IBC Oxford University Oral Abstract 7 - Outcomes of Braun procedure for reflux after OAGB- audit from a single centre

Abstract Introduction One anastomosis gastric bypass is an established bariatric procedure that gives good weight loss and resolution of obesity related morbidity. However, some patients suffer with bile reflux, presenting with debilitating symptoms like vomiting, nausea and retro-sternal burning. These symptoms can be difficult to control medically, and some patients require surgical intervention. Conversion to Roux-en-Y bypass is the most common procedure but it is major revisional surgery. Braun procedure, consisting of jejuno-jejunal anastomosis 30 cm distal to GJ anastomosis to bypass bile away from stomach is a less invasive option. Methods In this retrospective study of a prospective database, we analysed the outcomes of all the patients who underwent Braun procedure from October 2016–January 2024 for resolution of symptoms of bile reflux and to compare them with those of RYGB conversion. Patients who present with bile reflux are managed in the MDT setting and offered medical management. Diagnosis is confirmed with OGD and Barium study. Non-respond and those with severe reflux are offered surgical options of Braun Procedure and RYGB. Choice of procedure is based on MDT discussion considering the severity of reflux, quality of life, percentage excess weight loss and patient’s choice.Steps of Braun surgery- Video link. Results Total number of OAGB procedures done were 1024, 35 patients (3.4%) presented with bile reflux needing surgical management. 31/35 (88.6%) underwent Braun procedure. 4/35 (11.4%) underwent conversion to RYGB (3 for poor weight loss/weight regain and 1 patient choice). 27/31 Braun’s patients (88%) had immediate resolution of reflux symptoms, 23 (74%) maintained at 2 years follow up. None of the 4 had conversion to RYGB with 3 well controlled on PPI and one refused further surgery. 4/31 (13%) Braun’s patients did not improve at all. These were converted to RYGB. In total 8 patients had RYGB conversion (4 primary and 4 after failed Braun’s). All these patients had resolution of symptoms at 1 year follow up. There was no significant morbidity in either group. OAGB to RYGB group had 2 days hospital stay versus Braun group treated as day case. Conclusions Conversion to RYGB is the gold standard procedure for managing bile reflux Braun’s procedure is a safe and effective day case procedure with acceptable success rate and should be considered as an alternative.