Early and intermediate term outcomes after laparoscopic one-anastomosis gastric bypass for morbidly obese patients: a single center experience
Mahmoud Haggag1, Ali Salem1, Ahmad M. Sultan1, Ahmed N. Elghawalby1, Rehab T. Eldesoky2, Sara A. Eldegwi2, Nabil Gad Elhak1, Ahmed Shehta1
1Department of General Surgery, Gastrointestinal Surgery Center, Mansoura University Faculty of Medicine, Mansoura, Egypt
2Department of Clinical Pathology, Mansoura University Faculty of Medicine, Mansoura, Egypt
Objective: To evaluate our outcomes of laparoscopic one-anastomosis gastric bypass (LOAGB) as a primary weight loss procedure. We evaluated the impact of biliary reflux by combination of upper endoscopy (UGIE), ambulatory pH metry, and ambulatory biliary reflux monitoring.
Material and Methods: We reviewed the data of patients who underwent LOAGB during the period between July 2015 till August 2018.
Results: Forty consecutive patients were included in the study. Thirty-seven patients (92.5%) had obesity related comorbidities. The median follow-up duration was 18 months (6-36 months). The 1-, 2-, and 3-years excess weight loss percentages were 53.1%, 60.4%, and 62.3%. At three years follow-up, complete remission of diabetes mellitus occurred in 7/7 patients (100%) and of hypertension in 4/7 patients (57.1%). Eighteen patients (45%) accepted to undergo UGIE with routine biopsies and evaluation of acidic and biliary reflux. All examined patients had negative acid reflux results according to ambulatory PH metry with median DeMeester score of 2 (0.3-8.7). According to ambulatory biliary reflux monitoring, 17/18 patients (94.1%) had posi- tive result. Only 6/18 patients (33.3%) had symptoms of biliary reflux and had positive symptom index on bilimetric study. Regarding UGIE, all patients had just gastritis and reflux esophagitis with no evidence of gross mucosal changes. Pathological examination of all routine biopsies did not show any sign of faveolar hyperplasia, atypia or malignancy.
Conclusion: LOAGB is a safe and efficient bariatric procedure with acceptable morbidity rate. LOAGB is not associated with significant biliary reflux or pathological changes in the esophagogastric mucosa.
Keywords: One-anastomosis gastric bypass, morbid obesity, early outcomes
The approval for this study was obtained from Mansoura University Institutional Research Board (Proposal No: MS.18.03.82, Date: 25.03.2018).
Concept - A.M.S., A.S., M.H.; Design - A.M.S., A.S., M.H.; Supervision -N.G.E., A.S.; Materials - All of authors; Data Collection and/ or Processing - A.S., M.H.; Analysis and/or Interpretation - A.S., M.H.; Literature Search- All of authors; Writing Manuscript - M.H., A.S., A.M.S., A.S.; Critical Reviews - All of authors.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.