Key result
One anastomosis gastric bypass resulted in significantly greater weight loss and fewer severe complications (2.7% vs. 11.8%) compared to sleeve gastrectomy in super-super-obese patients.
Why the study?
Bariatric surgery in super-super-obese patients remains challenging due to intraabdominal fat masses, liver volume, and comorbidities, prompting comparison between one anastomosis gastric bypass and laparoscopic sleeve gastrectomy.
Does one anastomosis gastric bypass improve weight loss and reduce complications compared to laparoscopic sleeve gastrectomy in super-super-obese patients?
Cohort (n=243)
No
Does one anastomosis gastric bypass improve weight loss and reduce complications compared to laparoscopic sleeve gastrectomy in super-super-obese patients?
In super-super-obese patients, one anastomosis gastric bypass is associated with superior weight loss, shorter operative time, and fewer severe complications compared to laparoscopic sleeve gastrectomy.
BACKGROUND: Bariatric surgery in super-super-obese (SSO) patients remains a continuous challenge due to intraabdominal fat masses, higher liver volume and existing comorbidities. A convenient procedure in SSO patients is one anastomosis gastric bypass (OAGB). The aim of this study was to compare the outcome of SSO patients undergoing OAGB in comparison to laparoscopic sleeve gastrectomy (LSG). METHODS: We retrospectively reviewed data from SSO patients who underwent OAGB and LSG in our institution between 2008 and 2020. Primary endpoints included percentage total body weight loss and percentage BMI loss at 12, 24, and 36 months after the operation. Secondary endpoints were perioperative complications, procedure length, length of hospital stay and outcome of comorbidities. RESULTS: 243 patients were included in this study. 93 patients underwent LSG and 150 underwent OAGB. At any of the time points evaluated, weight loss in patients after OAGB was greater than in LSG patients, while procedure length was significantly shorter for OAGB than LSG (81.4 vs. 92.1 min, p-value < 0.001). Additionally, mean length of hospital stay was shorter in the OAGB group (3.4 vs. 4.5 days, p-value < 0.001). There were more severe complications (Clavien-Dindo ≥ 3a) in the LSG group (11.8% vs 2.7%, p-value = 0.005). CONCLUSION: In this retrospective analysis, OAGB was superior to LSG in terms of weight loss in SSO patients. Procedure length and hospital stay were shorter after OAGB in comparison to LSG and there were fewer severe complications. OAGB can therefore be regarded a safe and effective treatment modality for SSO patients.
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Schmitz et al. (2021) conducted a cohort in Super-super-obesity (n=243). One anastomosis gastric bypass (OAGB) vs. Laparoscopic sleeve gastrectomy (LSG) was evaluated on Percentage total body weight loss and percentage BMI loss at 12, 24, and 36 months. One anastomosis gastric bypass resulted in significantly greater weight loss and fewer severe complications (2.7% vs. 11.8%) compared to sleeve gastrectomy in super-super-obese patients.
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