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Single-Stage Revision From Gastric Band to Gastric Bypass or Sleeve Gastrectomy: Six-Month Outcomes
Allison M. Barrett*1, Kulmeet K. Sandhu2, Scott a. Cunneen1, Edward H. Phillips1, Miguel Burch1
1Surgery, Cedars Sinai Medical Center, Los Angeles, CA; 2Surgery, University of Southern California, Los Angeles, CA
Introduction: Laparoscopic adjustable gastric banding (LABG) is a restrictive weight-loss procedure, but can be ineffective or have complications that may require revision. Removal of the band and conversion to either laparoscopic sleeve gastrectomy (LSG) or laparoscopic roux-en-y gastric bypass (LRYGB) can be performed in a single-stage procedure, but little is known about the effect on weight loss and the safety of this approach.
Objective: To compare the safety and efficacy of single-stage revision from LAGB to either LRYGB or LSG at six months postoperatively.
Methods: Retrospective analysis was performed on patients who underwent single-stage revision between 2009 and 2013 at a single academic medical center. Patients were followed for six months postoperatively and reassessed for weight loss and complications.
Results: 21 patients underwent single-stage revision from LAGB to LRYGB, and 31 from LAGB to LSG. All cases were completed laparoscopically. The most common indication for surgery was insufficient weight loss in 69%, GERD or esophagitis in 15%, band slip in 12%, and port-related problems in 4%. Preoperative BMI was 41.62 in the LRYGB group and 38.58 in the LSG group (p=0.20). Median length of stay for both groups was 3 days. Three patients in the LRYGB group required reoperation within 30 days, two for leak at the gastrojejunostomy and one for bleeding. No patient in the LSG group required reoperation or had a major complication within 30 days (p=0.08). No patient in either group required readmission or ER visit within 30 days of operation. Two delayed complications were seen in the LSG group, with one developing a stricture requiring stenting at two months postoperatively, and another with a port-site hernia requiring operation at six months postoperatively. At three months postoperatively, percent excess weight loss (%EWL) was 34.32 for LRYGB and 34.41 for LSG (p=0.98). At six months, %EWL was 52.04 for LRYGB and 42.61 for LSG (p=0.34). Loss to follow-up was 38% at six months in both groups.
Conclusion: Single-stage revision from LAGB to either LRYGB or LSG is technically feasible, though there appears to be a higher early complication rate with conversion to LRYGB. Weight loss at three and six months postoperatively is equivalent for both operations.
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