5 St George Obesity Surgery Unit | Bariatric Book | The results of the RYGB continue to be very good with a durable outcome. The quality of life analysis, longevity and also the resolution of co-morbidities are good. It produces sustainable weight loss, however again this is all dependent on lifestyle and dietary modification. It is especially good at treating metabolic disease such as hypertension, high cholesterol, fatty liver, sleep apnoea and potentially poly cystic ovary syndrome with infertility issues. The latest evidence also showed weight loss would improve and significantly reduce the risk of certain cancers. One Anastomosis Gastric Bypass The One Anastomosis Gastric Bypass (OAGB) was first reported in 2001 and is now the third commonest primary, bariatric procedure worldwide. It involves the creation of a long, narrow gastric pouch, which is then connected to the small intestine bypassing approximately 150 to 200 cm of the upper part of the small intestine. It takes approximately 90-100 minutes to perform and is usually done laparoscopically. Most patients are admitted on the day of surgery and can expect to go home in one or two days after surgery. It is an effective bariatric procedure with weight loss and co-morbidity (such as Type 2 diabetes and high blood pressure) improvement outcomes that are similar, if not better, to the Laparoscopic Gastric Roux-en-Y (RYGB) and slightly better than Laparoscopic Sleeve Gastrectomy (LSG) It works differently compare to RYGB. The difference is, instead of having two anastomosis (joint), it only involves one join. The chance of an internal hernia is reduced compared to RYGB. It does have the drawback of stomal ulceration if patients are heavy smokers or use a fair amount of anti-inflammatory medication. In a limited amount of studies, there is comparable weight loss to RYGB or LSG. Most patients can expect weight loss of 30-40% from baseline. The exact mechanism is more a kin to a RYGB but there are certain hormonal effects that are slightly different and there is still ongoing global research about this operation. It has just been approved/endorsed by ASMBS American Society of Metabolic & Bariatric Surgery as a validated procedure, for insurance claiming. The OAGB procedure can be performed with remarkable safety. The risk of death from early complications of surgery (such as bleeding, leak, pulmonary embolism, etcetera) is approximately 0.1-0.2%. Risk of major complications that may require surgical intervention is approximately 2.03.0% in the early period after surgery. In the long-term, the three commonest complications associated with this procedure are ulcers at the joint between the stomach, malnutrition and acid/bile reflux. The risk of ulcers can be reduced by prophylaxis with acid-reducing medications (PP) and cessation of smoking. Patients also need to adopt a healthy diet and take life-long iron, vitamin D, Calcium, Vitamin B12, Folate and multivitamin-mineral supplements. If there is severe malnutrition and acid/bile reflux, further surgery may be required to correct this. Overall approximately 5.0% of patients need further surgery in the long- term. Like any other bariatric procedure, patients should undergo lifelong, annual follow-up and monitoring for early diagnosis and treatment of any vitamin/mineral deficiency.
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