Long-term quality of life after gastric band removal and concomitant conversion to gastric bypass: A single center cohort study

Abstract

Abstract Objective To report long-term quality of life and determine predictors for improved quality of life after gastric band removal and concomitant conversion to Roux-en-Y gastric bypass. Methods Clinical data of all patients who underwent conversion surgery from 2011 to 2017 were extracted from a prospectively maintained bariatric database and retrospectively analysed. During scheduled follow-up visits at 1, 6, 12, 24, 36, 48, and 60 months after surgery, physical and laboratory data as well as quality of life questionnaires were obtained. The primary outcome was change in postoperative Moorehead-Ardelt Quality of Life Questionnaire II Score (Moorehead Score). Secondary outcomes included common efficacy and safety outcomes utilized in bariatric surgery. Mixed ANOVA analysis, Chi Square test and Fisher's exact test were used. Results Overall, 108 patients who underwent conversion surgery were included. Mean duration of banding until conversion was 11.3 ± 4.3 years. The reason for conversion surgery was band failure in 45.4% (n=49) and band intolerance in 33.3% (n=36) of patients. In the remaining 21.3% (n=23) of cases a combination of both failure and intolerance was present. Mean follow-up time was 53 months. Postoperative mean Moorehead Score increased significantly after one (1.6 ± 0.9, p<0.01) and after five years (1.6 ± 0.8, p<0.01) compared to baseline values (0.7 ± 1.1). Mixed ANOVA analysis showed a significantly superior increase in Moorehead Score in males (p=0.024). No other significant predictors were identified. Neither the reason for conversion, nor preoperative parameters or long-term postoperative outcome parameters including postoperative weight loss or safety outcomes significantly affected postoperative quality of life improvement. Lasting BMI reduction (-4.6 kg/m2, p<0.01) to 33.0 ± 6.7 kg/m2 and weight loss (-12.9%, p<0.01) five years after conversion surgery were present. Internal hernia was the most common early postoperative complication, occurring in 14.8% (n=16) of cases. Conclusion Band removal with concomitant gastric bypass in patients with failed gastric banding improves long-term quality of life and may be the rescue procedure of choice in this setting.