One Anastomosis Gastric Bypass (OAGB), also known as Mini Gastric Bypass (MGB), is a bariatric procedure designed to assist in weight loss and treat obesity-related comorbidities. This surgical technique has gained popularity due to its simplicity, efficacy, and favorable outcomes compared to other bariatric procedures.

Historical Background

The OAGB was first described by Dr. Robert Rutledge in 1997. Since its introduction, it has undergone several modifications and improvements, enhancing its safety profile and outcomes. The procedure has evolved into a viable alternative to the more commonly performed Roux-en-Y Gastric Bypass (RYGB).

Procedure

The OAGB involves creating a long, narrow gastric pouch along the lesser curvature of the stomach. This pouch is then anastomosed to a loop of the small intestine, typically 200-250 cm distal to the ligament of Treitz. The procedure results in both restriction of food intake and malabsorption, contributing to significant weight loss.

Surgical Steps

Creation of the Gastric Pouch: Using a stapling device, a vertical gastric pouch is created starting from the antrum to the angle of His.
Identification of the Jejunum: The jejunum is identified approximately 200-250 cm distal to the ligament of Treitz.
Gastrojejunostomy: A single anastomosis is created between the gastric pouch and the jejunum, forming the gastrojejunostomy.
Advantages

Simplicity: OAGB is technically less complex than RYGB, with a shorter operative time.
Effective Weight Loss: Comparable to RYGB, OAGB provides substantial weight loss and improvement in obesity-related comorbidities such as type 2 diabetes, hypertension, and hyperlipidemia.
Lower Complication Rates: Studies have shown lower rates of internal hernias and marginal ulcers compared to RYGB.
Outcomes

Weight Loss: Patients typically experience a 60-70% excess weight loss (EWL) within the first year post-surgery. Long-term studies indicate sustained weight loss up to 10 years.

Metabolic Improvements: Significant improvements in type 2 diabetes, hypertension, dyslipidemia, and obstructive sleep apnea are observed. The procedure induces changes in gut hormones, enhancing insulin sensitivity and glucose homeostasis.

Complications

Nutritional Deficiencies: Due to malabsorption, patients are at risk of deficiencies in iron, calcium, vitamin B12, and fat-soluble vitamins. Lifelong supplementation and monitoring are necessary.
Bile Reflux: There is a potential risk of bile reflux gastritis due to the continuous exposure of the gastric pouch to bile.
Dumping Syndrome: Some patients may experience dumping syndrome, characterized by nausea, vomiting, and diarrhea after high-sugar meals.
Conclusion

OAGB is a safe and effective bariatric procedure with numerous benefits, including significant weight loss and improvement in metabolic conditions. However, careful patient selection and long-term follow-up are crucial to manage potential complications and ensure optimal outcomes. As more studies and long-term data become available, OAGB is likely to solidify its place as a primary bariatric surgery option.

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