Feasibility and Short-Term Outcomes of One-Step and Two-Step Sleeve Gastrectomy as Revision Procedures for Failed Adjustable Gastric Banding Compared With Those After Primary Sleeve Gastrectomy.

Omar Thaher,Christine Stroh,Jamal Driouch,Martin Hukauf,Ferdinand Köckerling

doi:10.3389/fsurg.2021.752319

Abstract

Background: The practice of bariatric surgery was studied using the German Bariatric Surgery Registry (GBSR). The focus of the study was to evaluate whether revision surgery One-Step (OS) or Two-Step (TS) sleeve gastrectomy (SG) has a large benefit in terms of perioperative risk in patients after failed Adjustable Gastric Banding (AGB).Methods: The data collection includes patients who underwent One-Step SG (OS-SG) or Two-Step SG (TS-SG) as revision surgery after AGB and primary SG (P-SG) between 2005 and 2019. Outcome criteria were perioperative complications, comorbidities, 30-day mortality, and operating time.Results: The study analyzed data from 27,346 patients after P-SG, 320 after OS-SG, and 168 after TS-SG. Regarding the intraoperative complication, there was a significant difference in favor of P-SG and TS-SG compared to OS-SG (p < 0.001). The incidence of pulmonary complications was significantly higher in the OS-SG (p < 0.001). There was also a significant difference in occurrence of staple line stenosis in favor of TS-SG (p = 0.005) and the occurrence of sepsis (p = 0.008). The mean operating time was statistically longer in the TS-SG group than in the OS-SG group (p < 0.001). The 30-day mortality was not significantly different between the three groups (p = 0.727).Conclusion: In general, our study shows that converting a gastric band to a SG is safe and feasible. However, lower complications were obtained with TS-SG compared to OS-SG. Despite acceptable complication and mortality rates of both procedures, we cannot recommend any surgical method as a standard procedure. Proper patient selection is crucial to avoid possible adverse effects.

Highlights

Extreme obesity is a severe clinical problem in the Western world [1]
There are still uncertainties as to which surgical method represents the best outcome for the patient
If a one surgical method fails, alternative therapy methods should be used to achieve an adequate outcome for the patients with obesity

Summary

Introduction

Extreme obesity is a severe clinical problem in the Western world [1]. In recent decades, bariatric surgery, regardless of the type of surgical procedure used, has shown great success in changing body mass index (BMI) compared to the results of non-surgical procedures [2]. A well-known bariatric surgical procedure for treating severe obesity is adjustable gastric banding (AGB) [4]. Surgeons should use other surgical procedures to achieve tremendous %TWL and effective complication management. Several clinical studies investigated the effect of SG on BMI change and complication management as revision surgery after failed gastric banding [8,9,10]. Our study aims to show the safety of One-Step vs Two-Step revision surgery from AGB to SG and compare the results with those after P-SG. The long-term outcomes, such as %TWL and change in BMI, were not investigated in our study. The focus of the study was to evaluate whether revision surgery One-Step (OS) or Two-Step (TS) sleeve gastrectomy (SG) has a large benefit in terms of perioperative risk in patients after failed Adjustable Gastric Banding (AGB)

Methods

Results

Discussion

Conclusion