Surgical Technique of Diverted One-Anastomosis Gastric Bypass

Laparoscopic diverted one-anastomosis gastric bypass (D-OAGB) is a bariatric procedure combining the principles of restriction, malabsorption, and other factors to induce weight loss. It is achieved by creating a narrow, long gastric pouch and bypassing a part of the small bowel (biliopancreatic limb). D-OAGB was first described by Dr. Ribero in 2013 and is technically a variation of the very heterogeneous group of Roux-en-Y gastric bypass operations. There are different technical variants to perform D-OAGB and to organize pre- and postoperative care. The following article is based on the approach to bariatric surgery as taken at the Department of General Surgery at the Medical University of Vienna. This article focuses on patient preparation before bariatric/metabolic surgery with mandatory and optional preoperative examinations to find the surgical procedure best suited for each individual patient and to decrease the patient's risk. The surgical technique of D-OAGB itself, including positioning of the patient and related technical highlights, as well as the specifics of the postoperative course, are described. D-OAGB is an effective procedure for patients with symptomatic gastroesophageal reflux for adequate weight loss and remission of comorbidities with a low risk of malnutrition. For D-OAGB to be successful, important technical steps, such as creating a narrow, long pouch, exact length of the biliopancreatic and alimentary limb, and additional hiatoplasty (if necessary), should be taken. In terms of the postoperative course, regular checkups are vital to ensure desirable outcome in the long-term follow up and early detection of adverse developments.