TOPLINE:
There is no advantage to performing one-anastomosis gastric bypass (OABG) instead of Roux-en-Y gastric bypass (RYGB) in most patients undergoing bariatric surgery, a superiority study shows.
METHODOLOGY:
- The researchers standardized the bypass length in OAGB and RYGB and randomly assigned 120 bariatric surgery patients from two Finnish hospitals to undergo the procedures (60 patients each).
- Patients started a very low-calorie diet for 4-6 weeks, ending on the day of surgery.
- Weight, body composition, metabolic features (insulin sensitivity, lipids, inflammation, nutrition), and comorbidities were measured at baseline and at 6 and 12 months after the procedure.
- The primary outcome of this superiority trial was the difference in the percentage of excess weight loss at 1 year between OAGB and RYGB.
TAKEAWAY:
- Mean excess weight loss was similar between RYGB and OAGB at 6 months (51.5% vs 55.8%, respectively) and 12 months (60.1% vs 63.4%). Mean total weight loss also was similar with RYGB and OAGB at 6 months (21.2% vs 22.8%) and 12 months (25.4% vs 26.1%).
- Mean fat mass and percentage of body fat in the RYGB and OAGB groups decreased significantly and similarly (25.4 kg vs 25.1 kg; 11.8% in each group) from baseline to 12 months.
- At 6 and 12 months, remission of type 2 diabetes was significant in both groups, and improvements were similar in fasting plasma glucose and insulin, A1c, and homeostatic model assessment and Matsuda indices.
- Antihypertensive drug use was reduced in both groups compared with baseline at 6 and 12 months. However, at 12 months, the reduction was significantly greater with RYGB (61% vs 28%).
- Higher rates of vitamin D-25 deficiency and lower vitamin D-25 levels were observed with OAGB vs RYGB throughout the follow-up. There were no between-group differences in adverse effects.
IN PRACTICE:
"Our trial suggests similar weight loss and improvement in metabolism and comorbidities with RYGB and OAGB at 1 year, without superiority of OAGB over RYGB in glucose tolerance," the researchers write. "There is no need to change current practices of RYGB in favor of OAGB. OAGB may be selected when appropriate because it may be easier to conduct in certain patient groups who are not prone to malnutrition or bile reflux."
SOURCE:
Sini Heinonen, MD, PhD, of the University of Helsinki, Finland, led the study, which was published online on November 21, 2023.
LIMITATIONS:
Study follow-up was brief, yet weight gain, nutritional deficiencies, and metabolic and other complications may take longer to develop. In addition, some variation may have occurred in measuring the length of the small bowel even though a standardized measuring technique was used.
DISCLOSURES:
The study was supported by the Academy of Finland; the Finnish Medical Foundation; the Finnish Diabetes Research Foundation; the Orion Foundation; the Novo Nordisk Foundation; the Paulo Foundation; the Gyllenberg Foundation; the Sigrid Juselius Foundation; the Paavo Nurmi Foundation; Helsinki University Hospital Research Funds; Government Research Funds; and the University of Helsinki. The authors declare no conflicts of interest.
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