title: Revision surgery for one anastomosis gastric bypass with anti-reflux mechanism: a new surgical procedure using only not previously operated intestine.
abstract: BACKGROUND
  Obesity is now an epidemic in industrialized countries with high prevalence (U.S. with 67%, Europa from 40% to 50%). This had led to the development of many bariatric procedures. Nevertheless, the primary surgery could fails due to several conditions. There is no standard re-operative procedure of revision for primary bariatric failure. Re-operate in the place of the primary surgery imply high rate of risks. We have developed a new procedure for revision surgery working only on not previously operated tissue.
  
  
  METHODS
  We measure the common channel from gastro- jejunal anastomosis until the ileocecal valve. Depending on the measure, we decide the length of intestine to be excluded (biliopancreatic limb and common channel). We interrupt the afferent loop before gastro-jejunostomy and the efferent loop 20 cm below the gastro-jejunostomy. For restoring the gastro-intestinal transit, we anastomose the upper part of the afferent and efferent loop side-to-side and the efferent loop segment to the upper part of the new common channel.
  
  
  CONCLUSIONS
  There is no standard procedure for revision of primary surgery. Even, the gold standard surgery Roux-en-Y gastric bypass is one of the most failed procedure (≤ 35%). We have developed the revision for One Anastomosis Gastric Bypass (BAGUA) working always in healthy tissue not previously used.
  
  
  CONCLUSIONS
  A few number of patients with tailored BAGUA for morbid obesity will require a surgical rescue procedure due to excess or insufficient weight loss or weight regain. This new procedure has been proven to be easy and safe, avoiding the surgical difficulties of the classical revision through the scar tissue.
authors.affiliation: Dept. of Surgery University Malaga, Spain.. gcaballe@uma.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Garciacaballero
authors.affiliation: Dept. of Surgery University Malaga, Spain. Autonomous University of the State of México (UAEMex). U.M.F. 229, Del. 16. Mexican Social Security Institute. México.. gcaballe@uma.es.
authors.forename: Alexander
authors.initials: A
authors.lastname: Reyes-Ortiz
authors.affiliation: Dept. of Surgery University Malaga, Spain.. gcaballe@uma.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Martínez-Moreno
authors.affiliation: Dept. of Surgery University Malaga, Spain.. gcaballe@uma.es.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Mínguez-Mañanes
authors.affiliation: Dept. of Surgery University Malaga, Spain.. gcaballe@uma.es.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Toval-Mata
authors.affiliation: Dept. of Surgery University Malaga, Spain.. gcaballe@uma.es.
authors.forename: Diego
authors.initials: D
authors.lastname: Osorio-Fernández
authors.affiliation: Dept. of Surgery University Malaga, Spain.. gcaballe@uma.es.
authors.forename: José María
authors.initials: JM
authors.lastname: Mata-Martín
mesh_terms: D015390:Gastric Bypass / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D007422:Intestines / Q000601:surgery; D007582:Jejunostomy; D009767:Obesity, Morbid / Q000601:surgery; D011182:Postoperative Care; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies