Prevention of Malnutrition After One Anastomosis Gastric Bypass: Value of the Common Channel Limb Length

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2024 May 16

PMID 38755612

Authors

Elyas Mostafapour

Masoumeh Shahsavan

Shahab Shahabi Shahmiri

Noura Jawhar

Omar M Ghanem

Mohammad Kermansaravi

Affiliations

Soon will be listed here.

Abstract

Purpose: Hypoalbuminemia and anemia are commonly observed indications for one anastomosis gastric bypass (OAGB) reversal and remain significant concerns following the procedure. Sufficient common channel limb length (CCLL) is crucial to minimize nutritional complications. However, limited literature exists regarding the impact of CCLL on OAGB outcomes. This study aimed to assess the effect of CCLL on weight loss and nutritional status in patients who underwent OAGB.

Methods: A prospective cohort study was conducted from August 2021 to July 2022, involving 64 patients with a body mass index of 40-50 kg/m. The standardized length of the biliopancreatic limb (BPLL) for all patients in this study was set at 175 cm. Additionally, the measurement of the common channel limb length (CCLL) was performed consistently by the same surgeon for all included patients.

Results: The mean age and BMI of the patients were 39.91 ± 10.03 years and 43.13 ± 2.43 kg/m, respectively, at the time of surgery. There was a statistically significant negative correlation between CCLL and percent total weight loss (%TWL) at the 12-month mark after OAGB (P = 0.02). Hypoalbuminemia was observed in one patient (1.6%), while anemia was present in 17 patients (26.6%) at the one-year follow-up. Statistical analysis revealed no significant difference in the incidence of anemia and hypoalbuminemia between patients with CCLL < 4 m and those with CCLL ≥ 4 m.

Conclusion: A CCLL of 4 m does not appear to completely prevent nutritional complications following OAGB. However, maintaining a CCLL of at least 4 m may be associated with a reduced risk of postoperative nutritional deficiencies.

References

Soong T, Almalki O, Lee W, Ser K, Chen J, Wu C . Measuring the small bowel length may decrease the incidence of malnutrition after laparoscopic one-anastomosis gastric bypass with tailored bypass limb. Surg Obes Relat Dis. 2019; 15(10):1712-1718. DOI: 10.1016/j.soard.2019.08.010. View

Kermansaravi M, Abdolhosseini M, Kabir A, Pazouki A . Severe hypoalbuminemia and steatohepatitis leading to death in a young vegetarian female, 8 months after mini gastric bypass: A case report. Int J Surg Case Rep. 2017; 31:17-19. PMC: 5233785. DOI: 10.1016/j.ijscr.2016.12.004. View

Rutledge R . The mini-gastric bypass: experience with the first 1,274 cases. Obes Surg. 2001; 11(3):276-80. DOI: 10.1381/096089201321336584. View

Tourky M, Issa M, Salman M, Salman A, Shaaban H, Safina A . Nutritional Complications After Laparoscopic Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass: A Comparative Systematic Review and Meta-Analysis. Cureus. 2022; 14(1):e21114. PMC: 8752406. DOI: 10.7759/cureus.21114. View

Ahuja A, Tantia O, Goyal G, Chaudhuri T, Khanna S, Poddar A . MGB-OAGB: Effect of Biliopancreatic Limb Length on Nutritional Deficiency, Weight Loss, and Comorbidity Resolution. Obes Surg. 2018; 28(11):3439-3445. DOI: 10.1007/s11695-018-3405-7. View

Slagter N, de Heide L, Jutte E, Kaijser M, Damen S, van Beek A . Outcomes of the One Anastomosis Gastric Bypass with Various Biliopancreatic Limb Lengths: a Retrospective Single-Center Cohort Study. Obes Surg. 2021; 31(10):4236-4242. PMC: 8458216. DOI: 10.1007/s11695-021-05555-y. View

Lee W, Lee Y, Ser K, Chen S, Chen J, Su Y . Revisional surgery for laparoscopic minigastric bypass. Surg Obes Relat Dis. 2010; 7(4):486-91. DOI: 10.1016/j.soard.2010.10.012. View

Carbajo M, Garcia-Caballero M, Toledano M, Osorio D, Garcia-Lanza C, Carmona J . One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg. 2005; 15(3):398-404. DOI: 10.1381/0960892053576677. View

Sofi N, Jain M, Kapil U, Seenu V, Ramakrishnan L, Yadav C . Status of Serum Vitamin D and Calcium Levels in Women of Reproductive Age in National Capital Territory of India. Indian J Endocrinol Metab. 2017; 21(5):731-733. PMC: 5628545. DOI: 10.4103/ijem.IJEM_134_17. View

10.

Felsenreich D, Langer F, Eichelter J, Jedamzik J, Gensthaler L, Nixdorf L . Bariatric Surgery-How Much Malabsorption Do We Need?-A Review of Various Limb Lengths in Different Gastric Bypass Procedures. J Clin Med. 2021; 10(4). PMC: 7916324. DOI: 10.3390/jcm10040674. View

11.

Lee W, Wang W, Lee Y, Huang M, Ser K, Chen J . Laparoscopic mini-gastric bypass: experience with tailored bypass limb according to body weight. Obes Surg. 2008; 18(3):294-9. DOI: 10.1007/s11695-007-9367-9. View

12.

Komaei I, Sarra F, Lazzara C, Ammendola M, Memeo R, Sammarco G . One Anastomosis Gastric Bypass-Mini Gastric Bypass with Tailored Biliopancreatic Limb Length Formula Relative to Small Bowel Length: Preliminary Results. Obes Surg. 2019; 29(9):3062-3070. DOI: 10.1007/s11695-019-04019-8. View

13.

Kermansaravi M, Parmar C, Chiappetta S, Shahabi S, Abbass A, Abbas S . Patient Selection in One Anastomosis/Mini Gastric Bypass-an Expert Modified Delphi Consensus. Obes Surg. 2022; 32(8):2512-2524. DOI: 10.1007/s11695-022-06124-7. View

14.

Kermansaravi M, Shahsavan M, Ebrahimi R, Mousavimaleki A, Gholizadeh B, Valizadeh R . Effect of anti-reflux suture on gastroesophageal reflux symptoms after one anastomosis gastric bypass: a randomized controlled trial. Surg Endosc. 2024; 38(5):2562-2570. DOI: 10.1007/s00464-024-10792-0. View

15.

Kassir R, Giudicelli X, Lointier P, Breton C, Blanc P . Omega Loop Gastroileal Bypass (OLGIBP/SAGI) Versus One Anastomosis Gastric Bypass (OAGB): Medium-Term Results. Obes Surg. 2021; 31(4):1597-1602. DOI: 10.1007/s11695-020-05165-0. View

16.

Perez S, Alessi I, Wheeler A . Hypoalbuminemia as a risk factor for complications in revisional/conversional bariatric surgery: an MBSAQIP analysis. Surg Obes Relat Dis. 2023; 19(6):555-561. DOI: 10.1016/j.soard.2022.12.010. View

17.

Gopal D, Kalogeropoulos A, Georgiopoulou V, Tang W, Methvin A, Smith A . Serum albumin concentration and heart failure risk The Health, Aging, and Body Composition Study. Am Heart J. 2010; 160(2):279-85. PMC: 2919495. DOI: 10.1016/j.ahj.2010.05.022. View

18.

Brethauer S, Kim J, El Chaar M, Papasavas P, Eisenberg D, Rogers A . Standardized outcomes reporting in metabolic and bariatric surgery. Obes Surg. 2015; 25(4):587-606. DOI: 10.1007/s11695-015-1645-3. View

19.

Dawson-Hughes B, Heaney R, Holick M, Lips P, Meunier P, Vieth R . Estimates of optimal vitamin D status. Osteoporos Int. 2005; 16(7):713-6. DOI: 10.1007/s00198-005-1867-7. View

20.

Kermansaravi M, Shahmiri S, Khalaj A, Jalali S, Amini M, Malekpour Alamdari N . The First Web-Based Iranian National Obesity and Metabolic Surgery Database (INOSD). Obes Surg. 2022; 32(6):2083-2086. DOI: 10.1007/s11695-022-06014-y. View