Skip to main content

Advertisement

SpringerLink
Log in

The Hardship of Recovering a Patient from Liver Failure after One Anastomosis Gastric Bypass

  • Multimedia Article
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Background

The one anastomosis gastric bypass (OAGB) was first described in 2001 as a safe and effective procedure that meets the criteria for the “ideal” weight loss operation. However, revisions for malnutrition and liver failure were reported.

Case Report

We report a patient who was transferred to our institution with protein calorie malnutrition and liver failure after undergoing OAGB.

Methods

A 42-year-old morbidly obese female patient underwent a laparoscopic sleeve gastrectomy (LSG) in 2012 followed by conversion to OAGB in 2018 for weight regain at another institution. Nine months after conversion, she was transferred to our institution with dehydration, vomiting, dysphagia, generalized edema, and steatorrhea (7 times/day). She had become wheelchair bound. On examination, there was gross edema, protein–calorie malnutrition, dermatitis, and muscle wasting. She had anemia (8 g/dl) reference range (11.5–15.5 g/dl), bilirubin (1.8 mg/dl) (0.2–1.2 mg/dl), hypoalbuminemia (1.4 g/dl) (3.5–5 g/dl), and elevated international normalized ratio (INR). The patient was admitted to the hospital and was started on total parenteral nutrition (TPN), with thiamine, vitamins, iron injections, and trace mineral replacement. Her course was complicated by multiple episodes of line sepsis and bacteremia. After 6 weeks, we succeeded in raising her albumin to 2.9 g/dl and proceeded with surgery.

Technique

Laparoscopic exploration started with identifying the anatomy and measuring the biliopancreatic limb (BPL = 430 cm) and the common channel (CC = 380 cm). First, we restored the continuity of the small bowel. Then the long gastric pouch was trimmed. Finally, the patient was converted to a Roux-en-Y gastric bypass (RYGB) with a 30 cm BP limb and 70 cm Roux limb. The patient had an uneventful recovery and was discharged home on the fourth postoperative day. At 3 months of follow-up, her symptoms resolved, her laboratory work up normalized, and she regained mobility.

Conclusion

Malnutrition and liver failure after OAGB are not uncommon. It is encountered with configurations of longer BP limb. BPL length of 150 to 200 cm seems to reduce such complications. Preoperative nutritional optimization is key. Conversion to a proximal RYGB is a safe and feasible approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Rutledge R. The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001;11(3):276–80. https://doi.org/10.1381/096089201321336584.

    Article  CAS  PubMed  Google Scholar 

  2. Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28(12):3783–94. https://doi.org/10.1007/s11695-018-3450-2.

    Article  PubMed  Google Scholar 

  3. Haddad A, Fobi M, Bashir A, et al. Outcomes of one anastomosis gastric bypass in the IFSO Middle East North Africa (MENA) Region. Obes Surg. 2019;29(8):2409–14. https://doi.org/10.1007/s11695-019-03881-w.

    Article  PubMed  Google Scholar 

  4. Motamedi MAK, Barzin M, Ebrahimi M, et al. Severe fatal protein malnutrition and liver failure in a morbidly obese patient after mini-gastric bypass surgery: case report. Int J Surg Case Rep. 2017;33:71–4. https://doi.org/10.1016/j.ijscr.2017.02.033.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Eilenberg M, Langer FB, Beer A, et al. Significant liver-related morbidity after bariatric surgery and its reversal-a case series. Obes Surg. 2018;28(3):812–9. https://doi.org/10.1007/s11695-017-2925-x.

    Article  PubMed  Google Scholar 

  6. Higa KD, Ho T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A. 2001;11(6):377–82. https://doi.org/10.1089/10926420152761905.

    Article  CAS  PubMed  Google Scholar 

  7. Musella M, Susa A, Greco F, et al. The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review. Surg Endosc. 2014;28(1):156–63. https://doi.org/10.1007/s00464-013-3141-y.

    Article  CAS  PubMed  Google Scholar 

  8. Musella M, Susa A, Manno E, et al. Complications following the mini/one anastomosis gastric bypass (MGB/OAGB): a multiinstitutional survey on 2678 patients with a mid-term (5 years) follow-up. Obes Surg. 2017;27(11):2956–67. https://doi.org/10.1007/s11695-017-2726-2.

  9. Bruzzi M, Voron T, Zinzindohoue F, et al. Revisional singleanastomosis gastric bypass for a failed restrictive procedure: 5- year results. Surg Obes Relat Dis. 2016;12(2):240–5. https://doi.org/10.1016/j.soard.2015.08.521.

    Article  PubMed  Google Scholar 

  10. Taha O, Abdelaal M, Abozeid M, et al. Outcomes of omega loop gastric bypass, 6-years experience of 1520 Cases. Obes Surg. 2017;27(8):1952–60. https://doi.org/10.1007/s11695-017-2623-8.

    Article  PubMed  Google Scholar 

  11. Carbajo MA, Luque-de-León E, Jiménez JM, et al. Laparoscopic one-anastomosis gastric bypass: technique, results, and long-term follow-up in 1200 Patients. Obes Surg. 2017;27(5):1153–67. https://doi.org/10.1007/s11695-016-2428-1.

    Article  PubMed  Google Scholar 

  12. Bruzzi M, Voron T, Zinzindohoue F, et al. Revisional single-anastomosis gastric bypass for a failed restrictive procedure: 5-year results. Surg Obes Relat Dis. 2016;12(2):240–5. https://doi.org/10.1016/j.soard.2015.08.521.

    Article  PubMed  Google Scholar 

  13. Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg. 2012;22(5):697–703. https://doi.org/10.1007/s11695-012-0618-z.

    Article  PubMed  Google Scholar 

  14. Facchiano E, Leuratti L, Veltri M, et al. Laparoscopic conversion of one anastomosis gastric bypass to Roux-en-Y gastric bypass for chronic bile reflux. Obes Surg. 2016;26(3):701–3. https://doi.org/10.1007/s11695-015-2017-8.

    Article  PubMed  Google Scholar 

  15. Nimeri A, Al Shaban T, Maasher A. Laparoscopic conversion of one anastomosis gastric bypass/mini gastric bypass to Roux-en-Y gastric bypass for bile reflux gastritis. Surg Obes Relat Dis. 2017;13(1):119–21. https://doi.org/10.1016/j.soard.2016.09.033.

    Article  PubMed  Google Scholar 

  16. Nimeri A, Al Shaban T, Maasher A. Conversion of one anastomosis gastric bypass/mini gastric bypass to Roux-en-Y gastric bypass for bile reflux gastritis after failed Braun jejunojejunostomy. Surg Obes Relat Dis. 2017;13(2):361–3. https://doi.org/10.1016/j.soard.2016.10.022.

    Article  PubMed  Google Scholar 

  17. Haddad A, Bashir A, Nimeri A. Gastrogastric fistula: an unusual cause for severe bile reflux following conversion of sleeve gastrectomy to one anastomosis gastric bypass. Obes Surg. 2018;28(7):2151–3. https://doi.org/10.1007/s11695-018-3288-7.

    Article  PubMed  Google Scholar 

  18. Tacchino RM. Bowel length: measurement, predictors, and impact on bariatric and metabolic surgery. Surg Obes Relat Dis. 2015;11(2):328–34. https://doi.org/10.1016/j.soard.2014.09.016.

    Article  PubMed  Google Scholar 

  19. Khalaj A, Kalantar Motamedi MA, Mousapour P, et al. Protein-calorie malnutrition requiring revisional surgery after one-anastomosis-mini-gastric bypass (OAGB-MGB): case series from the Tehran Obesity Treatment Study (TOTS). Obes Surg. 2019;29(6):1714–20. https://doi.org/10.1007/s11695-019-03741-7.

    Article  PubMed  Google Scholar 

  20. Gazer B, Rosin D, Bar-Zakai B, et al. Accuracy and inter-operator variability of small bowel length measurement at laparoscopy. Surg Endosc. 2017;31(11):4697–704. https://doi.org/10.1007/s00464-017-5538-5.

    Article  PubMed  Google Scholar 

  21. Muise ED, Tackett JJ, Callender KA, et al. Accurate assessment of bowel length: the method of measurement matters. J Surg Res. 2016;206(1):146–50. https://doi.org/10.1016/j.jss.2016.07.022.

    Article  PubMed  Google Scholar 

  22. Addeo P, Cesaretti M, Anty R, et al. Liver transplantation for bariatric surgery-related liver failure: a systematic review of a rare condition. Surg Obes Relat Dis. 2019;15(8):1394–401. https://doi.org/10.1016/j.soard.2019.06.002.

    Article  PubMed  Google Scholar 

  23. Nabil TM, Khalil AH, Mikhail S, et al. Conventional versus distal laparoscopic one-anastomosis gastric bypass: a randomized controlled trial with 1-year follow-up. Obes Surg. 2019;29(10):3103–10. https://doi.org/10.1007/s11695-019-03991-5.

    Article  PubMed  Google Scholar 

  24. Pizza F, Lucido FS, D’Antonio D, et al. Biliopancreatic limb length in one anastomosis gastric bypass: which is the best? Obes Surg. 2020;30(10):3685–94. https://doi.org/10.1007/s11695-020-04687-x.

    Article  PubMed  Google Scholar 

  25. Mahawar KK, Parmar C, Carr WRJ, et al. Impact of biliopancreatic limb length on severe protein-calorie malnutrition requiring revisional surgery after one anastomosis (mini) gastric bypass. J Minim Access Surg. 2018;14(1):37–43. https://doi.org/10.4103/jmas.JMAS_198_16.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gastrintestinal, Bariatric, and Metabolic Center (GBMC), Jordan Hospital, Queen Noor St., 4th Circle, P.O BOX 3073, Amman, 11181, Jordan

    Ashraf Haddad & Ahmad Bashir

Authors
  1. Ashraf Haddad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmad Bashir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashraf Haddad.

Ethics declarations

Conflict of Interest

The authors declare that they have conflict of interest.

Informed Consent

For this type of study, formal consent is not required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

(MP4 291,192 kb)

ESM 2

Image 1 Lower extremities showing gross edema, dermatitis, muscle wasting, and signs of protein–calorie malnutrition (DOCX 430 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haddad, A., Bashir, A. The Hardship of Recovering a Patient from Liver Failure after One Anastomosis Gastric Bypass. OBES SURG 31, 1395–1398 (2021). https://doi.org/10.1007/s11695-020-05210-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-020-05210-y

Keywords

Search

Navigation