Letter to the Editor Concerning: Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB)
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LETTER TO THE EDITOR
Letter to the Editor Concerning: Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) for Biliary Reflux Resistant to Medical Treatment: Lessons Learned from a Retrospective Series of 2780 Consecutive Patients Undergoing OAGB Amir Hosein Davarpanah Jazi 1,2 & Shahab Shahabi 1,2 & Farid Nasr Esfahani 1,3
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Editor, We read the interesting article of Kassir et al. regarding the conversion of one anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB) in patients with bile reflux resistant to medical treatments [1]. They evaluated 2780 patients who underwent OAGB. Thirty-two (1.2%) patients with bile reflux that fulfill the criteria underwent conversion of OAGB to RYGB to treat bile reflux. They reported the method which they used to convert OAGB to RYGB and the longterm results of this conversion with a mean length of followup of 47.6 months. While we were reading the article, some concerns rose that based on their method, some complications may develop for the patients. The length of the gastric pouch has an important role in developing postoperative complications in both OAGB and RYGB surgeries. While a short gastric pouch in OAGB surgery may lead to developing bile reflux, a long gastric pouch in RYGB surgery may lead to other complications such as
* Farid Nasr Esfahani [email protected] Amir Hosein Davarpanah Jazi [email protected] Shahab Shahabi [email protected] 1
Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2
Department of Minimally Invasive Surgery, Al Zahra Hospital, Isfahan, Iran
3
School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
developing marginal ulcer. Musella et al. reported a positive correlation between gastric pouches shorter than 9 cm and developing bile reflux [2]. Also in different studies, a longer gastric pouch was correlated to more risk of developing a symptomatic marginal ulcer [3, 4]. In the Kassir’s study, the authors did not mention the length of the gastric pouch. Also, they left the gastrojejunal anastomosis unchanged. If they used a short gastric pouch, it could be the reason for developing bile reflux, and if they used an appropriate gastric pouch length in the first surgery, it was critical to change the size of the gastric pouch when converting OAGB to RYGB to prevent developing marginal ulcers. Besides, due to the anatomical structure of the gastrointestinal (GI) system after OAGB surgery, we have two major concerns with OAGB patients. One is about the high risk of bile reflux and the other is developing malnutrition due to malabsorption. In the Kassir’s study, in the first surgery, 150 cm of the small bowel was bypassed and in the second surgery, they bypassed another 100 cm to convert it to RYGB. So, the total length of the bypassed part of the bowel after conversion of OAGB to RYGB was increased to 250 cm. With this increase in the bypassed part o
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