One anastomosis gastric bypass (OAGB) may be performed in patients with hiatal hernia with acceptable gastroesophageal reflux disease (GERD) outcomes, but caution is advised in patients with preoperative GERD symptoms, according to study results published in Obesity Surgery.
Although OAGB offers favorable weight loss outcomes and is associated with reduced morbidity and mortality when compared with other mainstream bariatric procedures, it appears that a higher proportion of patients experience GERD after the procedure compared with roux-en-Y gastric bypass (RYGB). As such, clinicians may consider the procedure unsuitable for patients with a preoperative hiatal hernia or symptoms of GERD.
Therefore, researchers conducted a retrospective review of patients undergoing OAGB who were taking a proton pump inhibitor (PPI) for symptoms of GERD preoperatively, as well as patients with hiatal hernia or esophagitis identified on preoperative endoscopy. Medium-term follow-up data at 23 to 28 months were available for 89 patients; of these patients, 63 had hiatal hernia, 34 had preoperative GERD requiring PPI, and 9 had confirmed esophagitis.
The researchers found that the conversion rate to roux-en-Y configuration (RYC) was zero (0/63) in patients with hiatal hernia. However, 14.7% (5/34) of patients with preoperative GERD on PPI required conversion to RYC at a median time interval of 16 months. In patients already on a PPI preoperatively, 16/34 (47.1%) needed to continue on a PPI for the long term. In patients with hiatal hernia, 20.6% (13/63) experienced de novo GERD symptoms.
The authors concluded, “The findings from our study do not overwhelmingly support OAGB for patients with [hiatal hernia/GERD] but do reflect relative safety in patients with [hiatal hernia], while need for caution in patients with preoperative [GERD] needing daily medications.”
They added, “Larger, randomized studies are needed to confirm our findings.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Winstanley J, Ahmed S, Courtney M, et al. One anastomosis gastric bypass in patients with gastrooesophageal reflux disease and/or hiatus hernia. Obes Surg. Published online January 6, 2021. doi:10.1007/s11695-020-05149-0