Surgery · 2026
Comparative midterm ramifications of one anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy: A retrospective cohort study of 6,234 patients.
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Vinograd Adi, Keinan Boker Lital, Dichtiar Rita, Rosenberg Alina, Romano-Zelekha Orly, Globus Inbal
Аннотация
BACKGROUND: One-anastomosis gastric bypass is a commonly performed metabolic bariatric surgery, yet comprehensive comparisons of its midterm outcomes with Roux-en-Y gastric bypass and sleeve gastrectomy remain limited. The study aimed to assess midterm outcomes, including weight loss and 3-year post-metabolic bariatric surgery complications, in a nationwide cohort.
METHODS: This retrospective cohort study included patients aged ≥18 years who underwent one-anastomosis gastric bypass, Roux-en-Y gastric bypass, or sleeve gastrectomy between 2016 and 2019, using data from the National Metabolic Bariatric Surgery Registry and Maccabi Health Services, the second largest health provider. Adjusted odds ratios for study outcomes were estimated using multivariable logistic regressions and propensity score matching.
RESULTS: The study comprised 2,249 one-anastomosis gastric bypass (36.1%), 447 Roux-en-Y gastric bypass (7.2%), and 3,538 sleeve gastrectomy (56.8%) patients. Preoperative mean body mass index values were 41.3 ± 4.9, 40.4 ± 4.7, and 41.6 ± 4.9 kg/m2 for one-anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy, respectively. One-anastomosis gastric bypass achieved the greatest weight-loss efficacy of 30.9% at 3 years of follow-up (P < .001). One-anastomosis gastric bypass was associated with higher odds of anal fissure (adjusted odds ratio, 1.85; 95% confidence interval, 1.38-2.49) alongside lower odds of constipation (adjusted odds ratio, 0.62; 95% confidence interval, 0.49-0.79), compared with sleeve gastrectomy. Both one-anastomosis gastric bypass and Roux-en-Y gastric bypass were associated with a higher likelihood of abdominal pain, diarrhea, and stomach ulcers compared with sleeve gastrectomy, after adjustment for potential confounders.
CONCLUSION: One-anastomosis gastric bypass demonstrated a greater magnitude of weight loss compared with sleeve gastrectomy but was associated with a higher incidence of specific gastrointestinal complications. These findings suggest additional considerations when selecting the optimal metabolic bariatric surgery approach, alongside tailored postoperative surveillance.
METHODS: This retrospective cohort study included patients aged ≥18 years who underwent one-anastomosis gastric bypass, Roux-en-Y gastric bypass, or sleeve gastrectomy between 2016 and 2019, using data from the National Metabolic Bariatric Surgery Registry and Maccabi Health Services, the second largest health provider. Adjusted odds ratios for study outcomes were estimated using multivariable logistic regressions and propensity score matching.
RESULTS: The study comprised 2,249 one-anastomosis gastric bypass (36.1%), 447 Roux-en-Y gastric bypass (7.2%), and 3,538 sleeve gastrectomy (56.8%) patients. Preoperative mean body mass index values were 41.3 ± 4.9, 40.4 ± 4.7, and 41.6 ± 4.9 kg/m2 for one-anastomosis gastric bypass, Roux-en-Y gastric bypass, and sleeve gastrectomy, respectively. One-anastomosis gastric bypass achieved the greatest weight-loss efficacy of 30.9% at 3 years of follow-up (P < .001). One-anastomosis gastric bypass was associated with higher odds of anal fissure (adjusted odds ratio, 1.85; 95% confidence interval, 1.38-2.49) alongside lower odds of constipation (adjusted odds ratio, 0.62; 95% confidence interval, 0.49-0.79), compared with sleeve gastrectomy. Both one-anastomosis gastric bypass and Roux-en-Y gastric bypass were associated with a higher likelihood of abdominal pain, diarrhea, and stomach ulcers compared with sleeve gastrectomy, after adjustment for potential confounders.
CONCLUSION: One-anastomosis gastric bypass demonstrated a greater magnitude of weight loss compared with sleeve gastrectomy but was associated with a higher incidence of specific gastrointestinal complications. These findings suggest additional considerations when selecting the optimal metabolic bariatric surgery approach, alongside tailored postoperative surveillance.