Biliary reflux after one anastomosis gastric bypass

Abstract

Introduction: One-anastomosis gastric bypass is one of the most popular bariatric procedure in the world. Nevertheless, there is ?ontroversy remains regarding biliary reflux after mini-gastric bypass/one-anastomosis gastric bypass (MGB/OAGB). The aim of this study was to analyze biliary reflux and its potential long-term consequences on esofagogastric mucosae in OAGB operated patients.

Methods: Immediate and long-term outcomes (up to 30 months, mean 12 month) in a cohort of 70 patients undergoing surgery between 2014 and 2017 were analyzed. Patients were divided into two clinical groups, depending on the technique of gastroenteroanastomosis. A standard five-port laparoscopic technique was used. The first group included 32 patients who underwent MGB in a modified way in our clinic with the making of hand-sewn gastroenteroanastomosis. 38 patients were used the traditional technique with the making of anastomosis with using a linear stapler with a 45 mm blue cartridge. Then, mean 12 months after MGB, all patients was filled out a reflux symptom questionnaire. A gastroscopy with biopsies was done for all patients with a bile-reflux positive symptoms.

Results: The number of patients who underwent surgery were 70 (mean body mass index 46 kg/m2). Mean percent excess weight loss (%EWL) at 12 months was 74.3%. Comorbidity resolution, determined by medication use, showed a reduction in diabetes (71.8% to 15.6%), hypertension (37.2% to 21.4%) and hypercholesterolaemia (40.4% to 13.4%). The absence of enterogastric biliary reflux was observed in 81.2% of patients in the study group, the absence of an ulcer of the gastroenteroanastomosis was observed in 97% of the study group, respectively. There was one death unrelated to surgery.

Conclusions: Modified MGBP appears to be a safe and effective operation for the morbidly obese. It is durable, with good weight loss at up to 12 months post-surgery. The proposed technique for the formation of hand-sewn gastroenteroanastomosis allows decreasing the postoperative bile reflux up to 8,8%.