Abstract Background The common indications for revision of Sleeve gastrectomy are for gastroesophageal reflux disease (GERD) or experience inadequate weight loss or weight regain. Frequently performed revisional procedures are Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB). While both techniques are widely utilised, their comparative effectiveness and safety remain important areas of clinical investigation. Aim To investigate the clinical outcomes of post Sleeve Gastrectomy revisions to RYGB versus OAGB through a systematic review and meta-analysis of comparative studies. Methods A comprehensive search of PubMed, Embase, Cochrane CENTRAL, and Web of Science was conducted up to January 2025, following PRISMA guidelines. Eligible studies included direct comparisons of revisional RYGB and OAGB after primary sleeve gastrectomy and reported on at least one of the following outcomes: gastroesophageal reflux disease (GERD), percentage total weight loss (%TWL), percentage excess weight loss (%EWL), remission of diabetes mellitus, hypertension, obstructive sleep apnoea (OSA), Barrett’s Oesophagus, Oesophagitis, complication rates (bleeding, anastomotic leak, reoperation), or operative duration. Eight studies met the inclusion criteria, comprising one randomised controlled trial, one retrospective cross-sectional study, one case-control study, one multi-centre study, and several single-centre comparative cohort studies. Results A total of 880 patients were included—459 underwent RYGB and 421 underwent OAGB. The primary outcome of interest was GERD prevalence, which was significantly lower following RYGB (10.0%) whilst has higher with OAGB (15.4%) that is statistically significant (P 0.0003). RYGB also consistently demonstrated superior GERD remission rates across studies over OAGB. Patients who underwent OAGB had a higher mean pre-operative BMI, suggesting it may be selected more often for individuals with greater baseline obesity. Weight loss outcomes, including percentage total weight loss, were higher in the OAGB group, and the difference was statistically significant (P 0.00001). Both procedures were effective in resolving diabetes, hypertension, and OSA, with OAGB showing slightly better diabetes control in several cohorts. Complication rates—including bleeding, anastomotic leak, and reoperations were low and comparable between groups. Operative duration tended to be shorter for OAGB. Conclusion Both RYGB and OAGB are effective and safe revisional procedures following primary sleeve gastrectomy, addressing both GERD management and weight-related issues. RYGB may be more effective for GERD resolution, while OAGB may be preferred in patients with higher BMI or when greater weight loss is desired. The inclusion of studies with diverse methodologies—including randomised, multi-center, and observational designs strengthens these findings. Surgical approach should be individualised based on patient profile, clinical goals, and institutional expertise.
Gowda et al. (Thu,) studied this question.