Revisional single-anastomosis gastric bypass for a failed restrictive procedure: 5-year results

Abstract

BackgroundLong-term outcomes of revisional laparoscopic single anastomosis-gastric bypass for a failed restrictive procedure (rSAGB) have not been analyzed. ObjectivesTo assess 5-year outcomes of rSAGB compared with 5-year outcomes of primary SAGB (pSAGB). SettingUniversity public hospital, France. MethodsOne hundred twenty-six patients who underwent SAGB between October 2006 and October 2008 were included in this retrospective study. rSAGB was defined as SAGB performed after failure of a first restrictive procedure. Five-year outcomes of each procedure regarding mortality, morbidity (i.e., Clavien-Dindo score), weight loss (change in body mass index [BMI] and percentage of excess BMI loss [%EBMIL]), co-morbidities remission, and Gastrointestinal Quality of Life Index (GIQLI) score, were assessed. ResultsThirty patients (24%) who had prior restrictive bariatric surgery (including 22 laparoscopic adjustable gastric bandings, 4 vertical banded gastroplasties, and 4 sleeve gastrectomies) underwent conversion to rSAGB. Ninety-six patients (76%) underwent primary SAGB (pSAGB group). Both groups were comparable in age, gender, BMI, and preoperative co-morbidities. Preoperative mean BMI of the rSAGB group was 45.5±7 kg/m2. There were no deaths and the major complications rate was 10%. No increase in morbidity was found between the 2 groups. Two patients required conversion to RYGB after rSAGB because of intractable biliary reflux. At 5 years, mean BMI was 32 kg/m2 and mean %EBMIL was 66% after rSAGB; no significant differences were found compared with pSAGB (BMI = 31 kg/m2, %EBMIL = 73%). Co-morbidities and remission rates were statically similar. Overall, GIQLI score was significantly lower in the rSAGB group (104.1±17.6 versus 112.5±16.8, P = .025). Significant differences were found in “upper gastrointestinal symptoms” and “psychological” scores. ConclusionAt 5 years, rSAGB for a failed restrictive procedure was safe and effective, but quality of life and upper gastrointestinal function were lower compared with pSAGB.