One Anastomosis Gastric Bypass How effective is the One Anastomosis Gastric Bypass (OAGB/Bagua)?

What kind of pathology do we want to treat and control? • Morbid obesity is a Chronic Inflammatory Disease. • Dangerous, severe and mortal due to its high cardiovascular risk. • Progressive and unstoppable. • Uncontrollable by the mind or any other conventional procedure. • Incurable and fatal.

What are the objectives of an “ideal” bariatric surgery? Eradicate or control long term overweight (> 10 years) Solve, improve or control severe co-morbidities and long term cardiovascular risk (>10 years) Enhance life´s quality, improve health and avoid an early death. Return the patients to them personal, social and familiar life.

Which must be the principles and criteria of an “IDEAL” bariatric procedure? Must be safe Must eliminate and control all the associated co- morbidities To loose and keep the weight lost in life time term. Easy to reproduce and without complications Short time in surgery No more than 24/48hrs in hospital bed No more than 24 hrs in hospital bed Short time surgeries Minimum blood lost Do not need ICU Minimum post-surgery pain. Patient feels grateful with it. As easily reversible as reviewed by laparoscopic approach. That does not produce nausea or vomiting Hardly any complication. Fast recovery and aloud the patient to walk at the next day. Aloud the patient returning to work in a week. Minimum risk of PTE Minimum risk of gastro-jejunostomy ulcers Easily management of mal-absortion Do not need any kind of prosthetic supplies. To be easily checked and debated in data bases. To be done in a continuous and follow-up program The process must be guided by a distinguished Center of Excellence or by The European Accreditation Council of the International Federation of Obesity Surgery Societies.

What procedures, endoscopic or surgical, can we use? 1.- Non-complex surgeries (Restrictive) ——-VBG, GB, SG, GP **Successful results at short and medium time. No long-term success report. 2.- Complex surgeries Standard combined ——-GBYR ** Partial efficiency at medium term, less at long term (<50% of patient at 10 yrs) Mal-absortive pure ——-DS, BD, SADi *Real success at long-term (>50% >10 yr) ** Higher surgical, morbidity and mortality risk. ***Higher rate complications on long-term. Combined: mal-absortive and restrictive ——-OABP/BAGUA * Long term real efficiency (>50% patients >10 yr) ** Less proportion of surgical, morbidity and mortality risk. *** Less rate complications on long-term. Endoscopic: Ballon, POSE, Endobarrier, Endoscopic gastroplasty…… None of these had proved real efficacy

Failure in Weight Loss or Weight Regain!!! Stenosis Leak Bleeding Chronic Marginal Ulcer Severe Dumping. Stenosis Leak Bleeding Obstruction Stenosis Leak Bleeding Volvulus Intussuception Internal Hernia Obstruction?? Failure in Weight Loss or Weight Regain!!! Two Anastomosis GB 12 Possible Risk Factors OAGB/BAGUA 4 Possible Risk Factors .

Post-operative X-Ray control Radiologic control at 10 years LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS ROBOTIC - IDRIVE ULTRA POWERED STAPLING SYSTEM (OAGB) Post-operative X-Ray control Radiologic control at 10 years However the different series published a global complication rate ranged from 20.5 to

References Rutledge R. The mini-gastric bypass: experience with first 1,274 cases. Obes Surg 2001;11:276-80.   Garcia-Caballero M, Carbalo M. One anastomosis gastric bypass: a simple, safe and efficient procedure for treating morbid obesity. Nutr Hosp 2004;19:372-5. Carbajo M, Garcia-Caballero M, Toledano M, Osorio D, Garacia-Lanza C, Carmona JA. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg 2005;15:398-404. Rutledge R. Hospitalization before and after mini-gastric bypass surgery. Int J Surg 2007;5:35-40. Piazza L, Ferrara F, Leanza S, Coco D, Sarvà S, Bellia A, Di Stefano C, Basile F, Biondi A. Laparoscopic mini-gastric bypass: short-term single-institute experience. Updates Surg 2011;63:239-42. Garcia-Caballero M, Valle M, Martinez-Moreno JM, et al.  Resolution of diabetes mellitus and metabolic syndrome in normal weight 24-29 BMI patients with one anastomosis gastric bypass. Nutr Hosp 2012;27:623-31. Musella M, Sousa A, Greco F, De Luca, Manno E, Di Stefano C, Milone M, Bonfanto R, Segato G, Antonino A, Piazzo L. The laparoscopic mini-gastric bypass: The Italian experience: outcomes from 974 consecutive cases in a multi-center review. Surg Endosc 2014;28:156-63. Musella M, Milone M. Still “controversies” about the mini gastric bypass? Obes Surg 2014;24”:643-4. Kim MJ, Hur KY. Short-term outcomes of laparoscopic single anastomosis gastric bypass (LSAGB) for the treatment of type 2 diabetes in lower BMI (<30 kg/m(2)) patients. Obes Surg 2014;24:1044-51. Lee WJ, Chong K, Lin YH, Wei JH, Chen SC. Laparoscopic sleeve gastrectomy versus single anastomosis (mini-) gastric bypass for the treatment of type 2 diabetes mellitus: 5-year results of a randomized trial and study of incretin effect. Obes Surg 2014;24:1552-62. Kular KS, Manchanda N, Rutledge R.  Analysis of the five-year outcomes of sleeve gastrectomy and mini gastric bypass: A report from the Indian sub-continent. Obes Surg 2014;24:1724-8.  Georgiadou D, Sergentanis TN, Nixon A, Diamantis T, Tsigris C, Psaltopoulou T. Efficacy and safety of laparoscopic mini-gastric bypass. A systematic review. Surg Obes Relat Dis 2014;10:984-91. Musella M. Milone M, Gaudioso D, Bianco P, Palumbo R, Bellini M, Milone F. A decade of bariatric surgery. What have we learned? Outcome in 520 patients from a single institution. Int J Surg 2014;12 Suppl 1:S183-8. Garciacaballero M, Reyes-Ortiz A, Garcia M, Martinez-Moreno JM, Toval-Mata JA. Super obese behave different from simple and morbid obese patients in the changes of body composition after tailored one anastomosis gastric bypass (BAGUA). Nutr Hosp 2014;29:1013-9. Garciacaballero M, Reyes-Ortiz A, Martinez-Moreno M, Minquez-Mananes A, Toval-Mata JA, Osorio-Fernandez D, Mata-Martin JM. Revision surgery for one anastomosis gastric bypass with anti-reflux mechanism: a new surgical procedure using only not previously operated intestine. Nutr Hosp 2014;30:1232-6. Garciacaballero M, Reyes-Ortiz A, Garcia M, Martinez-Moreno JM, Toval JA, Garcia A, Minquez A, Osorio D, Mata JM, Miralles F. Changes of body composition in patients with BMI 23-50 after tailored one anastomosis gastric bypass (BAGUA): influence of diabetes and metabolic syndrome. Obes Surg 2014;24:2040-7. Carbajo MA, Jimenez JM, Castro MJ, Ortiz-Solorzano J, Arango A. Outcomes and weight loss, fasting blood glucose and glycosylated hemoglobin in a sample of 415 obese patients, included in the database of the European Accreditation Council for Excellence Centers for Bariatric Surgery with Laparoscopic One Anastomosis Gastric Bypass. Nutr Hosp 2014;30:1032-8. Carbajo MA, Vazquez-Pelcastre, Aparicio-Ponce R, Luque de Lyon E, Jimenez JM, Ortiz-Solarzano J, Castro MJ. 12-year old adolescent with super morbid Musella M, Apers J, Rheinwalt K, Ribeiro R, Manno E, Greco F, Milone M, Di Stefano C, Guler S, Van Lessen IM, Guerra A, Maglio MN, Bonfanti R, Novotna R, Coretti G, Piazza L. Efficacy of bariatric surgery in type 2 diabetes mellitus remission: the role of mini gastric bypass/one anastomosis gastric bypass and sleeve gastrectomy at 1 year of follow-up. A European survey. Obes Surg 2015 Sep 4 [Epub ahead of print].obesity, treated with laparoscopic one anastomosis gastric bypass (LOAGB/BAGUA): A case report after 5-year follow-up. Nutr Hosp 2015;31:2327-32.

Follow-up of number and percentage of patients at each year from July 2002 to Octuber 2008

Weigh loss evolution after OAGB in 1200 morbidly obese patients

Outcomes of OAGB on comorbidity conditions in 1200 morbidly obese patients

EWL and EBMIL 1200 patients in 12 years

European database register of IFSO Center of Excellence from Jan 2010-2015 comparative EWL study between OAGB (Dr. Carbajo) vs RYGB, SG, and GB 87% 64% 39% 21%

European database register of IFSO Center of Excellence from Jan 2010-2015 comparative EBMIL study between OAGB (Dr. Carbajo) vs RYGB, SG, and GB 108% 72% 48% 24%

How effective is the One Anastomosis Gastric Bypass (OAGB/Bagua)? Conclusions: 1.- In behalf of our 25 years bariatric surgery experience performing restrictive, combined, mal-absortive and OAGB procedures, we have eliminated: Restrictive surgeries due to its inefficiency at long term. RYGB due to its high complications rates and lack of adequate results. Mal-absortive surgeries due to its complexity and medium/long term complications.

How effective is the One Anastomosis Gastric Bypass (OAGB/Bagua)? Conclusions: 2.- Likewise any other complex technique, OAGB/BAGUA, needs its own learning curve, bariatric experience, physiopatology knowledge of the obesity, laparoscopic abilities and advance technology use.

How effective is the One Anastomosis Gastric Bypass (OAGB/Bagua)? Conclusions: 3.- We do not recommend start OAGB/BAGUA technique without previos guide of experts. Even though is an excellent procedure, is not excluded to presents some of the severe or fatal complications like any other GI-Bypass 4.- A suitable technique to re-do any kind of restrictive procedure no matter if is surgical or endoscopic.

How effective is the One Anastomosis Gastric Bypass (OAGB/Bagua)? Conclusions: 5.- OAGB/BAGUA Is an easily duplicated technique Decreases four times YRGB´s complications and its weighloss at long-term is higher, keeping the same results after 10 years as pure mal-absortive does, without its complications or mortality. With an excellent life´s quality after surgery, is the procedure which approaches the most to the theoretical “IDEAL”.

CENTER OF EXCELLENCE FOR THE STUDY AND OBESITY SURGERY TREATMENT