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

Abstract:

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.

journal_name

Minerva Chir

journal_title

Minerva chirurgica

authors

Mahawar KK,Parmar C,Graham Y

doi

10.23736/S0026-4733.18.07844-6

subject

Has Abstract

pub_date

2019-04-01 00:00:00

pages

126-136

issue

2

eissn

0026-4733

issn

1827-1626

pii

S0026-4733.18.07844-6

journal_volume

74

pub_type

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