流（29.4%，占总数的0.52%）、边缘溃疡（7.4%，占总数的0.12%）、过度吸收不良（5.9%，占总数的0.06%）和狭窄（5.9%，占总数的0.12%）。68例患者的翻修手术包括胆胰支延长（47%）、转为RYGB（29.4%）、再次胃空肠吻合（13.3%）、胆胰支缩短（5.9%）和胃囊调整大小（4.4%）。术后无重大并发症，轻微并发症发生率为5.8%，均经保守处理。在20个月时，98.5%的翻修手术成功，反流、吻合口溃疡和狭窄的症状完全缓解。体重反复增加组在3个月、1年和2年时的%EWL平均值分别为33.7%、57.4%和84%。OAGB似乎是一种安全的手术，翻修率较低。必要时，手术翻修程序可以量身定制，成功率高且发病率低。已制定并提出了一种管理算法。
