| Summary: | Background: One-anastomosis gastric bypass (OAGB) is an emerging metabolic bariatric surgery (MBS) type used in both primary OAGB (pOAGB) and revisional OAGB (rOAGB). We studied ≤30-day outcomes of pOAGB and rOAGB and identified predictors of early complications. Methods: Electronic medical records of all OAGBs performed between January 2017 and December 2021 at a high-volume bariatric clinic in Israel comprising four hospital centers were scanned retrospectively using specialized data software (MDClone software, version 6.1). Data gathered were patients’ characteristics, surgical procedure, and ≤30-day complications with Clavien–Dindo Classification (CDC). Multivariate logistic regression analyses were used to identify factors related to early complications of pOAGB and rOAGB. Results: A total of 6722 patients underwent a pOAGB (<i>n</i> = 5088, 75.7%) or rOAGB (<i>n</i> = 1634, 24.3%) procedure at our institution. Preoperative mean age and body mass index (BMI) were 40.6 ± 11.5 years and 41.2 ± 4.6 kg/m<sup>2</sup>, respectively. Early complications occurred in 258 (3.8%) patients (176 pOAGB and 82 rOAGB) and included mainly bleeding (<i>n</i> = 133, 2.0%), leaks (<i>n</i> = 31, 0.5%), and obstruction/strictures (<i>n</i> = 19, 0.3%). CDC complications for grades 1–2 and grades 3a-–5 were 1.5% and 1.6%, respectively. The overall mortality rate was 0.03% (<i>n</i> = 2). Age, operative time ≥3 h, and any additional concomitant procedure were independent predictors of early complications following pOAGB, while a diagnosis of diabetes mellitus and operative time ≥3 h were independent predictors of early complications following rOAGB. Conclusions: OAGB was found to be a safe primary and revisional MBS procedure in the ≤30-postoperative day term. The most common complications were gastrointestinal bleeding, leaks, and obstruction/stricture.
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