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Single Stage Conversion From Gastric Banding to a Stapled Bariatric Procedure: an Analysis of Complications
Collin E. Brathwaite*1, Keneth N. Hall1, Owen J. Pyke1,2, Alex Barkan1, Joshua R. Karas1, Patricia D. Cherasard1, Elizabeth Carruthers1
1Surgery, Winthrop University Hospital, Mineola, NY; 2Stony Brook University School of Medicine, Stony Brook, NY
Introduction: Single stage conversion from gastric banded procedures to other bariatric surgery approaches has been associated with increased rates of strictures and other complications, likely due to scarring and reaction to the foreign body. The objective of this study was to review the experience with this group of patients at our hospital, a Center of Excellence in the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).
Methods: Our prospective database was queried for the 6-year period ending 10/31/2013. Only patients who had a single stage conversion from Adjustable Gastric Banding (AGB) to Roux-En-Y Gastric Bypass (RNY) or Laparoscopic Sleeve Gastrectomy (LSG), performed at our hospital, were included. Outcomes including rates of organ failure, venous thromboembolism (VTE), wound infection, persistent nausea and vomiting (N/V), strictures, staple line leaks and mortality were assessed.
Results: Of 1,840 patients having bariatric surgery in the time period, 81 underwent conversion from a banding procedure. We excluded 30 patients: 13 who had been converted from Vertical Banded Gastroplasty (VBG) and 17 because of multi-staged procedures after AGB, primarily due to emergency exploration for band slippage or erosion. Fifty-one patients (50 female) were identified. Their median follow-up period was 1.65 years. Mean age, weight and BMI of RNY patients were 49.5 years, 120 Kg and 46.2 Kg/M2 respectively and were not significantly different from LSG patients. Thirty-one patients underwent conversion to RNY and 20 to LSG. There were no strictures, organ failures, VTEs, wound infections, or deaths in either group. Persistent N/V was no different between the two groups. There were 2 leaks (6.4%) after conversion to RNY vs. 0 after LSG and 0.28% in the remaining bariatric population, (p< .0058, Fisher's exact test).
Conclusion: Single stage conversion from AGB to RNY and LSG does not appear to carry an increased risk of stricture, wound infection, VTE, organ failure or death. However, the risk of staple line leak appears to be higher with conversion to RNY vs. LSG. This finding may be of value in selecting a revision procedure in the high risk patient. Further studies and comparison to an elective population of patients with a 2-stage procedure are warranted.
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