Revisions After MGB/OAGBNCT03859596
Revisional Surgery After 925 OAGB[One Anastomosis Gastric Bypass] Operations Retrospective Cohort Study of the UK MGB/OAGB Collaborative Group.
An observational study of Revisions After MGB/OAGB and Morbidities, run by ABDULZAHRA HUSSAIN.
Trial summary
Background: One anastomosis Gastric Bypass/Mini Gastric Bypass (OAGB/MGB) is a new operation that provides comparable outcomes to the common bariatric procedures. Revisional surgery is still needed after a number of OAGB/MGB procedures. The aim of this study is to report the causes and management of these revisions. Read more about this study
- Who is it for?
- Ages 18 to 71 years
- Conditions the study is for
- Revisions After MGB/OAGB, Morbidities, Morality
- What is being tested?
- MGB/OAGB
- Type of treatment
- Surgery or procedure
- How many people
- 925 participants
- Where
- No sites listed yet
- Study dates
- 1 Jan 2010to 1 Jan 2019
- How long will I take part?
- 3 Years
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 71 years
- All sexes
- Adult, Older adult
Study population: Consequent series of obese patients with BMI more than 35 for English patients and more than 30 for Asians with comorbidities
Who may be able to join
- They have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 40 kg/m2 and other significant disease (for example, type 2 diabetes or high blood pressure) that could be improved if they lost weight.
- All appropriate non-surgical measures have been tried but the person has not achieved or maintained adequate, clinically beneficial weight loss.
- The person has been receiving or will receive intensive management in a tier 3 service.
- The person is generally fit for anaesthesia and surgery.
- The person commits to the need for long-term follow-up.
- Age 18-71 years -
Who cannot join
- Less than 18 or more than 71 years of age
- Not fit for bariatric surgery
- Psychiatric illness -
About this study
Official title: Revisional Surgery After 925 OAGB Operations Retrospective Cohort Study of the United Kingdom MGB[Mini Gastric Bypass]/OAGB Collaborative Group.
Background: One anastomosis Gastric Bypass/Mini Gastric Bypass (OAGB/MGB) is a new operation that provides comparable outcomes to the common bariatric procedures. Revisional surgery is still needed after a number of OAGB/MGB procedures. The aim of this study is to report the causes and management of these revisions.
Methods: From 2010 -2018, 925 OAGB/MGB operations were performed at 7 bariatric units across the United Kingdom and included in this retrospective cohort study. The data was retrospectively collected and analysed. The primary end point was identification of the causes and management of revisions. Follow up ranged from 6 months to 3 years.
Read more
Results: Twenty-two patients (2.3%) required revisional surgery after OAGB/MGB. Five patients (0.5%) developed severe diarrhoea managed by shortening the bilio-pancreatic limb (BPL) to 150cm. Four patients (0.4%) developed afferent loop syndrome and bile reflux was reported in another 3 (0.3%) cases; all were managed by either conversion to Roux en Y Gastric Bypass (RYGB) or a Braun anastomosis. Postoperative bleeding was controlled laparoscopically in 3 patients (0.3%). Liver decompensation was reported in 2 patients (0.2%) was treated by shortening the BPL in one patient and a reversal to normal anatomy in another. The liver failure resolved in both patients. Other indications for revision included two gastro-jejunal stenosis (0.2%), one perforated ulcer (0.1%), one patient (0.1%) with excessive weight loss and one case (0.1%) of protein malnutrition. None of the 22 patients undergoing revisional surgery after OAGB/MBG died. Lost to follow up rate was 0.2%.
Conclusion: Complications requiring revisional surgery after OAGB/MGB are uncommon (2.3%) and the majority can be managed by bilio-pancreatic limb shortening, the addition of a Braun side-to-side anastomosis or conversion to RYGB. Bilio-pancreatic limb length of 200 cm or more resulted in serious complications of liver failure, protein malnutrition, excessive weight loss and diarrhoea.
Read the detailed description
The UK OAGB/MGB collaborative group of 12 consultant bariatric surgeons was founded in 2017 and the data of 925 OAGB/MGB procedures were retrospectively collected and analysed in this cohort study. The treatment pathway is the SAME at each NHS centre. The indications for referral, consultations, and follow up after surgery are similar. This is agreed bariatric practice governed by British Obesity and Metabolic Surgery Society's [BOMSS] guidance.
The patients' age, BMI, presence of T2DM, comorbidities, Gastro-oesophageal reflux and hiatus hernia, Barrett's oesophagus, family history of upper gastro-intestinal cancer, and the patient choice were the main factors to influence the decision to the procedure type. Each centre is offering Roux en Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG), MGB/OAGB and Adjustable Gastric Band (AGB). The allocation of the procedure is finalised after mutual agreement between the patient and the surgeon taking in consideration the above factors and patient's choice. The data was retrospectively collected by the surgical team at each institution and sent to the lead of the collaborative group. The follow up is conducted by clinical visits, blood tests and radiology [ultrasound, computed tomography ] when needed.
The procedures were performed between September 2010 and May 2018. A long gastric pouch of average 15cm was constructed over a 34-36F bougie using laparoscopic staplers. The start point of stapling is at the crow's foot. The omentum was only divided in selected cases such as male patients with a very high Body Mass Index (BMI). After identifying the duodeno-jejunal junction, a BPL ranging from 150-300 cm was measured. The end-side /side-side gastro-jejunostomy was made using a combined hand-sewn /stapled technique. Use of drains and closure of Petersen's space varied between different surgeons. The patients were discharged after 2-3 nights. The follow up was ranged from 6 months to 3 years. In the UK the NHS and private practice are following National Institute of Clinical Excellence [NICE] guidelines in management and post operative follow up. Thus there is very strict follow up for two years after the operation. The patients are seen two weeks after the primary surgery at which clinical examination, dietary assessment and baseline post operative blood test is performed. Then the patients are seen one month after that, then 3 monthly period for the initial year, and 6 monthly for the last year. During all these visits, clinical, dietary and routine biochemical assessments were conducted. For patients who developed complications, a different and longer pathway of follow up is adopted until they recover and then, discharged to their general practitioners (GPs). The paper was written to comply with STROCSS guidelines (www.strocssguideline.com).
- Conditions
- Revisions After MGB/OAGB, Morbidities, Morality
- Being tested
- MGB/OAGB
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
MGB/OAGBProcedure or surgery
BARIATRIC PROCEDURE INVOLVED CREATION OF SLENDER GASTRIC POUCH OF 12-15CM IN LENGTH AND BILIO-PANCREATIC LIMB OF 150-200 CM
| Study group | Role | What they receive |
|---|---|---|
| MGB/OAGB | Consequent group of patients who underwent MGB/OAGB Receives: Procedure: MGB/OAGB |
What is being measured
The primary outcome is the main question the study is designed to answer.
Morbidities assessed by liver failure, protien malnutrition, diarrhea , bleeding, afferent loop syndrome,stomal ulcer,perforation, leak,infection
Liver failure, protien malnutrition, diarrhea , bleeding, afferent loop syndrome, stomal ulcer perforation,leak,infection.
Measured: 3 years
Secondary outcomes (1)
Mortality
Death after revision
Measured: 3 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Mar 2019
- Study start1 Jan 2010
- Primary completion1 May 2018
- Study completion1 Jan 2019
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Revisions After MGB/OAGBStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Other
- Enrolment
- 925 participants (actual)
- Target duration
- 3 Years
Sponsor and investigators
- Lead sponsor
- ABDULZAHRA HUSSAIN
- Sponsor type
- University, hospital or other
- Collaborators
- Phoenix Healthcare Group, Heart of England NHS Trust, The Whittington Hospital NHS Trust, Doncaster And Bassetlaw Hospitals NHS Foundation Trust, Spire, Inc., King's College Hospital NHS Trust
- Responsible party
- Sponsor-investigator, ABDULZAHRA HUSSAIN, ParkHill Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03859596
- Sponsor's protocol ID
- 0000
- Status last verified
- Feb 2019
- First submitted
- 26 Feb 2019
- Last updated
- 1 Mar 2019
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 1 Mar 2019. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Revisional Surgery After 925 OAGB Operations Retrospective Cohort Study of the United Kingdom MGB[Mini Gastric Bypass]/OAGB Collaborative Group.
- ClinicalTrials.gov ID
- NCT03859596
- Acronym / sponsor ID
- 0000
- Conditions
- Revisions After MGB/OAGB, Morbidities, Morality
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 925 participants (actual)
- Lead sponsor
- ABDULZAHRA HUSSAINUniversity, hospital or other
- Collaborators
- Phoenix Healthcare Group, Heart of England NHS Trust, The Whittington Hospital NHS Trust, Doncaster And Bassetlaw Hospitals NHS Foundation Trust, Spire, Inc., King's College Hospital NHS Trust
- Study start
- 1 Jan 2010 (actual)
- Primary completion
- 1 May 2018 (actual)
- Study completion
- 1 Jan 2019 (actual)
- First posted
- 1 Mar 2019 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Background: One anastomosis Gastric Bypass/Mini Gastric Bypass (OAGB/MGB) is a new operation that provides comparable outcomes to the common bariatric procedures. Revisional surgery is still needed after a number of OAGB/MGB procedures. The aim of this study is to report the causes and management of these revisions.
Methods: From 2010 -2018, 925 OAGB/MGB operations were performed at 7 bariatric units across the United Kingdom and included in this retrospective cohort study. The data was retrospectively collected and analysed. The primary end point was identification of the causes and management of revisions. Follow up ranged from 6 months to 3 years.
Results: Twenty-two patients (2.3%) required revisional surgery after OAGB/MGB. Five patients (0.5%) developed severe diarrhoea managed by shortening the bilio-pancreatic limb (BPL) to 150cm. Four patients (0.4%) developed afferent loop syndrome and bile reflux was reported in another 3 (0.3%) cases; all were managed by either conversion to Roux en Y Gastric Bypass (RYGB) or a Braun anastomosis. Postoperative bleeding was controlled laparoscopically in 3 patients (0.3%). Liver decompensation was reported in 2 patients (0.2%) was treated by shortening the BPL in one patient and a reversal to normal anatomy in another. The liver failure resolved in both patients. Other indications for revision included two gastro-jejunal stenosis (0.2%), one perforated ulcer (0.1%), one patient (0.1%) with excessive weight loss and one case (0.1%) of protein malnutrition. None of the 22 patients undergoing revisional surgery after OAGB/MBG died. Lost to follow up rate was 0.2%.
Conclusion: Complications requiring revisional surgery after OAGB/MGB are uncommon (2.3%) and the majority can be managed by bilio-pancreatic limb shortening, the addition of a Braun side-to-side anastomosis or conversion to RYGB. Bilio-pancreatic limb length of 200 cm or more resulted in serious complications of liver failure, protein malnutrition, excessive weight loss and diarrhoea.
Detailed description
The UK OAGB/MGB collaborative group of 12 consultant bariatric surgeons was founded in 2017 and the data of 925 OAGB/MGB procedures were retrospectively collected and analysed in this cohort study. The treatment pathway is the SAME at each NHS centre. The indications for referral, consultations, and follow up after surgery are similar. This is agreed bariatric practice governed by British Obesity and Metabolic Surgery Society's [BOMSS] guidance.
The patients' age, BMI, presence of T2DM, comorbidities, Gastro-oesophageal reflux and hiatus hernia, Barrett's oesophagus, family history of upper gastro-intestinal cancer, and the patient choice were the main factors to influence the decision to the procedure type. Each centre is offering Roux en Y Gastric Bypass (RYGB), Laparoscopic Sleeve Gastrectomy (LSG), MGB/OAGB and Adjustable Gastric Band (AGB). The allocation of the procedure is finalised after mutual agreement between the patient and the surgeon taking in consideration the above factors and patient's choice. The data was retrospectively collected by the surgical team at each institution and sent to the lead of the collaborative group. The follow up is conducted by clinical visits, blood tests and radiology [ultrasound, computed tomography ] when needed.
The procedures were performed between September 2010 and May 2018. A long gastric pouch of average 15cm was constructed over a 34-36F bougie using laparoscopic staplers. The start point of stapling is at the crow's foot. The omentum was only divided in selected cases such as male patients with a very high Body Mass Index (BMI). After identifying the duodeno-jejunal junction, a BPL ranging from 150-300 cm was measured. The end-side /side-side gastro-jejunostomy was made using a combined hand-sewn /stapled technique. Use of drains and closure of Petersen's space varied between different surgeons. The patients were discharged after 2-3 nights. The follow up was ranged from 6 months to 3 years. In the UK the NHS and private practice are following National Institute of Clinical Excellence [NICE] guidelines in management and post operative follow up. Thus there is very strict follow up for two years after the operation. The patients are seen two weeks after the primary surgery at which clinical examination, dietary assessment and baseline post operative blood test is performed. Then the patients are seen one month after that, then 3 monthly period for the initial year, and 6 monthly for the last year. During all these visits, clinical, dietary and routine biochemical assessments were conducted. For patients who developed complications, a different and longer pathway of follow up is adopted until they recover and then, discharged to their general practitioners (GPs). The paper was written to comply with STROCSS guidelines (www.strocssguideline.com).
Study design
- Observational model
- Cohort
- Time perspective
- Other
- Target follow-up
- 3 Years
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| MGB/OAGB | – | Procedure: MGB/OAGBConsequent group of patients who underwent MGB/OAGB |
Who may qualify
- Ages
- 18 to 71 years
- Sex
- All
- Age groups
- Adult, Older adult
- Study population
- Consequent series of obese patients with BMI more than 35 for English patients and more than 30 for Asians with comorbidities
Key inclusion criteria (6 listed)
- They have a BMI of 40 kg/m2 or more, or between 35 kg/m2 and 40 kg/m2 and other significant disease (for example, type 2 diabetes or high blood pressure) that could be improved if they lost weight.
- All appropriate non-surgical measures have been tried but the person has not achieved or maintained adequate, clinically beneficial weight loss.
- The person has been receiving or will receive intensive management in a tier 3 service.
- The person is generally fit for anaesthesia and surgery.
- The person commits to the need for long-term follow-up.
Key exclusion criteria (3 listed)
- Less than 18 or more than 71 years of age
- Not fit for bariatric surgery
- Psychiatric illness -
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| MGB/OAGBBARIATRIC PROCEDURE INVOLVED CREATION OF SLENDER GASTRIC POUCH OF 12-15CM IN LENGTH AND BILIO-PANCREATIC LIMB OF 150-200 CM | Procedure or surgery | MGB/OAGB |
Primary outcome
Morbidities assessed by liver failure, protien malnutrition, diarrhea , bleeding, afferent loop syndrome,stomal ulcer,perforation, leak,infection
Time frame: 3 years
Liver failure, protien malnutrition, diarrhea , bleeding, afferent loop syndrome, stomal ulcer perforation,leak,infection.
1 secondary outcome
Mortality
Time frame: 3 years
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 1 Mar 2019.
- Individual participant dataSharing planned: Undecided
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
An observational study of Revisions After MGB/OAGB and Morbidities, run by ABDULZAHRA HUSSAIN.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 6 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 1 Mar 2019. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Morbidities assessed by liver failure, protien malnutrition, diarrhea , bleeding, afferent loop syndrome,stomal ulcer,perforation, leak,infection (time frame: 3 years). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 1 Mar 2019.