Comparative Effect of Roux-en-Y Gastric Bypass vs. One-Anastomosis Gastric Bypass for Revisional Surgery After Sleeve Gastrectomy With Insufficient Clinical Response: A Systematic Review and Meta-analysis

Abstract

Background: Sleeve gastrectomy (SG) is the most performed bariatric procedure worldwide. Although effective in the short term, it has a high insufficient clinical response rate, leading to weight regain and gastroesophageal reflux disease (GERD), necessitating revisional surgery. The two primary options for conversion procedures are the Roux-en-Y gastric bypass (RYGB), considered the gold standard, and the one-anastomosis gastric bypass (OAGB), recognized for its simplicity and metabolic benefits.

Objective: To compare the effectiveness and safety of RYGB and OAGB as revisional procedures after insufficient clinical response to SG in terms of weight loss, metabolic improvements, surgical complications, and operative time.

Methods: This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive search was conducted across six databases (PubMed, Scopus, Web of Science, Cochrane, Ovid/Medline, and Embase). Out of 236 identified studies, five met the inclusion criteria. Data were analyzed using relative risk (RR) for categorical variables and mean difference (MD) for continuous outcomes, applying a random-effects model.

Results: OAGB showed a statistically significant advantage in total weight loss percentage (TWL%) compared to RYGB (MD, - 1.24; 95% CI, - 1.94, - 0.53; p = 0.0006). However, no significant difference was observed in BMI reduction (MD, 0.00; 95% CI, - 1.24, 1.24; p = 1.00). Both techniques demonstrated similar remission rates for hypertension (RR, 0.85; 95% CI, 0.60-1.22; p = 0.38), GERD (RR, 1.00; 95% CI, 0.86-1.17; p = 0.97), and type 2 diabetes (RR, 0.97; 95% CI, 0.79-1.21; p = 0.81). Postoperative complications were comparable between groups (RR, 0.89; 95% CI, 0.67-1.18; p = 0.42). However, operative time was significantly shorter in OAGB (MD, 30.10 min; 95% CI, 27.89, 32.32; p < 0.00001).

Conclusion: OAGB demonstrated greater total weight loss and a shorter operative time compared to RYGB, with a comparable safety profile. Both techniques were equally effective in managing hypertension and GERD, though OAGB showed a non-significant trend favoring type 2 diabetes remission. RYGB may be preferable for patients with severe GERD. Further high-quality, long-term studies are needed to establish the optimal revisional procedure for SG.

Keywords: Failed sleeve gastrectomy; One-anastomosis gastric bypass; Revisional bariatric surgery; Roux-en-Y gastric bypass; Weight loss surgery.