Letter to the Editor Concerning: Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) for Biliary Reflux Resistant to Medical Treatment: Lessons Learned from a Retrospective Series of 2780 Consecutive Patients Undergoing OAGB

Abstract

LETTER TO THE EDITOR Letter to the Editor Concerning: Conversion of One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) for Biliary Reflux Resistant to Medical Treatment: Lessons Learned from a Retrospective Series of 2780 Consecutive Patients Undergoing OAGB Amir Hosein Davarpanah Jazi 1,2 & Shahab Shahabi 1,2 & Farid Nasr Esfahani 1,3 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Dear Editor, We read the interesting article of Kassir et al. regarding the conversion of one anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB) in patients with bile reflux resistant to medical treatments [1]. They evaluated 2780 pa- tients who underwent OAGB. Thirty-two (1.2%) patients with bile reflux that fulfill the criteria underwent conversion of OAGB to RYGB to treat bile reflux. They reported the method which they used to convert OAGB to RYGB and the long- term results of this conversion with a mean length of follow- up of 47.6 months. While we were reading the article, some concerns rose that based on their method, some complications may develop for the patients. The length of the gastric pouch has an important role in developing postoperative complications in both OAGB and RYGB surgeries. While a short gastric pouch in OAGB sur- gery may lead to developing bile reflux, a long gastric pouch in RYGB surgery may lead to other complications such as developing marginal ulcer. Musella et al. reported a positive correlation between gastric pouches shorter than 9 cm and developing bile reflux [2]. Also in different studies, a longer gastric pouch was correlated to more risk of developing a symptomatic marginal ulcer [3, 4]. In the Kassir’s study, the authors did not mention the length of the gastric pouch. Also, they left the gastrojejunal anastomosis unchanged. If they used a short gastric pouch, it could be the reason for develop- ing bile reflux, and if they used an appropriate gastric pouch length in the first surgery, it was critical to change the size of the gastric pouch when converting OAGB to RYGB to pre- vent developing marginal ulcers