AI Article Synopsis

  • One anastomosis gastric bypass (OAGB) is a recognized method in metabolic and bariatric surgery, making up 7.6% of global procedures, but still has several ongoing controversies despite its approval as a standalone procedure.
  • A modified Delphi consensus was conducted with 86 experts from 25 countries, addressing 29 key questions about patient selection and surgical standards, achieving agreement on 22 items, including patient suitability and post-operative care protocols.
  • Important findings include that OAGB is suitable for adolescents over 15 and those with class 1 obesity with uncontrolled type 2 diabetes, while highlighting the need for tailored surgical practices and continued research for better patient outcomes.

Article Abstract

One anastomosis gastric bypass (OAGB) presently constitutes 7.6% of all metabolic and bariatric surgery (MBS) procedures globally. Despite being approved by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) as a standalone MBS procedure and two consensus efforts in the past, multiple areas of controversies remain. This consensus builds upon previous consensus efforts to address unresolved controversies in the field. A modified Delphi consensus exercise was conducted over 4 weeks under the aegis of the MGB-OAGB International Club. A panel of 86 bariatric experts from 25 countries participated in 3 rounds of voting on 29 questions on patient selection, technical standardization, revisional surgeries, and post-operative care. Consensus was defined as at least 70% agreement. Consensus was achieved on 22 out of 29 questions. Key areas of agreement included suitability of OAGB for adolescents above the age of 15 years and patients with class 1 obesity with uncontrolled type 2 diabetes. Patients with severe esophagitis and Barrett's esophagus were not considered as good candidates for OAGB. Crural repair with OAGB was considered as an appropriate procedure in patients with large hiatus hernia. While a bilio-pancreatic limb (BPL) length of 150 - 200 cm was deemed suitable, it was recommended to tailor the BPL length to prevent protein energy malnutrition. It was also agreed to routinely administer ursodeoxycholic acid and proton-pump inhibitors for 6 months post-operatively. This modified Delphi consensus represents a critical step forward in addressing the controversies surrounding OAGB. It also emphasizes on the importance of individualized patient care and the need for ongoing research to refine surgical practices and improve outcomes.

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Source
http://dx.doi.org/10.1007/s11695-024-07563-0DOI Listing

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