Safety and efficacy of single-stage conversion of failed adjustable gastric band to laparoscopic Roux-en-Y gastric bypass: a case-control study.

Abstract

We conducted the following study to evaluate the safety and efficacy of single-stage conversion of failed laparoscopic adjustable gastric band (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) as compared to a cohort of primary LRYGB patients. A single-institution, prospectively maintained bariatric database was used to retrospectively identify consecutive patients who underwent single-stage removal of LAGB with concomitant conversion to LRYGB between the years of 2007 and 2013. The study cohort was matched 1:1 for age, gender, body mass index (BMI), and approximate date of operation to patients who underwent primary LRYGB. Primary endpoints were operative time, complication rate, length of hospital stay (LOS), and percent excess BMI lost (%EBMIL) at 24-month follow-up. Ninety-four conversion patients met inclusion criteria. There were no statistically significant differences in the mean LOS (3.1 vs. 3.0days, p=0.97) or the major complication rate (3.2 vs. 1.1%, p=0.62) at 30days postoperatively. Likewise, 30-day minor complication rates, including readmission, were similar between groups (7.5 vs. 6.4%, p=0.77). The average operative time was significantly longer for conversion compared to primary LRYGB (193.5 vs. 132min; p<0.01). At most recent follow-up after conversion or primary LRYGB, median %EBMIL was 61.3 and 77.3% (p<0.01), percent total weight loss was 23.6 and 30.5% (p<0.01), and percent change in BMI was 23.4 and 30.5% (p<0.01), respectively. Median follow-up time was 17 and 18.6months after conversion and primary LRYGB, respectively. Single-stage conversion of LAGB to LRYGB is safe with an acceptable complication rate and similar LOS compared to primary LRYGB.