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Primary Sleeve Gastrectomy Compared to Sleeve Gastrectomy As Revisional Surgery
Allison M. Barrett*1, Kim T. Vu1, Kulmeet K. Sandhu2, Edward H. Phillips1, Scott a. Cunneen1, Miguel Burch1
1Surgery, Cedars Sinai Medical Center, Los Angeles, CA; 2Surgery, University of Southern California, Los Angeles, CA
Introduction: The laparoscopic adjustable gastric band (LAGB) can be revised to laparoscopic sleeve gastrectomy (LSG) due to insufficient weight loss, patient intolerance, or complications. Little is known about the weight-loss outcomes in this population when directly compared to patients undergoing primary sleeve gastrectomy.
Objective: To compare weight loss between patients undergoing primary LSG compared to those undergoing single-stage revision from LAGB to LSG, and to assess for complications.
Methods: Retrospective analysis was performed on patients who underwent single-stage revision from LAGB to LSG between 2009 and 2013 (revision group). A cohort of matched patients who underwent primary LSG was used for comparison (control group). All patients underwent surgery at the same academic medical center by the same surgeons. Patients were followed for six months postoperatively and evaluated for weight loss and complications.
Results: The revision group included 24 patients, with a matched cohort of 48 patients in the control group. There was no difference between the groups with respect to age and the presence of comorbidities. Preoperative BMI was 41.8 in the revision group and 42.6 in the control group (p=0.55). Average OR time was 154 minutes for the revision group and 114 minutes for the control group (p=0.002). Intraoperative blood loss was equivalent. Length of stay was 3.2 days in the revision group and 2.5 days in the control group (p=0.005). There were no reoperations or emergency visits within 30 days of surgery in either group. At three months, BMI was 35.15 in the revision group and 35.03 in the control group (p=0.90) with percent excess weight loss (%EWL) of 32.64 and 35.64 respectively (p=0.21). At six months postoperatively, BMI was 33.61 for the revision group and 32.87 for the control group (p=0.57), with %EWL of 40.94 and 48.68 respectively (p=0.03). Average change in BMI was 7.90 in the revision group and 9.69 in the control group (p=0.06).
Conclusion: Single-stage revision from LAGB to LSG can be performed safely and with only a minor increase in length of stay compared to primary LSG. At six months postoperatively, there is a trend toward improved weight loss following primary LSG compared to revision from LAGB to LSG.
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