Tips and Tricks of Converting Laparoscopic Adjustable Gastric Banding to Roux-en-Y Gastric Bypass in one Stage.

Abstract

Conversion of laparoscopic adjustable gastric banding (LAGB) to other operations is commonly done for significant weight recidivism and complications. This is a consecutive series of LAGB converted to RYGB done at the Bariatric and Metabolic Institute (BMI) Abu Dhabi from 2009 to 2013 for weight recidivism. Our preferred approach is to convert LAGB to LRYGB in one stage. All patients undergo upper endoscopy (EGD) and upper gastrointestinal series and are started on clears liquids 2h after surgery without performing UGI studies. This video outlines the steps as well as tips and tricks in converting LAGB to hand-sewn ante-colic ante-gastric RYGB in one stage. We performed 40 cases of conversion of LAGB to LRYGB in one or two stages, 80% were females, mean age was 36.7years (range 20-53), initial mean BMI was 48kg/m2 (range 35-62), initial weight was 134.6kg (range 80-220), and weight prior to conversion to RYGB was 131.8kg (range 90-195). We converted LAGB to RYGB in one stage in 79.4% (27/34); 6 patients presented to us after LAGB removal. Mean EWL% at 2years was 60% (18-111%). Mortality was 0%, conversion to open 0%, blood transfusion 2.5%, leak was 5%, and 7.5% patients developed gall stones and needed cholecystectomy. Follow-up was complete for 85% of patients (34/40). Conversion of LAGB to RYGB in one step can be performed with acceptable morbidity but provides lower weight loss than expected from primary RYGB at 2years.