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Was macht den Mini‑/One-anastomosis-gastric-Bypass zu einem Standardverfahren? – Evidenz zur Einschlingenrekonstruktion

Evidence of the Mini-/One-anastomosis-gastric-Bypass for being a standard procedure in obesity and metabolic surgery

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Zusammenfassung

Hintergrund

Der Mini-gastric-Bypass/One-anastomosis-gastric-Bypass (MGB/OAGB) war im Jahr 2017 mit 1044 Eingriffen (13,9 % der Gesamtoperationen, StuDoQ|MBE) der dritthäufigste operative Eingriff für Adipositas in Deutschland.

Ziel der Arbeit

Diese Analyse soll die aktuelle Evidenz des MGB/OAGB und die historische Evidenz zur Einschlingenrekonstruktion wiedergeben.

Material und Methoden

Es erfolgte eine systematische Literaturanalyse in der elektronischen Datenbank MEDLINE via PubMed und im Studienregister Clinicaltrials.gov. Wir fanden 35 relevante Artikel: 19 retrospektive Studien, 8 retrospektive Vergleichsstudien, 2 Übersichtsarbeiten, 3 systematische Reviews und Metaanalysen und 3 prospektiv randomisiert kontrollierte Studien. In Clinicaltrials.gov waren 8 prospektiv randomisierte Studien registriert.

Ergebnisse

Nach MGB/OAGB betrug die 30-Tage-Mortalität 0–0,9 %, interventionspflichtige Komplikationen traten bei einer perioperativen Gesamtmorbidität von 3,2–10,8 % zu 0,8–7 % auf. Der „total weight loss“ betrug 31–38 % nach einem und 23–32 % nach 5 Jahren. In allen Arbeiten zeigte sich eine positive Wirkung auf die metabolischen Begleiterkrankungen. Studien zu harten Endpunkten wie „Endorganschäden bei Diabetes“, „Reduktion kardiovaskulärer Ereignisse“ und eine Verlängerung des Überlebens existieren bislang nur für den Roux-Y-Magenbypass.

Diskussion

Der MGB/OAGB hat eine geringe perioperative Komplikationsrate und bietet kurzfristig Vorteile bezüglich des Gewichtsverlusts und des antidiabetischen Wirkungsgrades im Vergleich zu den etablierten Standardverfahren Roux-Y-Magenbypass und Schlauchmagen. Der Stellenwert des biliären Refluxes und einer damit verbundenen Möglichkeit der Entartung im Langzeitverlauf ist derzeit unklar. Bisher ausstehende Ergebnisse der registrierten prospektiv randomisierten Studien werden in Zukunft eine bessere Evidenz bieten können.

Abstract

Background

The Mini gastric bypass/One anastomosis gastric bypass (MGB/OAGB) was the third most commonly performed procedure in Germany, with 13.9% of all obesity and metabolic procedures in 2017 (StuDoQ|MBE).

Objective

This article reviews the currently published evidence for MGB/OAGB and the historical evidence on one anastomosis reconstruction.

Material and methods

A systematic literature search was performed in MEDLINE via PubMed and in Clinicaltrials.gov. from inception to 13 March 2018. A total of 35 studies met the inclusion criteria: 19 retrospective studies, 8 retrospective comparative trials, 2 systematic reviews, 3 systematic reviews and meta-analyses and 3 randomized clinical trials. A total of eight randomized clinical trials regarding MGB/OAGB are currently registered at Clinicaltrials.gov.

Results

In this study 35 eligible studies were included reporting data on >15,000 patients. The 30-day mortality rate ranged from 0–0.9% and severe complications needing intervention ranged from 0.8–7%, whereas perioperative morbidity ranged from 3.2–10.8%. The use of MGB/OAGB induced substantial weight loss with a total weight loss of 31–38% after 1 year and 23–32% after 5 years. Moreover, it showed a resolution or improvement in all major obesity-related diseases. Studies evaluating endpoints, such as end organ damage in diabetes, reduction of cardiovascular events and extending survival are missing and are available only for the Roux-en Y gastric bypass.

Conclusion

This systematic review confirms the advantages of MGB/OAGB regarding weight loss and the antidiabetic effect in the short-term in comparison to Roux-en Y gastric bypass and sleeve gastrectomy. The role of bile reflux as a possible risk factor for neoplastic lesions in the long-term remains a point of discussion. The results of the registered randomized controlled trials will provide a better evidence in the future.

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Abb. 1

Abbreviations

AH:

Arterielle Hypertonie

BMI:

Body-Mass-Index

BPL:

„Biliopancreatic limb“ (biliopankreatischer Schenkel)

CI:

„Confidence interval“

DM2:

Diabetes mellitus Typ 2

EBMIL:

„Excess BMI loss“

EWL:

„Excess weight loss“

FU:

Follow-up

GB:

„Gastric banding“ (Magenband)

GERD:

„Gastroesophageal reflux disease“

MGB:

Mini-anastomosis-gastric-Bypass

OAGB:

One-anastomosis-gastric-Bypass

OR:

„Odds ratio“

PPI:

Protonenpumpeninhibitoren

RNYGB:

Roux-Y-Magenbypass

SAGB:

Single-anastomosis-gastric-Bypass

SG:

„Sleeve gastrectomy“ (Schlauchmagenoperation)

WL:

„Total weight loss“

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  1. Klinik für Adipositas- und Metabolische Chirurgie, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach am Main, Deutschland

    S. Chiappetta & R. Weiner

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  1. S. Chiappetta
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Correspondence to S. Chiappetta.

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Chiappetta, S., Weiner, R. Was macht den Mini‑/One-anastomosis-gastric-Bypass zu einem Standardverfahren? – Evidenz zur Einschlingenrekonstruktion. Chirurg 89, 589–596 (2018). https://doi.org/10.1007/s00104-018-0663-9

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