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Applying an Anti-reflux Suture in the One Anastomosis Gastric Bypass to Prevent Biliary Reflux: a Long-Term Observational Study

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Abstract

Introduction

The one anastomosis gastric bypass (OAGB) is an effective treatment to induce sustained weight loss in morbidly obese patients. Concerns remain regarding the development of reflux. The aim of this study was to investigate the effect of an “anti-reflux suture” as anti-reflux modification to prevent reflux.

Method

This is a single-center retrospective cohort study of patients who underwent a primary OAGB at the Center Obesity North-Netherlands (CON) between January 2015 and December 2016. Reflux was defined as symptoms of acid/bilious regurgitation or pyrosis. This was consequently asked and reported at each follow-up visit. Outcomes of patients with an anti-reflux suture were compared to those without.

Results

In 414 (59%) of the 703 included patients, an anti-reflux suture was applied. Follow-up at 3 years was 74%. The incidence of reflux did not differ between patients with or without an anti-reflux suture (57 versus 56%, respectively; P = 0.9). The presence of an anti-reflux suture was significantly associated with a lower incidence of conversion to Roux-en-Y gastric bypass (RYGB) for reflux (OR 0.56, 95%CI 0.34–0.91). Patients preoperatively diagnosed with gastroesophageal reflux disease (GERD) were 5.2 times more likely to need a conversion to RYGB for reflux (95%CI 2.7–10.1).

Conclusion

The presence of preoperative GERD should be weighted heavily in the decision to perform an OAGB as this is a major risk factor for conversion surgery due to reflux. The anti-reflux suture might be a valuable addition to the procedure of the OAGB because it results in fewer conversion surgeries for reflux.

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Authors and Affiliations

  1. Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands

    Nienke Slagter, Jonne Hopman, Anna G. Altenburg, Loek J. M. de Heide, Ewoud H. Jutte, Mirjam A. Kaijser, Stefan L. Damen & Marloes Emous

  2. Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands

    André P. van Beek

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  1. Nienke Slagter
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  2. Jonne Hopman
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  3. Anna G. Altenburg
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Slagter, N., Hopman, J., Altenburg, A.G. et al. Applying an Anti-reflux Suture in the One Anastomosis Gastric Bypass to Prevent Biliary Reflux: a Long-Term Observational Study. OBES SURG 31, 2144–2152 (2021). https://doi.org/10.1007/s11695-021-05238-8

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  • DOI: https://doi.org/10.1007/s11695-021-05238-8

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