The One Anastomosis Gastric Bypass is a modification of gastric bypass that involves the creation of a long lesser curvature based gastric pouch followed by a gastro-enterostomy 150 cm distal to DJ Flexure . It is now the third most common bariatric procedure worldwide, with tens of thousands of published cases in the scientific literature over a period of more than 20 years. Its weight loss and metabolic outcomes seem superior to Sleeve Gastrectomy or Roux-en-Y Gastric Bypass (RYGB).
The key anatomical differences from RYGB are longer pouch, absent Roux limb, and no jejuno-jejunostomy. This translates into higher early surgical safety and lower long term risk of internal hernia and chronic abdominal pain. At the same time, use of a longer Bilio-Pancreatic (BP) limb than what is used with RYGB means this procedure carries a higher risk of nutritional issues and liver failure. We should therefore urgently examine the efficacy of a BP limb of 100 cm with this procedure in future studies.
A loop configuration means that this procedure is associated with a higher risk of entero-gastric and gastro-oesophageal reflux disease (GORD) and may, therefore, not be suitable for those already needing regular medicaments for GORD. The risk of GORD has led to concerns from some that this procedure would be associated with a higher risk of gastric and/or esophageal cancer, although there is no clinical data to support this hypothesis. Marginal ulcer is another common complication with this procedure, but it is effectively prevented by long-term prophylaxis with proton pump inhibitors.
Patients need long-term nutritional supplements and life-long annual follow up, just like any other bariatric procedure, for early detection and management of complications.
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