One-Anastomosis Gastric Bypass by Laparoscopy: Results of the First 209 Patients

Background: One-Anastomosis Gastric Bypass (OAGB) by laparoscopy consists of constructing a divided 25-ml (estimated) gastric pouch between the esophago-gastric junction and the crow's foot level, parallel to the lesser curvature, which is anastomosed latero-laterally to a jejunal loop 200 cm distal to the ligament of Treitz. Methods: The results of our first 209 OAGB patients operated from July 2002 to June 2004 are reported. Mean age was 41 years (14-66), BMI 48 (39-86) and mean excess body weight 66 kg (35-220). In 144 patients, OAGB was the only operation performed, and in 61 patients it was accompanied by other surgery (18 cholecystectomies, 5 incisional hernia repairs, and 38 adhesiolysis), and in 4 patients a restrictive bariatric operation had been performed previously. Results: 2 patients (0.9%) were converted to open surgery due to uncontrollable bleeding. 3 patients (1.4%) needed re-operation in the immediate postoperative period. 5 patients (2.3%) needed prolonged hospital stay due to acute pancreatitis in 1 and anastomotic leakage in 4, all resolving with conservative treatment. 2 patients died (0.9%), 1 from fulminant pulmonary thromboembolism and 1 from nosocomial pneumonia. Long-term complications have occurred in only 2 patients who developed clinically significant iron-deficiency anemia. Mean excess weight loss was 75% after 1 year and >80% at 2 years. Conclusion: OAGB is a simple, safe and effective operation with less perioperative risk than conventional gastric bypass, quicker return to normal activities, and better quality of life.