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OAGB

Background OAGB

The one-anastomosis gastric bypass or mini-bypass is the third most commonly performed bariatric procedure in the world.

One Anastomosis (Mini) Gastric bypass (MGB-OAGB) was first described by Rutledge in 1997 and reported in 2001. It is a modification of the Mason’s loop gastric bypass.

The OAGB is a simplified version of a traditional Roux-en-Y gastric bypass with anastomosing a loop of jejunum to a long, narrow, gastric pouch created 2-3 cm below the crow’s foot. It was described as easier to perform and eliminating the need of creation of the roux limb.

The OAGB follows the same underlying principles that induce weight loss as other bypass procedures: by reducing the volume of the stomach (restrictive) and by decreasing the length of jejunum that is able to digest and absorb nutrients (malabsorption). Also in this procedure there are metabolic effects due to changes in patients' gut hormone profiles. The advantages of the procedure include shorter operative time, simplicity, a shorter learning curve, efficacy, and ease of revision and reversal.

Indications OAGB

  • Previous non-surgical attempts at weight loss for a minimum of 1 year.
  • Willingness to adopt both pre- and postoperative weight-loss behaviours.
  • Body Mass Index (BMI) ≥ 40 kg/m².
  • BMI of 35-45 kg/m² with a major comorbidity (e.g. hypertension).
  • No enteroenterostomy: no intussusception, less internal hernia, …
  • Less staplers, less expensive

Contraindications OAGB

  • High anesthetic risk
  • Barrett's esophagus
  • Severe Gerd

Relative contraindications OAGB

  • Diabetes type 1
  • Crohn's disease
  • Liver cirrhosis
  • Laparotomy
  • Large hiatal hernia
  • GERD

Possible complications OAGB

  • Immediate
    • Staple line bleeding and leakage
    • Trauma and thermal injury to local viscera, including the pancreas and vagus nerves.
  • Early
    • Staple line leak.
    • Outlet obstruction
    • Afferent loop syndrome
    • Port site hernia.
    • Marginal ulceration due to staple line infection
    • Chest infection.
    • Wound infection.
    • Deep vein thrombosis.
    • Pulmonary embolism.
  • Chronic/Late
    • GERD
    • Potential bile reflux
    • Internal herniation (less frequent than RNY gastric bypass)
    • Marginal ulceration
    • Malnutrition
    • Diarrhea