Concomitant Removal of Gastric Band and Gastric Bypass: Analysis of Outcomes and Complications from the ACS-NSQIP Database.

Abstract

Conversion of laparoscopic adjustable gastric banding (LGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) is an established procedure. However, multiple reports have indicated higher morbidity and mortality rates associated with this operation, especially when performed as a single-staged procedure. We sought to compare mortality and morbidity of LRYGB vs. LRYGB with concomitant gastric band removal (LRYGB/LGBR). Data from the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database was obtained for the time period of 2008 to 2014 using CPT codes for LRYGB and LGBR. Sepsis was the primary outcome measure with overall morbidity as a secondary outcome. Bivariate and multivariate analyses were carried out using SAS (Statistical Analysis System). During the study period, 64,866 patients had primary LRYGB and 1212 had LRYGB/LGBR. On bivariate analyses, mean operative time was lower for patients undergoing LRYGB rather than LRYGB/LGBR (132.88±56.29 vs. 177.72±70.21min, p<0.001). There was no statistically significant difference in the rate of postoperative mortality (0.16 vs. 0.08%, p>0.999), sepsis (0.78 vs. 0.74%, p=0.87), or other postoperative outcomes such as return to the operating room, wound infection, and venous thromboembolism. The odds ratio (OR) for sepsis remained not significant (OR=0.74; 95% confidence interval (CI)=(0.38-1.45)) after multivariate analysis. LRYGBP/LGBR is not associated with a higher morbidity and mortality compared to LRYGB alone. The data implies that a one-step revisional procedure is appropriate when converting a failed gastric band to LRYGB.