One-stage conversion of laparoscopic adjustable gastric banding to laparoscopic 1-anastomosis gastric bypass: a single-center experience on 1,000 patients at 5 years of follow-up.

Abstract

Data regarding the use of 1-anastomosis gastric bypass (OAGB) as a conversion technique after laparoscopic adjustable gastric banding (LAGB) failure is scarce in the literature. The aim of this study was to assess our experience with OAGB as a rescue procedure after failed LAGB. This study involved patients treated at a private hospital in France. This single-center retrospective study included all consecutive patients receiving OAGB from January 2005 to January 2016. Of the 3,224 patients, 63.5% received primary OAGB (pOAGB) and 36.5% received OAGB as a conversion procedure after LAGB (cOAGB). During the period considered, 2,046 patients with obesity received pOAGB, whereas 1,000 patients underwent conversion of LAGB to OAGB in 1 step. The rate of patients lost to follow-up at 5 years was 31% in the pOAGB group and 32.5% in the cOAGB group (P = .4). Five years after the surgery, the mean body mass index was 30.8 ± 10.2 kg/m2, the mean percentage total weight loss was 34.6% ± 9.6%, and the mean percentage excess weight loss was 76.1% ± 24.6% in the pOAGB group, and the mean was 29.7 ± 10.4 kg/m2 (P = .58), the mean percentage total weight loss was 33.8% ± 10.2% (P = .82) and the mean percentage excess weight loss was 73.5% ± 22.2% (P = .78) in the cOAGB group. There was no difference in terms of early complications between the 2 groups (3.2% pOAGB versus 3.6% cOAGB, P = .59), while there was a statistically significant difference in terms of late complications (11% pOAGB versus 18% cOAGB, P < .00001). In particular, there was a significantly higher incidence of symptomatic postoperative biliary reflux in the cOAGB group (12% in cOAGB versus 5% in pOAGB, P < .00001). In this study, OAGB was effective and safe as a rescue technique after LAGB failure. Conversion in one step did not appear to increase the risk of early complications, whereas a history of gastric banding seems to increase the risk of bile reflux in the long term.