Roux-en-Y Gastric Bypass Versus One Anastomosis Gastric Bypass as Revisional Surgery After Failed Sleeve Gastrectomy: A Systematic Review and Meta-analysis.

Journal of metabolic and bariatric surgery Pub Date : 2023-12-01 Epub Date: 2023-11-29 DOI:10.17476/jmbs.2023.12.2.57

Karim Ataya, Al Moutuz Al Jaafreh, Hussein El Bourji, Ayman Bsat, Hussein Nassar, Amir Al Ayoubi, George Abi Saad

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Abstract

Purpose: This study aimed to assess the outcomes of revisional procedures, namely Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) following unsuccessful laparoscopic sleeve gastrectomy.

Materials and methods: This systematic review and meta-analysis included 817 patients (404 in OAGB group, 413 in RYGB group) from seven retrospective comparative studies. Data on sample size, demographics, perioperative complications, operative time, pre- and post-revisional body mass index, total weight loss, and global weight loss over follow-up were extracted.

Results: The mean operative time was 98.2-201 minutes for RYGB versus 78.7-168 minutes for OAGB. Despite classical RYGB gastric bypass taking longer, mini gastric bypass resulted in greater weight loss than RYGB, with a mean difference of -5.84 (95% confidence interval [CI], -6.74 to -4.94; P<0.00001; I²=0%), greater total weight loss, and a higher diabetes remission rate (odds ratio [OR], 0.32; 95% CI, 0.14 to 0.71). However, OAGB was associated with a significantly higher incidence of postoperative gastroesophageal reflux than RYGB (52 vs. 31: OR, 0.40; 95% CI, 0.24 to 0.67; P=0.0005; I²=0%).

Conclusion: OAGB was performed more quickly and boasted greater total weight loss and higher diabetes remission rates compared to RYGB after failed sleeve gastrectomy. However, OAGB also demonstrated a higher incidence of postoperative gastroesophageal reflux disease. Thus, careful patient selection is essential when considering OAGB.

Trial registration: PROSPERO Identifier: CRD42023474966.

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作为袖状胃切除术失败后的翻修手术，Roux-en-Y 胃旁路术与单吻合胃旁路术：系统性回顾和 Meta 分析。

目的：本研究旨在评估腹腔镜袖带胃切除术不成功后的翻修手术，即Roux-en-Y胃旁路术（RYGB）和单吻合胃旁路术（OAGB）的效果：本系统回顾和荟萃分析纳入了七项回顾性比较研究中的 817 例患者（OAGB 组 404 例，RYGB 组 413 例）。研究提取了样本量、人口统计学、围手术期并发症、手术时间、术前和术后体重指数、总减重和随访期间总减重的数据：RYGB的平均手术时间为98.2-201分钟，而OAGB为78.7-168分钟。尽管传统的 RYGB 胃旁路术耗时更长，但迷你胃旁路术比 RYGB 胃旁路术的减重效果更好，平均差异为-5.84（95% 置信区间 [CI]，-6.74 至 -4.94；P2=0%），总减重效果更好，糖尿病缓解率更高（几率比 [OR]，0.32；95% 置信区间 [CI]，0.14 至 0.71）。然而，与 RYGB 相比，OAGB 术后胃食管反流的发生率明显更高（52 对 31：OR，0.40；95% CI，0.24 对 0.67；P=0.0005；I2=0%）：结论：与袖状胃切除术失败后的 RYGB 相比，OAGB 的手术速度更快，总重量减轻幅度更大，糖尿病缓解率更高。然而，OAGB 术后胃食管反流病的发生率也更高。因此，在考虑 OAGB 时，谨慎选择患者至关重要：试验注册：PROSPERO Identifier：CRD42023474966。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Journal of metabolic and bariatric surgery

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