One-Anastomosis Gastric Bypass Revision for Gastroesophageal Reflux Disease: Long Versus Short Biliopancreatic Limb Roux-en-Y Gastric Bypass

Purpose One-anastomosis gastric bypass (OAGB) may be associated with refractory gastroesophageal reflux disease (GERD). The nature of this GERD remains unclear. This complication can be treated either with an additional enteroenterostomy without shortening of gastric pouch (long biliopancreatic limb...

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Bibliographic Details
Published in:Obesity surgery 2022-04, Vol.32 (4), p.970-978
Main Authors: Tarhini, Ahmad, Rives-Lange, Claire, Jannot, Anne-Sophie, Baratte, Clement, Beaupel, Nathan, Guillet, Vincent, Krivan, Sylvia, Le Gall, Maude, Carette, Claire, Czernichow, Sebastien, Chevallier, Jean-Marc, Poghosyan, Tigran
Format: Article
Language:English
Subjects:
Body mass index
Diarrhea
Endoscopy
Gastroesophageal reflux
Gastrointestinal surgery
Life Sciences
Malnutrition
Medicine
Medicine & Public Health
Nutrition
Obesity
Original Contributions
Surgery
Ulcers
Weight control
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Summary:Purpose One-anastomosis gastric bypass (OAGB) may be associated with refractory gastroesophageal reflux disease (GERD). The nature of this GERD remains unclear. This complication can be treated either with an additional enteroenterostomy without shortening of gastric pouch (long biliopancreatic limb Roux-en-Y gastric bypass (L-BPL-RYGB)) or revision to conventional short biliopancreatic limb Roux-en-Y gastric bypass (S-BPL-RYGB). The objective of this study is to compare the aforementioned procedures in terms of efficacy on GERD symptoms. Materials and Methods Retrospective analysis between October 2012 and June 2020. Results Fifty-two patients underwent OAGB revision to S-BPL-RYGB ( n  = 21) or L-BPL-RYGB ( n  = 31) secondary to GERD. Investigation with pH impedance prior to revision was performed in 15 patients showing biliary reflux (BR) in 7 (46.6%), acid reflux (AR) in 6 (40%), and no confirmation in 2. Patients with AR had a revision to S-BPL-RYGB, whereas patients with BR underwent L-BPL-RYGB. Among the patients without pH metry results ( n  = 37), S-BPL-RYGB was performed for associated disabling digestive disorders or nutritional deficiencies. GERD was treated in 68% of patients with L-BPL-RYGB versus 95% of patients after S-BPL-RYGB. Patients, whose decision for revisional procedure was based on the results of pH impedance testing, did not reveal refractory GERD. Conclusion L-BPL-RYGB seems appropriate in patients with BR, whereas conversion to S-BPL-RYGB should be preferred if AR is present. Graphical Abstract
ISSN:0960-8923
1708-0428
DOI:10.1007/s11695-022-05892-6