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. 2022 Apr;32(4):970-978.
doi: 10.1007/s11695-022-05892-6. Epub 2022 Jan 17.

One-Anastomosis Gastric Bypass Revision for Gastroesophageal Reflux Disease: Long Versus Short Biliopancreatic Limb Roux-en-Y Gastric Bypass

Ahmad Tarhini  1   2 , Claire Rives-Lange  1   3 , Anne-Sophie Jannot  1   4 , Clement Baratte  1   2 , Nathan Beaupel  1 , Vincent Guillet  1   2 , Sylvia Krivan  5 , Maude Le Gall  1   6 , Claire Carette  1   3 , Sebastien Czernichow  1   3   7 , Jean-Marc Chevallier  1   2 , Tigran Poghosyan  8   9   10
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One-Anastomosis Gastric Bypass Revision for Gastroesophageal Reflux Disease: Long Versus Short Biliopancreatic Limb Roux-en-Y Gastric Bypass

Ahmad Tarhini et al. Obes Surg. 2022 Apr.

Abstract

Purpose: One-anastomosis gastric bypass (OAGB) may be associated with refractory gastroesophageal reflux disease (GERD). The nature of this GERD remains unclear. This complication can be treated either with an additional enteroenterostomy without shortening of gastric pouch (long biliopancreatic limb Roux-en-Y gastric bypass (L-BPL-RYGB)) or revision to conventional short biliopancreatic limb Roux-en-Y gastric bypass (S-BPL-RYGB). The objective of this study is to compare the aforementioned procedures in terms of efficacy on GERD symptoms.

Materials and methods: Retrospective analysis between October 2012 and June 2020.

Results: Fifty-two patients underwent OAGB revision to S-BPL-RYGB (n = 21) or L-BPL-RYGB (n = 31) secondary to GERD. Investigation with pH impedance prior to revision was performed in 15 patients showing biliary reflux (BR) in 7 (46.6%), acid reflux (AR) in 6 (40%), and no confirmation in 2. Patients with AR had a revision to S-BPL-RYGB, whereas patients with BR underwent L-BPL-RYGB. Among the patients without pH metry results (n = 37), S-BPL-RYGB was performed for associated disabling digestive disorders or nutritional deficiencies. GERD was treated in 68% of patients with L-BPL-RYGB versus 95% of patients after S-BPL-RYGB. Patients, whose decision for revisional procedure was based on the results of pH impedance testing, did not reveal refractory GERD.

Conclusion: L-BPL-RYGB seems appropriate in patients with BR, whereas conversion to S-BPL-RYGB should be preferred if AR is present.

Keywords: GERD; One-anastomosis gastric bypass; Revisional surgery; Roux-en-Y gastric bypass.

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