Updated information for patients after gastric bypass in 2025

For the One Anastomosis Gastric Bypass The Delphi consensus in 2024 reported:     OAGB is appropriate for younger patients (15-24 years) with severe obesity OAGB is not appropriate for patients with severe oesophagitis and/or Barrett’s oesophagus   RYGBP is a better procedure for patients with severe GORD and/or large hiatus hernia (but no consensus on the OAGB for symptomatic GORD)   Revision from OAGB to RYGBP is the procedure of choice for persistent bile reflux after 6 to 12 months from the index operation   In patients with a large hiatus hernia, OAGB with crural repair is an acceptable procedure Crural repair must be done in patients with Type 2, 3 and 4 hiatus hernia (but no consensus on the minimal gastric pouch length or the anti reflux stitch)   OAGB does not carry a higher risk of complications than RYGBP in patients with Child A cirrhosis OAGB is not appropriate for patients with Child’s B or C cirrhosis   OAGB is appropriate for BMI 30-32.5 (for the Western population) and 27.5-30 (Asian population) with uncontrolled T2DM despite optimum mrdical management   Recommended BP limb is 150-200cm The BP can be tailored to individual patient It is not mandatory to measure the total bowel length Reversal of the OAGB is the best way to treat protein energy malnutrition   The position of the gastro-enterostomy (anterior, posterior) does not make any difference to the outcomes   Petersen’s space may not always be closed   Patients are advised post op prophylaxis with urso-doexycholic acid for at least 6 months for prevention of gallstone formation   All patients be advised to take PPI medications for at least 6 months   Surveillance gastroscopy at regular intervals after OAGB is recommended after OAGB (but no consensus on the timing, frequency or intervals)   Medical management is the best approach for stomal ulcers

Ursodeoxycholic acid   The recommendation is to take this for at least 6 months after the gastric bypass to prevent gallstone or gall bladder disease (for patients who didn’t have a cholecystectomy in the past)   The prescribed dose is usually 500mg 2 times a day   Caution: This is not to be used for patients who are allergic or sensitive to this medication This is not to be used in children This is not to be used in female patients who are pregnant or breast feeding This medication may interact with other medications (such as cholestyramine, statin medications, antacids, others)     Side effects: Diarrhoea, itch, rash, nausea/vomiting, abdominal pain

Proton pump inhibitors anti-acid medications   The recommendation is to take this for at least 6 months after the gastric bypass to prevent gastric ulcers and/or acid reflux   All patients must not smoke, vape, have steroids or non steroidal anti-inflammatory tablets after gastric bypass   The prescribed dose is usually 20mg once a day   Side effects: Constipation or diarrhoea, flatulence, headache, nausea or vomiting, abdominal pain There is no clear evidence that PPI medication causes gastric cancers   Drug interaction: There may be drug interaction with warfarin, phenytoin, digoxin, methotrexate, cilostazol, some oral contraceptives or other medications

Gastroscopy check after gastric bypass   Sometime after the gastric bypass surgery we need to arrange a post op gastroscopy check   There is no charge from the anaesthetist or the surgeon   Please contact me via email victorliew@live.com.au or phone the office on 5648 3755

Contraception after bariatric surgery   It is recommended that female patients not to fall pregnant within the first 12 months after bariatric surgery   Oral contraceptive pills may or may not be properly absorbed after a gastric bypass   Some patients after gastric bypass should consider non oral contraception, examples include intra uterine device or implants Please talk to your GP or obstetrician