One-anastomosis gastric bypass (OAGB) may be tied to refractory gastroesophageal reflux disease (GERD). It can be managed either with an additional enteroenterostomy without shortening the gastric pouch (long biliopancreatic limb Roux-en-Y gastric bypass (L-BPL-RYGB)) or revision to short biliopancreatic limb Roux-en-Y gastric bypass (S-BPL-RYGB).

A study was designed to compare these procedures in terms of efficacy on GERD symptoms. A retrospective analysis was conducted between October 2012 and June 2020.

Fifty two patients were included; 21 of these were subjected to OAGB revision to S-BPL-RYGB while 31 underwent L-BPL-RYGB following GERD. Investigation with pH impedance before revision was done in 15 patients having biliary reflux (BR) in 7 (46.6%), acid reflux (AR) in 6 (40%), and no confirmation in 2 patients.

• Patients with AR had a revision to S-BPL-RYGB, while those with BR underwent L-BPL-RYGB.
• Among the 37 patients without pH metry results, S-BPL-RYGB was done for accompanying disabling digestive disorders or nutritional deficiency.
• GERD was treated in 68% of patients with L-BPL-RYGB compared to 95% of patients who underwent S-BPL-RYGB.
• Patients, whose decision for revision was based on the results of pH impedance testing, did not have refractory GERD.

To conclude, L-BPL-RYGB appears to be the appropriate procedure in patients with BR, while conversion to S-BPL-RYGB seems appropriate in case of AR.

Source: Tarhini A, Rives-Lange C, Jannot AS, et al. One-Anastomosis Gastric Bypass Revision for Gastroesophageal Reflux Disease: Long Versus Short Biliopancreatic Limb Roux-en-Y Gastric Bypass. Obes Surg. 2022 Jan 17.