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Revisional One Anastomosis Gastric Bypass (OAGB) for Poor Response of Duodenal-Jejunal Bypass with Sleeve Gastrectomy (DJB-SG) (Video Report)

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Abstract

Background

Bariatric surgery has actually focused not only on obesity but also more on the improvements or remission of the metabolic diseases. Therefore, revisional surgery is indicated for patients with poor response to the primary bariatric surgery to control weight and obesity-associated medical conditions.

Method

In this video report, the patient was a 27-year-old Asian female with an initial BMI of 36.5 kg/m2 and poorly controlled type 2 diabetes (HbA1c: 11.9%). She underwent primary bariatric surgery of laparoscopic duodenal-jejunal bypass with sleeve gastrectomy (DJB-SG) in June 2019. She had a nadir BMI of 28.8 kg/m2 (corresponding body weight of 72 kg) in June 2020. However, she regained weight (BMI: 34 kg/m2) and had a relapse of diabetes with an HbA1c of 12.0% at the time of consultation for revisional bariatric surgery (RBS) in September 2022. After a multidisciplinary team evaluation, laparoscopic procedures of one anastomosis gastric bypass (OAGB) with resizing the gastric tube, removal of duodenal-jejunal anastomosis, and lengthening of the biliopancreatic limb were performed.

Results

The operative time was 186 min and blood loss was 50 ml. There were no intraoperative or postoperative complications. The patient had an uneventful postoperative course and was discharged on postoperative day 5. At the 3-month follow-up after RBS, the patient had lost 13 kg (weight dropped from 85 to 72 kg) and achieve remission of diabetes with HbA1c of 5.7%.

Conclusion

Laparoscopic OAGB is technically feasible and practical as a revisional procedure for poor response of DJB-SG.

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Data Availability

All relevant unidentifiable patient data was provided in the content. Further data could be provided by the authors upon the reasonable request.

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Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan

    Fa-Guang Liu & Sheng-Chun Wang

  2. Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan

    Fa-Guang Liu, Shu-Wei Chang, Kuo-Feng Hsu, Hsin-Mei Pan, Guo-Shiou Liao & Chien-Hua Lin

  3. Research Assistant Center, Tainan Municipal Hospital (Managed By Show Chwan Medical Care Corporation), Tainan, Taiwan

    Yen-Ju Chen

  4. IRCAD Taiwan, Department of Surgery, Chang-Bing Show Chwan Memorial Hospital, Changhua, Taiwan

    Chien-Hua Lin

Authors
  1. Fa-Guang Liu
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  2. Shu-Wei Chang
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  3. Kuo-Feng Hsu
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  4. Yen-Ju Chen
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  5. Hsin-Mei Pan
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  7. Chien-Hua Lin
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  8. Sheng-Chun Wang
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Corresponding author

Correspondence to Kuo-Feng Hsu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Key Points

1. As a significant increase in bariatric surgery over the last decade, it is not surprising that the number of revisional bariatric procedures has progressively increased as well.

2. One anastomosis gastric bypass (OAGB) offers promising efficacy of both weight loss and resolution of concomitant metabolic disorders, particularly type 2 diabetes.

3. We present a practical revisional procedure of OAGB with resizing the gastric tube, removal of previous duodenal-jejunal bypass anastomosis, and lengthening of the biliopancreatic limb for poor response of duodenal-jejunal bypass with sleeve gastrectomy.

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Liu, FG., Chang, SW., Hsu, KF. et al. Revisional One Anastomosis Gastric Bypass (OAGB) for Poor Response of Duodenal-Jejunal Bypass with Sleeve Gastrectomy (DJB-SG) (Video Report). OBES SURG 33, 1616–1619 (2023). https://doi.org/10.1007/s11695-023-06529-y

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  • DOI: https://doi.org/10.1007/s11695-023-06529-y

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