Omega gastric bypass versus long biliary limb Roux-en-Y gastric bypass: a retrospective analysis with 1- and 3-year...

One-anastomosis gastric bypass (OAGB) has gained popularity, although concerns persist regarding biliary reflux and malnutrition, particularly when the biliopancreatic limb exceeds 200 cm. The long biliary limb Roux-en-Y gastric bypass (LB-RYGB), featuring a 120 cm biliary limb, has been proposed to enhance total weight loss (TWL). This study compared TWL, remission of obesity-associated comorbidities, and outcomes at 1- and 3-year follow-up between OAGB (150 cm biliary limb) and LB-RYGB (120 cm biliary limb).

Patients undergoing OAGB or LB-RYGB between February 2018 and February 2021 were evaluated at 1 and 3 years postoperatively. The primary endpoint was TWL at 1 year; secondary endpoints included TWL at 3 years, BMI, and postoperative outcomes.

Among 180 patients (127 OAGB, 53 LB-RYGB), median TWL did not differ at 1 year (26 [14-33] vs 25 [20-31]; p = 0.537) or 3 years (28 [18-32] vs 26 [19-32]; p = 0.856). Weight and BMI values were comparable at 1 and 3 years. Iron deficiency was more frequent after OAGB at 1 year (20% vs 6%; p = 0.032). Two OAGB patients required revision for anastomotic ulcers related to biliary reflux and one for stenosis with malnutrition, while internal hernias occurred exclusively after LB-RYGB (n = 3).

OAGB and LB-RYGB appear equally effective for weight loss and resolution of obesity-associated comorbidities. Key complications differ, biliary reflux in OAGB and internal hernia in LB-RYGB. OAGB with a 150 cm biliary limb remains an effective option, and future randomized trials should further evaluate these specific complications.