Home > Riviste > Minerva Surgery > Fascicoli precedenti > Minerva Chirurgica 2019 April;74(2) > Minerva Chirurgica 2019 April;74(2):126-36

ULTIMO FASCICOLO
 

JOURNAL TOOLS

eTOC
Per abbonarsi PROMO
Sottometti un articolo
Segnala alla tua biblioteca
 

ARTICLE TOOLS

Publication history
Estratti
Permessi
Per citare questo articolo
Share

 

REVIEW   

Minerva Chirurgica 2019 April;74(2):126-36

DOI: 10.23736/S0026-4733.18.07844-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

One anastomosis gastric bypass: key technical features, and prevention and management of procedure-specific complications

Kamal K. MAHAWAR 1, 2 , Chetan PARMAR 3, Yitka GRAHAM 1, 2

1 Bariatric Unit, Department of General Surgery, Sunderland Royal Hospital, Sunderland, UK; 2 Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK; 3 Whittington Hospital NHS Trust, London, UK



INTRODUCTION: One anastomosis gastric bypass (OAGB) is now a recognized mainstream bariatric procedure being adopted by an increasing number of surgeons. The purpose of this review was to present an evidence-based summary of its key technical aspects and prevention and management of its specific complications.
EVIDENCE ACQUISITION: We examined PubMed for all published articles on OAGB, including the ones published under one of its various other names.
EVIDENCE SYNTHESIS: An ideal OAGB procedure has a long, narrow pouch constructed carefully to avoid going too close to the greater curvature of the stomach especially at the bottom of the pouch and maintains a safe distance from the angle of His. A bilio-pancreatic limb length of 150 cm appears to be safest and a limb length of >200 cm is associated with a significantly increased incidence of protein-calorie malnutrition. We recommend routine closure of Petersen’s space to prevent Petersen’s hernia and suggest a protocol for micronutrient supplementation. This review also presents evidence-based algorithms for prevention and management of marginal ulcers, protein-calorie malnutrition, and gastroesophageal reflux disease after OAGB. We suggest lifelong supplementation with two multivitamin/mineral supplements (each containing at least 1.0 mg copper and 15 mg zinc) daily, 1.5 mg vitamin B12 orally daily or 3-monthly injection with 1 mg vitamin B12, 120 mg elemental iron daily, 1500 mg elemental calcium daily, and 3000 international units of vitamin D daily.
CONCLUSIONS: This review examines key technical steps of OAGB. We also discuss how to prevent and manage its specific complications.


KEY WORDS: Gastric bypass - Surgical anastomosis - Bariatric surgery - Complications - Dietary supplements

inizio pagina