Abstract

BackgroundReoperation, after failed gastric banding, is a controversial topic. A common approach is band removal with conversion to laparoscopic Roux-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in a single-step procedure.ObjectiveThis study aimed to assess the safety of revisional surgery to LSG compared to LRYGB after failed laparoscopic adjustable gastric banding (LAGB) based on MBSAQIP Participant User File from 2015 to 2018.MethodsPatients who underwent a one-stage conversion of LAGB to LSG (Conv-LSG) or LRYGB (Conv-LRYGB) were identified in the MBSAQIP PUF from 2015 to 2017. Conv-LRYGB cases were matched (1:1) with Conv-LSG patients using propensity scoring to control for potential confounding. The primary outcome was all-cause mortality.ResultsA total of 9974 patients (4987 matched pairs) were included in the study. Conv-LRYGB, as compared with conv-SG, was associated with a similar risk of mortality (0.02% vs. 0.06%; relative risk [RR], 0.33; 95% confidence interval [CI], 0.03 to 3.20, p = 0.32). Conversion to LRYGB increased the risk for readmission (6.16% vs. 3.77%; RR, 1.63; 95%CI, 1.37 to 1.94, p < 0.01); reoperation (2.15% vs. 1.36%; RR, 1.57; 95%CI, 1.17 to 2.12, p = <0.01); leak (1.76% vs. 1.02%; RR, 1.57; 95%CI, 1.72 to 2.42, p < 0.01); and bleeding (1.66% vs. 1.00%; RR, 1.66; 95%CI, 1.7 to 2.34, p < 0.01).ConclusionsThe study shows that single-stage LRYGB and LSG as revisional surgery after gastric banding, are safe in the 30-day observation with an acceptable complication rate and low mortality. However, conversion to LRYGB increased the risk of perioperative complications.

Highlights

  • Laparoscopic adjustable gastric banding (LAGB) was a popular bariatric procedure in the late 1990s and early 2000s [1] studies with long-term follow-up revealed poor weight loss outcomes and serious complications, including band erosion, slippage, and gastric pouch enlargement. [2] The majority of patients after laparoscopic adjustable gastric banding (LAGB) required band removal or conversion to another bariatric procedure due to weight regain and complications. [3,4,5,6,7] Reoperation, after failed gastric banding, is a controversial topic

  • In the analysis of MBSAQIP Participant User File (PUF) from 2015 revealed that conversion to sleeve gastrectomy might be a safer approach than gastric bypass surgery

  • This study aimed to assess the safety of revisional surgery to laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-Y gastric bypass (LRYGB) after failed laparoscopic adjustable gastric banding (LAGB) based on MBSAQIP Participant User File from 2015 to 2018

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Summary

Introduction

Laparoscopic adjustable gastric banding (LAGB) was a popular bariatric procedure in the late 1990s and early 2000s [1] studies with long-term follow-up revealed poor weight loss outcomes and serious complications, including band erosion, slippage, and gastric pouch enlargement. [2] The majority of patients after LAGB required band removal or conversion to another bariatric procedure due to weight regain and complications. [3,4,5,6,7] Reoperation, after failed gastric banding, is a controversial topic. [2] The majority of patients after LAGB required band removal or conversion to another bariatric procedure due to weight regain and complications. Band removal with conversion to gastric bypass or sleeve gastrectomy in a single-step procedure is one treatment option. In the analysis of MBSAQIP Participant User File (PUF) from 2015 revealed that conversion to sleeve gastrectomy might be a safer approach than gastric bypass surgery. This study aimed to assess the safety of revisional surgery to laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-Y gastric bypass (LRYGB) after failed laparoscopic adjustable gastric banding (LAGB) based on MBSAQIP Participant User File from 2015 to 2018. A common approach is band removal with conversion to laparoscopic Roux-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in a single-step procedure

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