One Anastomosis Gastric Bypass After Sleeve Gastrectomy Failure
Condition: Bariatric Surgery Candidate
Study type: Observational

Summary: 
      This study is a retrospective analysis of prospectively collected data on 582 obese patients.
      The primary aim of the study was to evaluate %Excess Weight Loss, Body Mass Index (BMI) and
      remission of comorbidity at mid- and long-term follow-up after One Anastomosis Gastric Bypass
      in subjects previously underwent Sleeve Gastrectomy. The secondary aim was to investigate the
      onset of esophagitis and gastritis at Upper Endoscopy (UE) and the presence of nutritional
      deficiencies in patients undergoing One Anastomosis Gastric Bypass as a redo surgery
    

Detailed description: 
      This study is a retrospective analysis of prospectively collected data on 582 obese patients.
      It was conducted according to the ethical principles stated in the Declaration of Helsinki.
      Written informed consent was obtained from all subjects. The study protocol was approved by
      the Regional Ethics Committee. From January 2014 to February 2019, morbid obesity patients
      who failed previous treatment with SG and referred to our bariatric center in the Department
      of General and Emergency Surgery of "A. Rizzoli" Hospital in Lacco Ameno (Naples, Italy) for
      a new bariatric procedure, were considered in the study. Redo surgery was only considered if
      patients still met the criteria for primary bariatric surgery according to guidelines [body
      mass index (BMI) >35 kg/m2 with co-morbidities, BMI >40 kg/m2] at the time clinical and
      anthropometrical revision8. A postoperative follow-up of at least 24 months was also
      considered inclusion criteria. Exclusion criteria were as follows: patients in whom Sleeve
      Gastrectomy was already performed as revision surgery; patients underwent any other abdominal
      surgical procedure after One Anastomosis Gastric Bypass not correlated to the bariatric
      procedure, the presence at baseline of esophagitis B according to the Los Angeles scale,
      Hiatal Hernia (HH) > 5 cm and history of GERD-related symptoms (i.e., heartburn, pyrosis,
      regurgitation) not responsive to proton pump inhibitors and/or severe Lower Esophageal
      Sfinter incontinence. All procedures were performed by the same experienced bariatric
      surgeons.

      Pre-operative evaluation All patients underwent a multidisciplinary preoperative evaluation
      including anthropometric measurements (height in cm, weight in kg, Body Mass Index in kg/m2),
      comorbidity evaluation, preoperative Upper Endoscopy with Helicobacter Pylori test, abdomen
      ultrasound, chest x-ray and nutritional status evaluation.

      Radiographic barium swallow test was performed for the diagnosis of HH or presence of gastric
      fundus. Barium swallow X-ray protocol consisted of five swallows of barium always using the
      same amount of liquid; anteroposterior and oblique views were obtained in upright and supine
      positions. Measurements were done using a standardized protocol: a distance of more than 2 cm
      between the gastroesophageal junction and the diaphragmatic hiatus was defined as a sliding
      Hiatal Hernia. Preoperative assessments of patient eligibility for bariatric surgery included
      consultation with the multidisciplinary committee (surgeon, radiologist, diabetologist and
      psychiatrist) to exclude patients with non-adjusted eating patterns or eating disorders.

      Failure of Sleeve Gastrectomy was defined as a consequence of Insufficient Weight Loss or
      Weight Regain. Insufficient Weight Loss or Weight Regain were analyzed considering the
      modifications of the percentage of excess weight loss <50% and/or the percentage of total
      weight loss <25%. A failure of Sleeve Gastrectomy was recognized if the subject was not able
      to reduce the Body Mass Index <35 with the persistence of co-morbidity or Body Mass Index <40
      at least 2-year after the primary surgery.
    

Intervention name(s): One anastomosis gastric bypass
Intervention type(s): Procedure
Intervention description(s): The linear stapler divides the stomach horizontally at the junction of the corpus and antrum at the level of crow's foot. In cases where the pre-operative study has shown the presence of the gastric fundus, if possible the fundus was dissected and a long, narrow gastric pouch was designed starting from beyond the crow's foot to just lateral the angle of His over a 42-Fr orogastric tube. Gastrojejunostomy was then performed between 200-220 cm distally to the ligament of Treitz using a 45-mm.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Patients underwent to One anastomosis gastric bypass after sleeve gastrectomy failure
      
Keywords: Sleeve gastrectomy; One Anastomosis gastric bypass