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

Background Biliary reflux resistant to medical treatment has an incidence of 0.6-10% after one anastomosis gastric bypass (OAGB) and may be a reason for revisional surgery. The aim of this study is to report the results of a single-institution series of patients who underwent conversion from OAGB to Roux-en-Y gastric bypass (RYGB) for biliary reflux. Methods Data of OAGB patients converted to RYGB between May 2010 and December 2017 were prospectively collected and retrospectively analyzed. The afferent limb was sectioned proximally to the gastrojejunal anastomosis. A jejuno-jejunal latero-lateral anastomosis was performed between the biliary and alimentary limb. The final RYGB had an alimentary limb of 100 cm and a biliary limb of 150 cm. Results During the study period, 2780 patients underwent OAGB. A total of 32 patients (1.2%) underwent conversion from OAGB to RYGB for biliary reflux, at a mean of 30.3 months from OAGB. Mean weight before RYGB was 70.6 kg, and mean body mass index BMI was 26 kg/m(2). Four patients experienced postoperative complications (12.5%). Patients' mean weight was 74.3 kg at 24 months follow-up, with BMI of 27.2 kg/m(2). Conversion to RYGB relieved symptoms of biliary reflux in all patients but 2 (93.8%). Conclusions Biliary reflux although rare can complicate OAGB. RYGB is a safe and feasible technique of revision in this case. A shorter length of the afferent limb during the initial operation facilitates the revision.