One Anastomosis Gastric Bypass in Patients with Gastrooesophageal Reflux Disease and/or Hiatus Hernia

Introduction One anastomosis gastric bypass (OAGB) offers favourable weight loss outcomes and is associated with reduced morbidity and mortality when compared to other mainstream bariatric procedures. However, a randomised trial reported a conversion rate to roux-en-Y configuration (RYC) of 3.1%, an...

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Bibliographic Details
Published in:Obesity surgery 2021-04, Vol.31 (4), p.1449-1454
Main Authors: Winstanley, Joseph, Ahmed, Salman, Courtney, Michael, Sam, Miraheal, Mahawar, Kamal
Format: Article
Language:English
Subjects:
Gastric Bypass
Gastroesophageal Reflux - surgery
Gastrointestinal surgery
Hernia, Hiatal - surgery
Hernias
Humans
Medicine
Medicine & Public Health
Obesity, Morbid - surgery
Original Contributions
Prospective Studies
Retrospective Studies
Surgery
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Summary:Introduction One anastomosis gastric bypass (OAGB) offers favourable weight loss outcomes and is associated with reduced morbidity and mortality when compared to other mainstream bariatric procedures. However, a randomised trial reported a conversion rate to roux-en-Y configuration (RYC) of 3.1%, and some surgeons consider the procedure unsuitable for patients with a preoperative hiatus hernia (HH) or symptoms of gastrooesophageal reflux disease (GORD). Methods We carried out a retrospective review of patients undergoing OAGB in our institution. Included were all patients on PPI for symptoms of GORD preoperatively, as well as patients with HH or oesophagitis on preoperative endoscopy. We recorded GORD outcomes as well as rates of conversion to RYC in patients. Results Medium term follow up data at 23–28 months was available for 89 patients. Of these, 63 had HH, 34 had preoperative GORD requiring PPI and 9 had confirmed oesophagitis. The conversion rate to RYC was nil (0/63) in patients with HH. At the same time, 14.7% (5/34) of patients with preop GORD on PPI required conversion to RYC at a median time interval of 16 months. In patients already on PPI preoperatively, 16/34 (47.1%) needed to continue on PPI long term. In patients with HH, 20.6% (13/63) suffered de novo GORD symptoms. Conclusion OAGB can be offered to patients with HH with acceptable GORD outcomes but caution is advised in patients with preoperative GORD symptoms. Larger prospective and randomised studies are required to further assess this subgroup.
ISSN:0960-8923
1708-0428
DOI:10.1007/s11695-020-05149-0