Purpose
Many studies have reported the advantages of one-anastomosis gastric bypass (OAGB) over other bariatric procedures. Despite that, there are still concerns about the risk for biliary reflux gastritis, esophagitis, and consequently gastric pouch/esophageal cancer after OAGB. The anastomosis during OAGB can be handsewn or mechanical using a linear stapler, with the stapler being the preferred method. There is currently a knowledge gap regarding the outcomes for different anastomosis techniques during OAGB. We proposed a new technique for performing the anastomosis in OAGB (a totally handsewn anastomosis creating a double mucosal intraluminal flap). This technique has the potential to minimize possible biliary reflux and its consequences. This study was done to evaluate the feasibility, safety, and efficacy of this new technique.
Patients and methods
The included patients underwent OAGB using the new technique. Patients were regularly followed up for a minimum of 12 months. At each visit, the percentage of excess weight loss and subjective symptoms of gastroesophageal reflux disease (GERD) using the GERD-Health-Related Quality of Life score were recorded. Patients were evaluated with an upper gastrointestinal endoscopy after 1 year.
Results
A total of 36 patients completed the minimum 1-year follow-up period after the operation. The mean operative time was 65 ± 23 min with no cases of conversion to open surgery. No major postoperative complications or mortality was recorded during the follow-up period. After 1 year, the mean total weight loss % was 39.4 ± 9.3%, the mean excess weight loss % was 78 ± 14%, and the mean GERD-Health-Related Quality of Life score decreased from 24 ± 6 preoperatively to 12 ± 6. Endoscopic findings revealed improvement of esophagitis in 10 of 12 patients. No cases of de novo esophagitis nor cases of significant bile pooling at gastric pouch were detected during endoscopy after 1 year.
Conclusion
Our new handsewn OAGB technique is a feasible and safe technique with results comparable to the standard stapled technique. It may minimize possible future bile reflux.