Revisional Laparoscopic One Anastomosis Gastric Bypass for Weight Loss Failure after Restrictive Procedures

Introduction Patients undergoing primary restrictive bariatric metabolic surgery procedures (BMS) are at risk of having suboptimal initial response (SIR) and late postoperative clinical deterioration (LPCD), which can be an indication for conversion. Roux-en-Y gastric bypass (RYGB) is currently the most common conversion procedure. Still, one anastomosis gastric bypass (OAGB) has emerged as a viable alternative conversion procedure to RYGB, due to its relative technical simplicity and easy reversibility. We aim to assess the safety and effectiveness of laparoscopic OAGB as a conversion procedure for managing SIR or LPCD after primary restrictive BMS procedures. Methods A retrospective observational study was conducted at our university hospital between July 2017 and December 2024. It included patients with failed primary restrictive bariatric procedures. All patients underwent conversion to OAGB and were followed for a minimum of 5 years. Results 115 patients completed the 5-year follow-up. The early postoperative complication rate was 7.6%, and the reoperation rate was 1.6%. After 5 years, late postoperative complications occurred in 11.3% of patients. The mean body mass index loss (BMIL%) was 28.59% and 17.4% of patients had SIR during the study period. Significant improvement in obesity-associated medical problems was observed after 5 years, with remission rates of 70.8% for type 2 diabetes mellitus, 82.4% for dyslipidemia, 64.1% for sleep apnea, and 61.3% for hypertension. Conclusion OAGB is a safe and effective conversion procedure for the management of SIR and LPCD after restrictive procedures, achieving favorable mid-term outcomes.