REVIEW   

Minerva Chirurgica 2019 April;74(2):126-36

DOI: 10.23736/S0026-4733.18.07844-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

One anastomosis gastric bypass: key technical features, and prevention and management of procedure-specific complications

Kamal K. MAHAWAR ^{1, 2} ✉, Chetan PARMAR ³, Yitka GRAHAM ^{1, 2}

¹ Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK; ² Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK; ³ Whittington Hospital NHS Trust, London, UK

INTRODUCTION: One anastomosis gastric bypass (OAGB) is now a recognized mainstream bariatric procedure being adopted by an increasing number of surgeons. The purpose of this review was to present an evidence-based summary of its key technical aspects and prevention and management of its specific complications.
EVIDENCE ACQUISITION: We examined PubMed for all published articles on OAGB, including the ones published under one of its various other names.
EVIDENCE SYNTHESIS: An ideal OAGB procedure has a long, narrow pouch constructed carefully to avoid going too close to the greater curvature of the stomach especially at the bottom of the pouch and maintains a safe distance from the angle of His. A bilio-pancreatic limb length of 150 cm appears to be safest and a limb length of >200 cm is associated with a significantly increased incidence of protein-calorie malnutrition. We recommend routine closure of Petersen’s space to prevent Petersen’s hernia and suggest a protocol for micronutrient supplementation. This review also presents evidence-based algorithms for prevention and management of marginal ulcers, protein-calorie malnutrition, and gastroesophageal reflux disease after OAGB. We suggest lifelong supplementation with two multivitamin/mineral supplements (each containing at least 1.0 mg copper and 15 mg zinc) daily, 1.5 mg vitamin B12 orally daily or 3-monthly injection with 1 mg vitamin B12, 120 mg elemental iron daily, 1500 mg elemental calcium daily, and 3000 international units of vitamin D daily.
CONCLUSIONS: This review examines key technical steps of OAGB. We also discuss how to prevent and manage its specific complications.

KEY WORDS: Gastric bypass - Surgical anastomosis - Bariatric surgery - Complications - Dietary supplements