One-anastomosis gastric bypass (OAGB) is an increasingly popular procedure in Australia, with all the potential metabolic benefits of Roux-en-Y gastric bypass (RYGB), but with a lower complication rate comparable to that of sleeve gastrectomy. The slow uptake of this procedure is attributed to concerns surrounding bile reflux, although there is a paucity of data concerning its incidence, diagnosis and treatment. The purpose of this study was to review bile reflux post OAGB in a single surgeon experience in Australia.
A review of a prospectively maintained database of the first 82 OAGB was performed.
82 OAGB were performed between June 2014 and May 2017. There were 60 females with a mean age of 43years and median preoperative BMI of 46.1kg/m2. 22 patients had undergone prior bariatric surgery (21 gastric banding, 1 sleeve gastrectomy), and 12 patients had concomitant hiatal hernia repair. Mean excess weight loss (EWL%) was 80% and 80% at 12 and 24months respectively. One patient was lost to follow-up. 9 patients reported reflux symptoms post-operatively, of whom 4 had volume symptoms consistent with bile reflux. All 4 patients were subsequently converted to RYGB with complete symptom resolution. Of note, these 4 patients all presented within 12 months of their index OAGB operation. All had reported preoperative reflux, 1 was a revisional case and 2 had concomitant hiatus hernia repair.
Bile reflux following OAGB requiring conversion to RYGB occurred in 4.9% (n=4) cases, with complete symptom resolution following conversion. This compares favourably to acid reflux following sleeve gastrectomy and internal hernias after primary RYGB. Pre-operative acid reflux is a possible risk factor for bile reflux post OAGB. In this series, post-operative bile reflux was detected clinically within the first twelve months. More research is required into subclinical bile reflux and its potential long term implications.