National introduction of one-anastomosis gastric bypass in the UK National Bariatric Surgery Registry: a cohort study

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AIM: There is a paucity of evidence regarding the national introduction of newer bariatric metabolic surgery procedures. This study assessed the impact of introducing one-anastomosis gastric bypass (OAGB) in bariatric surgical practice in the UK on 30-day postoperative morbidity and early postoperative weight loss. METHODS: Patients who underwent primary BMS in the UK National Bariatric Surgical Registry (2010-2019) were identified. Patient characteristics, 30-day postoperative morbidity, and 12-month total body weight loss (TBWL) were also assessed. Multivariate regression was performed for associations between 30-day postoperative morbidity and 12-month TBWL, with SG as a reference. Learning effects were assessed by factoring in the institutional OAGB caseload (0-24/25-49/50+ cases). RESULTS: A total of 59 226 patients underwent primary BMS during the study period (RYGB, 38 434; SG, 24 702; AGB, 12 627; OAGB, 3408; and others, 276). The 30-day postoperative morbidity was lower for OAGB 1.8% (51/2802) compared to RYGB 4.2% (1391/32 853) and SG 3.4% (725/21 333) but higher than AGB 1.2% (123/9915), while on multivariate regression, OAGB was associated with reduced morbidity once the institution caseload exceeded 50 operations (OR 0.35 (95% CI: 0.22-0.56; P <0.001) and no statistical difference to SG at lesser caseloads. Overall, 12-month greater than 25% TBWL was seen in 69.4% (27 736/39 971) (RYGB: 82.9% (17 617/21 246)), SG: 65.4% (7383/11 283)), AGB: 23.9% (1382/5572)) and OAGB: 82.9% (1328/1601)). On multivariate regression, OAGB was associated with the highest 12-month TBWL once the institution caseload exceeded 50 operations (OR 3.47 (95% CI 2.75-4.39; P <0.001). CONCLUSION: OAGB has been safely implemented in UK national bariatric surgery practice. It has lower reported postoperative morbidity and comparable weight loss to RYGB or SG, despite being offered to patients with more severe and complex obesity.

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