Visceral Surgery

Background:One-anastomosis gastric bypass (OAGB) has become an established procedure in the surgical treatment of obesity with comparable results to Roux-Y gastric bypass in terms of weight loss and improvement of obesity-associated comorbidities.Biliary reflux is a long-term complication of OAGB.In addition to restricted quality of life, it is feared that chronic biliary reflux promotes development of gastric or esophageal carcinomas. Material and methods:Frequency of clinically relevant biliary reflux after OAGB and its conservative and surgical therapeutic options and their effectiveness.Retrospective evaluation of 3913 patients who underwent OAGB as primary surgery at Schoen Clinic Hamburg Eilbek (Germany) between September 2016 and September 2025.Evaluation of the frequency of clinically relevant biliary reflux, which led to surgical revision with conversion of the OAGB into a Roux-Y-situation after conservative therapy options had been exhausted. Results:In the follow-up period up to September 2025, a total of 196 patients (5,01%) were converted into Roux-Y gastric bypass.In 165 patients (4,22%) biliary reflux was predominant and the biliary loop was distalized.In addition, 23 patients (0,59%) had a chronic anastomotic ulcer, which led to a resection of the gastrojejunostomy and a new anastomosis was performed simultaneously.Postoperative early complications (< 30 days) occurred in one patient (0,51%) with hematemesis, two patients (1,04%) with bleeding at the side of the jejuno-jejunostomy which required a laparoscopic revision and four patients (2.07%) with abdominal wall hematoma.Late complications observed: persistent reflux symptoms n=2 (1,04%) and dumping syndrome n=2 (1.04%).Recurrence of anastomotic ulcer n=5 (2,55% of revisional cases resp.0,13% of all cases). Conclusion:Biliary reflux is a rare long-term complication after OAGB.If conservative therapy attempts fail in the long term and the level of suffering is high, conversion into a Roux-Y-situation is a successful treatment option with low complication rates and high patient satisfaction.