Choice between Roux-en-Y gastric bypass and one-anastomosis gastric bypass_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

DONG Shiliang , LI Zhaoxing ,  DONG Zhiyong

Department of Gastrointestinal Surgery / Department of Bariatric Surgery, The First Affiliated Hospital, Jinan University, Guangzhou 510632, P. R. China;

Corresponding author：

DONG Zhiyong, Email: dongzy2008@163.com

Keywords：

Roux-en-Y gastric bypass; one-anastomosis gastric bypass; obesity

DOI：

10.7507/1007-9424.202509062

Video：

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Abstract Full text Figures/Tables Video References Cited by

In the field of metabolic and bariatric surgery, Roux-en-Y gastric bypass and one-anastomosis gastric bypass are the two most widely performed bypass procedures. Choosing between these operations remains a challenge both for patients considering surgery and for clinicians making procedural decisions. This commentary provides a structured appraisal across multiple dimensions, including procedural principles, available evidence, advantages and limitations, indications, outcomes, and complications, with the aim of informing clinical decision-making and offering expert perspective.

Citation： DONG Shiliang, LI Zhaoxing, DONG Zhiyong. Choice between Roux-en-Y gastric bypass and one-anastomosis gastric bypass. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(9): 1079-1083. doi: 10.7507/1007-9424.202509062 Copy

1.	Silva-Chavez W, Bustamante-Cabrejo A, Caballero-Alvarado J, et al. Comparative effect of Roux-en-Y gastric bypass vs. one-anastomosis gastric bypass for revisional surgery after sleeve gastrectomy with insufficient clinical response: a systematic review and meta-analysis. Obes Surg, 2025. doi: 10.1007/s11695-025-08162-3.
2.	Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet, 2019, 393(10178): 1299-1309.
3.	Uhe I, Douissard J, Podetta M, et al. Roux-en-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass? A systematic review and meta-analysis of randomized-controlled trials. Obesity (Silver Spring), 2022, 30(3): 614-627.
4.	de Oliveira Ramos JV, Andrade Fernandes JV, de Oliveira Ferreira CH, et al. One-anastomosis versus Roux-en-Y gastric bypass in the resolution of comorbidities: a non-inferiority meta-analysis and meta-regression. Obes Surg, 2025, 35(8): 3301-3309.
5.	Yu Z, Li P, Li P, et al. Meta-analysis of long-term relapse rate of type 2 diabetes following initial remission after Roux-en-Y gastric bypass. Obes Surg, 2021, 31(11): 5034-5043.
6.	董志勇, 杨华, 姜舒文, 等. 五孔“七步法”精准腹腔镜Roux-en-Y胃旁路手术技术分享. 中华胃肠外科杂志, 2021, 24(8): 690.
7.	Mason EE, Ito C. Gastric bypass in obesity. Surg Clin North Am, 1967, 47(6): 1345-1351.
8.	Griffen WO, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg, 1977, 186(4): 500-509.
9.	Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg, 2018, 28(12): 3783-3794.
10.	Kermansaravi M, Davarpanah Jazi AH, Shahabi Shahmiri S, et al. Revision procedures after initial Roux-en-Y gastric bypass, treatment of weight regain: a systematic review and meta-analysis. Updates Surg, 2021, 73(2): 663-678.
11.	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会 (CSMBS). 腹腔镜单吻合口胃旁路术规范化手术操作指南(2022版). 中华胃肠外科杂志, 2022, 25(10): 852-858.
12.	Rutledge R. The mini-gastric bypass: experience with the first 1 274 cases. Obes Surg, 2001, 11(3): 276-280.
13.	Carbajo M, García-Caballero M, Toledano M, et al. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg, 2005, 15(3): 398-404.
14.	De Luca M, Tie T, Ooi G, et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSO position statement. Obes Surg, 2018, 28(5): 1188-1206.
15.	中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢病综合管理与护理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2024年度报告. 中华肥胖与代谢病电子杂志, 2025, 11(2): 85-91.
16.	中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南 (2019版). 中国实用外科杂志, 2019, 39(4): 301-306.
17.	Jain M, Tantia O, Goyal G, et al. LSG vs MGB-OAGB: 5-year follow-up data and comparative outcome of the two procedures over long term-results of a randomised control trial. Obes Surg, 2021, 31(3): 1223-1232.
18.	Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg, 2012, 22(5): 697-703.
19.	Ataya K, Al Jaafreh AM, El Bourji H, et al. Roux-en-Y gastric bypass versus one anastomosis gastric bypass as revisional surgery after failed sleeve gastrectomy: a systematic review and meta-analysis. J Metab Bariatr Surg, 2023, 12(2): 57-66.
20.	Bruzzi M, Chevallier JM, Czernichow S. One-anastomosis gastric bypass: why biliary reflux remains controversial?. Obes Surg, 2017, 27(2): 545-547.
21.	Felsenreich DM, Vock N, Zach ML, et al. Update on esophageal function, acid and non-acid reflux after one-anastomosis gastric bypass (OAGB): high-resolution manometry, impedance-24-h pH-metry, and gastroscopy in a prospective mid-term study. Surg Endosc, 2025, 39(4): 2335-2345.
22.	Singh B, Saikaustubh Y, Singla V, et al. One anastomosis gastric bypass (OAGB) vs Roux en Y gastric bypass (RYGB) for remission of T2DM in patients with morbid obesity: a randomized controlled trial. Obes Surg, 2023, 33(4): 1218-1227.
23.	Heinonen S, Saarinen T, Meriläinen S, et al. Roux-en-Y versus one-anastomosis gastric bypass (RYSA study): weight loss, metabolic improvements, and nutrition at 1 year after surgery, a multicenter randomized controlled trial. Obesity (Silver Spring), 2023, 31(12): 2909-2923.
24.	Balamurugan G, Leo SJ, Sivagnanam ST, et al. Comparison of efficacy and safety between Roux-en-Y gastric bypass (RYGB) vs one anastomosis gastric bypass (OAGB) vs single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): a systematic review of bariatric and metabolic surgery. Obes Surg, 2023, 33(7): 2194-2209.
25.	Almalki OM, Lee WJ, Chong K, et al. Laparoscopic gastric bypass for the treatment of type 2 diabetes: a comparison of Roux-en-Y versus single anastomosis gastric bypass. Surg Obes Relat Dis, 2018, 14(4): 509-515.
26.	Baig SJ, Priya P, Mahawar KK, et al. Weight regain after bariatric surgery-a multicentre study of 9 617 patients from Indian Bariatric Surgery Outcome Reporting Group. Obes Surg, 2019, 29(5): 1583-1592.
27.	Bhandari M, Nautiyal HK, Kosta S, et al. Comparison of one-anastomosis gastric bypass and Roux-en-Y gastric bypass for treatment of obesity: a 5-year study. Surg Obes Relat Dis, 2019, 15(12): 2038-2044.
28.	Liagre A, Benois M, Queralto M, et al. Ten-year outcome of one-anastomosis gastric bypass with a biliopancreatic limb of 150 cm versus Roux-en-Y gastric bypass: a single-institution series of 940 patients. Surg Obes Relat Dis, 2022, 18(10): 1228-1238.
29.	Poublon N, Chidi I, Bethlehem M, et al. One anastomosis gastric bypass vs. Roux-en-Y gastric bypass, remedy for insufficient weight loss and weight regain after failed restrictive bariatric surgery. Obes Surg, 2020, 30(9): 3287-3294.
30.	Elsaigh M, Awan B, Marzouk M, et al. Comparative safety and efficacy of Roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a systematic review and meta-analysis of randomized clinical trials. Cureus, 2024, 16(10): e71193. doi: 10.7759/cureus.71193.
31.	Santoro G, Alfred J, Rehman A, et al. Revisional bariatric surgery following sleeve gastrectomy: a meta-analysis comparing Roux-en-Y gastric bypass and one anastomosis gastric bypass. Ann R Coll Surg Engl, 2025, 107(3): 180-187.
32.	Robert M, Poghosyan T, Maucort-Boulch D, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass at 5 years (YOMEGA): a prospective, open-label, non-inferiority, randomised extension study. Lancet Diabetes Endocrinol, 2024, 12(4): 267-276.
33.	Jaruvongvanich V, Matar RH, Movitz BR, et al. Long-term outcomes of Roux-en-Y gastric diversion after failed surgical fundoplication in a large cohort and a systematic review. Surg Obes Relat Dis, 2021, 17(1): 161-169.
34.	Coakley KM, Groene SA, Colavita PD, et al. Roux-En-Y gastric bypass following failed fundoplication. Surg Endosc, 2018, 32(8): 3517-3524.
35.	Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2020–2021: current trends for bariatric and metabolic procedures. Obes Surg, 2024, 34(4): 1075-1085.
36.	Shin RB. Evaluation of the learning curve for laparoscopic Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis, 2005, 1(2): 91-94.
37.	Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc, 2003, 17(2): 212-215.
38.	Oliak D, Ballantyne GH, Weber P, et al. Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc, 2003, 17(3): 405-408.
39.	El-Kadre L, Tinoco AC, Tinoco RC, et al. Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience. Surg Obes Relat Dis, 2013, 9(6): 867-872.
40.	Doumouras AG, Saleh F, Anvari S, et al. Mastery in bariatric surgery: the long-term surgeon learning curve of Roux-en-Y gastric bypass. Ann Surg, 2018, 267(3): 489-494.
41.	Musella M, Berardi G, Velotti N, et al. Safety and efficacy of OAGB/MGB during the learning curve: setting a benchmark in a bariatric center of excellence. Updates Surg, 2023, 75(1): 169-174.
42.	Lo HC. The learning curve of one anastomosis gastric bypass and its impact as a preceding procedure to Roux-en Y gastric bypass: initial experience of one hundred and five consecutive cases. BMC Surg, 2020, 20(1): 37. doi: 10.1186/s12893-020-00697-9.
43.	Musella M, Susa A, Manno E, et al. Complications following the mini/one anastomosis gastric bypass (MGB/OAGB): a multi-institutional survey on 2 678 patients with a mid-term (5 years) follow-up. Obes Surg, 2017, 27(11): 2956-2967.
44.	Level L, Rojas A, Piñango S, et al. One anastomosis gastric bypass vs. Roux-en-Y gastric bypass: a 5-year follow-up prospective randomized trial. Langenbecks Arch Surg, 2021, 406(1): 171-179.
45.	Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA, 2013, 310(22): 2416-2425.

1. Silva-Chavez W, Bustamante-Cabrejo A, Caballero-Alvarado J, et al. Comparative effect of Roux-en-Y gastric bypass vs. one-anastomosis gastric bypass for revisional surgery after sleeve gastrectomy with insufficient clinical response: a systematic review and meta-analysis. Obes Surg, 2025. doi: 10.1007/s11695-025-08162-3.
2. Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet, 2019, 393(10178): 1299-1309.
3. Uhe I, Douissard J, Podetta M, et al. Roux-en-Y gastric bypass, sleeve gastrectomy, or one-anastomosis gastric bypass? A systematic review and meta-analysis of randomized-controlled trials. Obesity (Silver Spring), 2022, 30(3): 614-627.
4. de Oliveira Ramos JV, Andrade Fernandes JV, de Oliveira Ferreira CH, et al. One-anastomosis versus Roux-en-Y gastric bypass in the resolution of comorbidities: a non-inferiority meta-analysis and meta-regression. Obes Surg, 2025, 35(8): 3301-3309.
5. Yu Z, Li P, Li P, et al. Meta-analysis of long-term relapse rate of type 2 diabetes following initial remission after Roux-en-Y gastric bypass. Obes Surg, 2021, 31(11): 5034-5043.
6. 董志勇, 杨华, 姜舒文, 等. 五孔“七步法”精准腹腔镜Roux-en-Y胃旁路手术技术分享. 中华胃肠外科杂志, 2021, 24(8): 690.
7. Mason EE, Ito C. Gastric bypass in obesity. Surg Clin North Am, 1967, 47(6): 1345-1351.
8. Griffen WO, Young VL, Stevenson CC. A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann Surg, 1977, 186(4): 500-509.
9. Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2016: primary, endoluminal, and revisional procedures. Obes Surg, 2018, 28(12): 3783-3794.
10. Kermansaravi M, Davarpanah Jazi AH, Shahabi Shahmiri S, et al. Revision procedures after initial Roux-en-Y gastric bypass, treatment of weight regain: a systematic review and meta-analysis. Updates Surg, 2021, 73(2): 663-678.
11. 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会 (CSMBS). 腹腔镜单吻合口胃旁路术规范化手术操作指南(2022版). 中华胃肠外科杂志, 2022, 25(10): 852-858.
12. Rutledge R. The mini-gastric bypass: experience with the first 1 274 cases. Obes Surg, 2001, 11(3): 276-280.
13. Carbajo M, García-Caballero M, Toledano M, et al. One-anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg, 2005, 15(3): 398-404.
14. De Luca M, Tie T, Ooi G, et al. Mini gastric bypass-one anastomosis gastric bypass (MGB-OAGB)-IFSO position statement. Obes Surg, 2018, 28(5): 1188-1206.
15. 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢病综合管理与护理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2024年度报告. 中华肥胖与代谢病电子杂志, 2025, 11(2): 85-91.
16. 中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南 (2019版). 中国实用外科杂志, 2019, 39(4): 301-306.
17. Jain M, Tantia O, Goyal G, et al. LSG vs MGB-OAGB: 5-year follow-up data and comparative outcome of the two procedures over long term-results of a randomised control trial. Obes Surg, 2021, 31(3): 1223-1232.
18. Noun R, Skaff J, Riachi E, et al. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Obes Surg, 2012, 22(5): 697-703.
19. Ataya K, Al Jaafreh AM, El Bourji H, et al. Roux-en-Y gastric bypass versus one anastomosis gastric bypass as revisional surgery after failed sleeve gastrectomy: a systematic review and meta-analysis. J Metab Bariatr Surg, 2023, 12(2): 57-66.
20. Bruzzi M, Chevallier JM, Czernichow S. One-anastomosis gastric bypass: why biliary reflux remains controversial?. Obes Surg, 2017, 27(2): 545-547.
21. Felsenreich DM, Vock N, Zach ML, et al. Update on esophageal function, acid and non-acid reflux after one-anastomosis gastric bypass (OAGB): high-resolution manometry, impedance-24-h pH-metry, and gastroscopy in a prospective mid-term study. Surg Endosc, 2025, 39(4): 2335-2345.
22. Singh B, Saikaustubh Y, Singla V, et al. One anastomosis gastric bypass (OAGB) vs Roux en Y gastric bypass (RYGB) for remission of T2DM in patients with morbid obesity: a randomized controlled trial. Obes Surg, 2023, 33(4): 1218-1227.
23. Heinonen S, Saarinen T, Meriläinen S, et al. Roux-en-Y versus one-anastomosis gastric bypass (RYSA study): weight loss, metabolic improvements, and nutrition at 1 year after surgery, a multicenter randomized controlled trial. Obesity (Silver Spring), 2023, 31(12): 2909-2923.
24. Balamurugan G, Leo SJ, Sivagnanam ST, et al. Comparison of efficacy and safety between Roux-en-Y gastric bypass (RYGB) vs one anastomosis gastric bypass (OAGB) vs single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): a systematic review of bariatric and metabolic surgery. Obes Surg, 2023, 33(7): 2194-2209.
25. Almalki OM, Lee WJ, Chong K, et al. Laparoscopic gastric bypass for the treatment of type 2 diabetes: a comparison of Roux-en-Y versus single anastomosis gastric bypass. Surg Obes Relat Dis, 2018, 14(4): 509-515.
26. Baig SJ, Priya P, Mahawar KK, et al. Weight regain after bariatric surgery-a multicentre study of 9 617 patients from Indian Bariatric Surgery Outcome Reporting Group. Obes Surg, 2019, 29(5): 1583-1592.
27. Bhandari M, Nautiyal HK, Kosta S, et al. Comparison of one-anastomosis gastric bypass and Roux-en-Y gastric bypass for treatment of obesity: a 5-year study. Surg Obes Relat Dis, 2019, 15(12): 2038-2044.
28. Liagre A, Benois M, Queralto M, et al. Ten-year outcome of one-anastomosis gastric bypass with a biliopancreatic limb of 150 cm versus Roux-en-Y gastric bypass: a single-institution series of 940 patients. Surg Obes Relat Dis, 2022, 18(10): 1228-1238.
29. Poublon N, Chidi I, Bethlehem M, et al. One anastomosis gastric bypass vs. Roux-en-Y gastric bypass, remedy for insufficient weight loss and weight regain after failed restrictive bariatric surgery. Obes Surg, 2020, 30(9): 3287-3294.
30. Elsaigh M, Awan B, Marzouk M, et al. Comparative safety and efficacy of Roux-en-Y gastric bypass versus one-anastomosis gastric bypass: a systematic review and meta-analysis of randomized clinical trials. Cureus, 2024, 16(10): e71193. doi: 10.7759/cureus.71193.
31. Santoro G, Alfred J, Rehman A, et al. Revisional bariatric surgery following sleeve gastrectomy: a meta-analysis comparing Roux-en-Y gastric bypass and one anastomosis gastric bypass. Ann R Coll Surg Engl, 2025, 107(3): 180-187.
32. Robert M, Poghosyan T, Maucort-Boulch D, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass at 5 years (YOMEGA): a prospective, open-label, non-inferiority, randomised extension study. Lancet Diabetes Endocrinol, 2024, 12(4): 267-276.
33. Jaruvongvanich V, Matar RH, Movitz BR, et al. Long-term outcomes of Roux-en-Y gastric diversion after failed surgical fundoplication in a large cohort and a systematic review. Surg Obes Relat Dis, 2021, 17(1): 161-169.
34. Coakley KM, Groene SA, Colavita PD, et al. Roux-En-Y gastric bypass following failed fundoplication. Surg Endosc, 2018, 32(8): 3517-3524.
35. Angrisani L, Santonicola A, Iovino P, et al. IFSO worldwide survey 2020–2021: current trends for bariatric and metabolic procedures. Obes Surg, 2024, 34(4): 1075-1085.
36. Shin RB. Evaluation of the learning curve for laparoscopic Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis, 2005, 1(2): 91-94.
37. Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc, 2003, 17(2): 212-215.
38. Oliak D, Ballantyne GH, Weber P, et al. Laparoscopic Roux-en-Y gastric bypass: defining the learning curve. Surg Endosc, 2003, 17(3): 405-408.
39. El-Kadre L, Tinoco AC, Tinoco RC, et al. Overcoming the learning curve of laparoscopic Roux-en-Y gastric bypass: a 12-year experience. Surg Obes Relat Dis, 2013, 9(6): 867-872.
40. Doumouras AG, Saleh F, Anvari S, et al. Mastery in bariatric surgery: the long-term surgeon learning curve of Roux-en-Y gastric bypass. Ann Surg, 2018, 267(3): 489-494.
41. Musella M, Berardi G, Velotti N, et al. Safety and efficacy of OAGB/MGB during the learning curve: setting a benchmark in a bariatric center of excellence. Updates Surg, 2023, 75(1): 169-174.
42. Lo HC. The learning curve of one anastomosis gastric bypass and its impact as a preceding procedure to Roux-en Y gastric bypass: initial experience of one hundred and five consecutive cases. BMC Surg, 2020, 20(1): 37. doi: 10.1186/s12893-020-00697-9.
43. Musella M, Susa A, Manno E, et al. Complications following the mini/one anastomosis gastric bypass (MGB/OAGB): a multi-institutional survey on 2 678 patients with a mid-term (5 years) follow-up. Obes Surg, 2017, 27(11): 2956-2967.
44. Level L, Rojas A, Piñango S, et al. One anastomosis gastric bypass vs. Roux-en-Y gastric bypass: a 5-year follow-up prospective randomized trial. Langenbecks Arch Surg, 2021, 406(1): 171-179.
45. Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA, 2013, 310(22): 2416-2425.

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Choice between Roux-en-Y gastric bypass and one-anastomosis gastric bypass

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