A Comprehensive Review of the Literature: Does an Optimal Type of Anastomosis Exist for One Anastomosis Gastric Bypass?

One anastomosis gastric bypass (OAGB) is a popular bariatric procedure known for its efficacy in promoting weight loss and improving metabolic outcomes. However, the optimal anastomotic technique for OAGB remains a subject of debate. This literature review comprehensively examines the three primary anastomotic techniques - linear stapled, circular stapled, and hand-sewn - to determine their suitability for OAGB. Linear stapled anastomosis is favored for its shorter operative time and lower complication rates, such as a reduced incidence of gastrojejunal stenosis. However, its larger anastomotic diameter increases the risk of marginal ulcers due to greater exposure of the gastric mucosa to bile and gastric acids. Circular stapled anastomosis offers a uniform and consistent lumen, which may reduce the risk of postoperative stenosis but is associated with a higher incidence of strictures and ulcers, making it less ideal for use in OAGB. Hand-sewn anastomosis, while time-intensive, provides superior control over anastomotic size and tension, resulting in the lowest rates of strictures and anastomotic leaks, although its effectiveness is highly dependent on surgical expertise. Overall, the current literature lacks large-scale, multicenter studies directly comparing these techniques in the context of OAGB. Future research should focus on randomized controlled trials to establish the most effective and safe anastomotic method for this procedure. Understanding the nuanced benefits and drawbacks of each technique is crucial for optimizing clinical outcomes in OAGB.