1. (OAGB) “How do I do it” Laparoscopic One Anastomosis Gastric ByPass
Concepts and results in a series of
14-years experience with 2,750 patients

2. 7th International Congress of the Spanish Society of Obesity Surgery.
Valladolid - Spain
May, 2004.

3. 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 .

4. LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS ROBOTIC - IDRIVE ULTRA POWERED STAPLING SYSTEM (OAGB)

5. ONE ANASTOMOSIS GASTRIC BYPASS
LAPAROSCOPIC
ONE ANASTOMOSIS GASTRIC BYPASS
(OAGB/BAGUA)
Illustration Dr. A. Valdés

6. KEY STEPS OF THE PROCEDURE
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS ROBOTIC - IDRIVE ULTRA POWERED STAPLING SYSTEM (OAGB)
KEY STEPS OF THE PROCEDURE
1. Bilio-Pancreatic Limb: between 200 to 350 cm average.
2. Section of Greater Omentum: in supermorbid and central obesity.
3. Hiss Angle, Fat and G-E membrane Totally Dissected.
4. Gastric Pouch: length: 15-18cm, capacity: ~ 30/40 cc. (calibrated with a 36 French tube). Total dissection of fat in the posterior gastric wall.
5. “Anti-reflux Mechanism”: afferent loop suspended at least 10 cm on the gastric pouch.
6. Gastro-Ileal Anastomosis Side to Side: ~ 2.5 cm. width.
However the different series published a global complication rate ranged from 20.5 to

7. 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

8. RESULTS: Patient Characteristics (July 2002 to February 2016)
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 14-YEAR EXPERIENCE IN PATIENTS
RESULTS: Patient Characteristics (July to February 2016)
Age
43 ( )
Gender
Female
1691 (61.5%)
Male
1059 (38.5%)
BMI
46 ( )
EBW (kg)
65 ( )
The results of the first 209 patients operated on with the technique have confirmed our hypothesis. Our patients have no clinical symptoms as well as no objective evidence of GERD (measured in the 20 first patients by endoscopy and pHmetry) and margin ulcers.

9. RESULTS: Patient Characteristics (July 2002 to February 2016)
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 14-YEAR EXPERIENCE IN PATIENTS
RESULTS: Patient Characteristics (July to February 2016)
Primary Surgery
1580 (57.4%)
Other Previous Open Surgery
663 (24.1%)
Other Associated Procedures
432 (15.7 %)
Revisional Surgery
75 (2.7%)
The results of the first 209 patients operated on with the technique have confirmed our hypothesis. Our patients have no clinical symptoms as well as no objective evidence of GERD (measured in the 20 first patients by endoscopy and pHmetry) and margin ulcers.

10. Length of Hospital Stay
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 14-YEAR EXPERIENCE IN PATIENTS
Length of Hospital Stay
Uncomplicated Patients
2,715 (98.8%)
1 day
( h.)
Patients with Major Complications
35 (1.2%)
9 days
(4-32 d.)
The results of the first 209 patients operated on with the technique have confirmed our hypothesis. Our patients have no clinical symptoms as well as no objective evidence of GERD (measured in the 20 first patients by endoscopy and pHmetry) and margin ulcers.

11. Surgical Early Major Complications
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 14-YEAR EXPERIENCE IN 2,750 PATIENTS
Surgical Early Major Complications
Intraoperative Complications (resolved by Open Surgery)
4 (0.14%)
Bleeding
2 (0.072 %)
Gastro-esophageal Perforation
1 (0.036 %)
Incorrect Gastric Transection
Immediate Postoperative
Complications (resolved by Open Surgery)
6 (0.21%)
Leaks
Intestinal Obstruction
Partial Necrosis of Excluded Stomach
Immediate Postoperative
Complications (resolved by Lap. Surgery)
17 (0.61%)
10 (0.36%)
3 (0.109 %)
Acute Gastric Distension
The results of the first 209 patients operated on with the technique have confirmed our hypothesis. Our patients have no clinical symptoms as well as no objective evidence of GERD (measured in the 20 first patients by endoscopy and pHmetry) and margin ulcers.
TOTAL (0.909%)

12. Mortality Non Surgical Early Major Complications Mortality Total
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 14-YEAR EXPERIENCE IN PATIENTS
Non Surgical Early Major Complications
Mortality
Complications Treated Conservatively
Mortality
Leaks
8 (0.29 %)
Acute Pancreatitis
1 (0.036 %)
Infected Hematoma
Total
10 (0.36%)
Massive Pulmonary Embolism
1 (0.036 %)
Nosocomial Pneumonia (Post-reintervention)
DIC-Post Band reversion
Total
3 (0.109%)

13. Gastro-intestinal stenosis
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 14-YEAR EXPERIENCE IN 2,750 PATIENTS
Late Complications
Gastro-intestinal stenosis
9 (0.3%)
Pneumatic Dilatation
7 (0.25%)
Prosthesis
2 (0.072%)
Anastomotic
Ulcer
Medical Treatment
22 (0.8%)
Malnutrition
Medical treatment
23 (0.83%)
B1-B6 Vitamin
(severe deficit)
3 (0.1%)
Weight regain
Revisional surgery
1 (0.03%)
TOTAL
45 (1.63 %)

14. Endoscopic Studies at 5-Year Follow-Up
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 14-YEAR EXPERIENCE IN 2,750 PATIENTS
Endoscopic Studies at 5-Year Follow-Up
Postop. UGI endoscopic (control) studies planned for all patients completing 5-year f/u
1,900 patients completed at least 5-Year f/u
- 608 (32%) underwent UGI endoscopic studies
NO significant acute or chronic lesions found
NO erosive esophagitis or severe alkaline reflux
Findings:
Stomal ulcer: 4 (0.7%)
Mild / Moderate pouch gastritis: 41 (7%)
H. Pylori +: 10 (1.7%)

15. Percent of mean (and range)
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 14-YEAR EXPERIENCE IN 2,750 PATIENTS
Weight Loss
Percent of mean (and range)
EWL at:
1 year
84% (55 –112%)
2 year
88% (58 –115%)
3 year
81% (55 –103%)
4 year
79% (51 –102%)
5 year
77% (48 –100%)
10 year
12 year
70% (45–98%)
69% (43–98%)

16. Arterial Hypertension
LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS: 14-YEAR EXPERIENCE IN 2,750 PATIENTS
Severe Comorbidities - Resolution Index
at Two years
at Ten years
Dyslipidemia
98%
86%
Type II Diabetes
99%
90%
Arterial Hypertension
87%
Sleep apnea
100%

17. Distribution of Operated Patients IFSO- European Database Control
Procedure
Total
Gastric Banding
2,521
Gastric Plication
196
Gastric Sleeve
10,233
MGB / OAGB
2,256
*OAGB Centro Carbajo
810
Gastric Bypass
12,763
Gastroplasty 4
Bilio-pancreatic Diversion -Scopinaro
179
Duodenal Switch
615
Other Bariatric Surgery
794
29,561
January 2010 – January 2016
* Incluidas en las 2,256 de MGB/OAGB

18. IFSO- European Database Control
COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG
IFSO- European Database Control
(January 2010-January 2016)
BMI Distribution
TOTAL OPERATIONS 810
TOTAL OPERATIONS 12,763
OAGB/ Dr. Carbajo
RYGB
TOTAL OPERATIONS 2,521
TOTAL OPERATIONS 10,233 GB SG

19. IFSO- European Database Control
COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG
IFSO- European Database Control
( )

20. IFSO- European Database Control
COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG
IFSO- European Database Control
(January 2010 – January 2016)
Hospital Stay
TOTAL OPERATIONS 810
TOTAL OPERATIONS 12,763
OAGB/ Dr. Carbajo
RYGB
TOTAL OPERATIONS 2,521
TOTAL OPERATIONS 10,233 GB SG

21. IFSO- European Database Control
COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG
IFSO- European Database Control
(Since January 2010)

22. IFSO- European Database Control
COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG
IFSO- European Database Control
(January 2010-January 2016)

23. IFSO- European Database Control Post-operative Complications
COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG
IFSO- European Database Control
( )
Post-operative Complications

24. IFSO- European Database Control
COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG
3 years follow-up
IFSO- European Database Control
Evolution of % EWL 87 64 52 32

25. IFSO- European Database Control
COMPARATIVE: OAGB vs. RYGB vs. GB vs. SG
3 years follow-up
IFSO- European Database Control
Evolution of % EBMIL 92 71 59 35

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

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

28. LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS:
14-YEAR EXPERIENCE IN 2,750 PATIENTS
CONCLUSIONS
The OAGB (BAGUA) technique in our experience does not reduce the “complexity” of the surgical procedure, but significantly reduces operative time and length of hospital stay compared to other, simple or complex techniques; it also substantially decreases both early and late complication rates.
In conclusion

29. LAPAROSCOPIC ONE ANASTOMOSIS GASTRIC BYPASS:
14-YEAR EXPERIENCE IN 2,750 PATIENTS
CONCLUSIONS
Excellent results in our long-term follow- up in regards to EWL/EBMIL resolution of co-morbidities and quality of life make OAGB a safe and effective technique, comparatively with others simple/complex bariatric techniques.
Furthermore, is a powerful alternative for the treatment of morbid and super-morbid obesity after a 14-year experience.
In conclusion

31. CENTER OF EXCELLENCE FOR THE STUDY AND OBESITY SURGERY TREATMENT