High rates of revision surgery have been reported for (LSG) laparoscopic sleeve gastrectomy , with (WR) weight regain as the most frequently reported cause. Roux-en-Y gastric bypass (RYGB) is the best and the most commonly performed revision procedure, whereas one-anastomosis gastric bypass (OAGB) is a less popular approach.
Roux-en-Y Gastric Bypass (RYGB):
Roux-en-Y gastric bypass (RYGB) is a type of weight-loss surgery or bariatric surgery.
RYGB done as a laparoscopic surgery, with small incisions in the abdomen.
This type of surgery is used to treat severe obesity, for people who have tried a lot of weight loss methods without long-term success, and for people with a body mass index (BMI) over 40. Or for people who have a body mass index between 35-40 but have health condition problems such as sleep apnea, high blood pressure, heart disease, or type 2 diabetes.
This surgery reduces the size of the upper stomach to a small pouch about the size of an egg.
To reduce the amount of food you can eat, the doctor does this by stapling off the upper section of the stomach.
The doctor then attaches this pouch directly to part of the small intestine called the Roux limb. This forms a “Y” shape.
The food you eat then bypasses the rest of the stomach and the upper part of your small intestine.
Risks of Roux-en-Y Gastric Bypass:
There were common risks followed by any surgery such as bleeding, infections, and blood clots.
Breathing problems also may occur because of general anesthesia.
There were possible problem over time like:
- Low levels of vitamins that’s taken daily.
- Low level of calcium and iron
- Weight regain
- Need for additional surgery
One-Anastomosis Gastric Bypass (OAGB):
OAGB is the third common bariatric procedure worldwide. This procedure combines restriction and malabsorption, which are achieved by creating a narrow and long gastric pouch and bypassing part of the small bowel (duodenum and part of the jejunum).
OAGB is simple procedure and effective in resolution of obesity, shorter operative time and low complication rates with long-term safety profile with regards to biliary reflux, risk of esophagogastric malignancies, and marginal ulcer.
Contraindication of One-Anastomosis Gastric Bypass (OAGB):
- These are drug/alcohol dependency.
- Unstable coronary artery disease.
- End-stage lung disorders.
- Severe heart failure.
- Patients receiving active cancer treatment.
- Portal hypertension.
- Crohn’s disease.
Complications of (OAGB):
- Staple line bleeding.
- Anastomotic leak.
- Stricture.
- Marginal ulcer.
- Surgical site infections.
- Port site hernia.
- Diarrhea.
Revisional Bariatric Surgery:
Revisional bariatric surgery is performed to fix or change a previous weight loss surgery.
Revisional surgeries are often more complex than initial bariatric surgeries, skilled surgeons have a wealth of experience performing gastric bypass revisions and gastric sleeve revisions.
It might be appropriate for the patient who had less-than-optimal weight loss or weight regain, or if he experienced complications from the original procedure.
Revisional RYGB and Revisional OAGB have comparable significant weight loss effects:
Both two procedures showed significant BMI reductions after revision surgery.
The weight loss effects of both RYGB and OAGB were almost equal. Data available from some retrospective comparisons of RYGB to OAGB after LSG showed significantly higher weight loss effects in the OAGB group than in the RYGB group.
Conclusion:
The two procedures had significant weight loss effects when performed for WR after LSG, with comparable resolution or improvement of associated medical problems.
But OAGB may have a greater chance of being the optimal revision procedure because it is a simpler and easier procedure if longer follow-up data are available.
After a two-year follow-up, both OAGB and RYGB were safe, with no significant differences in the occurrence of complications and nutritional deficits.