Laparoscopic conversion of one anastomosis gastric bypass/mini gastric bypass to Roux-en-Y gastric bypass for bile reflux gastritis

摘要

One anastomosis gastric bypass/mini gastric bypass (OAGB/MGB) is emerging as a popular procedure in the Middle East and Asia for several reasons. These reasons include the relative simplicity and short learning curve of OAGB/MGB compared with Roux-en-Y gastric bypass (RYGB) [1]. In addition, patients with type 2 diabetes (T2D) and super obesity are common in the Middle East and Asia, and OAGB/MGB is more effective for these patients than laparoscopic sleeve gastrectomy (LSG) [2]. Furthermore, patients presenting with failure after laparoscopic adjustable gastric banding or LSG are common in the Middle East and Asia. OAGB/MGB is ideal for these patients [3]. Bile reflux gastritis after OAGB/MGB was a significant concern, especially after a multicenter series by DeMaria et al. [4] described bile reflux gastritis as the predominant complications in patients presenting with complications after OAGB/MGB. However, large series from France and Italy have shown that this feared complication of bile reflux gastritis is relatively uncommon after OAGB/MGB and operative correction is needed in less than 1% of patients [5,6]. Despite the short learning curve for OAGB/ MGB compared with RYGB, attention to key technical steps are needed to minimize the complication of bile reflux gastritis. One of these technical steps is creating a long, narrow pouch [7].