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Sleeve Gastrectomy As Revisional Surgery Compared to Primary Sleeve Gastrectomy At 12 Month Follow up
Louise Yeung*, Cary Kraft, Scott a. Cunneen, Allison M. Barrett, Miguel Burch
Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
Introduction: Sleeve gastrectomy has rapidly gained acceptance as an effective weight loss procedure, whereas increasing complications and failures of laparoscopic adjustable gastric banding (LABG) have led to increasing need for band removal and revisional surgery. Conversion to laparoscopic sleeve gastrectomy (LSG) as a single-stage procedure appears to be viable, but long-term follow up data on safety and weight loss outcomes are limited.
Methods: Retrospective review of cases performed from 2010-2013. From the primary LSG group, a control group was matched in a 1:1 ratio.
Results: 72 patients underwent single-stage revision from LAGB to LSG. The most common indication for revision was insufficient weight loss (65%) followed by slipped band (20.8%). Operative time for revision and control groups was 156 and 98 minutes respectively (p<0.0001). Hospital stay was 2 days for both groups (p=0.62). Overall 30-day complication rate for revision and control patients was 8.33% and 4.48% respectively (p=0.23). In the revision sleeve group there was one leak (1.39%), one reoperation for incisional hernia (1.39%), one sleeve kink seen on UGI that resolved without further intervention (1.39%), two post-operative pneumonias (2.78%) and one readmission for pancreatitis (1.39%) within 30 days, with a total of 5 complications Grade 3 or higher in the first 12 months as determined by the Clavien-Dindo scale. In the primary sleeve group there were no leaks, one post-operative bleed (1.49%), one readmit for pancreatitis (1.49%) and one post-operative bronchitis requiring antibiotics (1.49%) within 30 days, and a total of one complication Grade 3 or higher in the first 12 months. For patients with BMI>30 at surgery, change in BMI at 12 months for primary and revision was 11.97 and 8.85 respectively (p<0.006). Additionally, in these patients who were also on medications for diabetes or hypertension at time of primary or revisional surgery, primary sleeve gastrectomy was more effective in eliminating the need for medications at 6 months for diabetic patients (77% vs 17%, p<0.02) and at 6 months for hypertensive patients (53% vs 19%, p<0.03) and 12 (93% vs 38%, p<0.05).
Conclusion: Single-stage revision from band to sleeve gastrectomy can be performed with comparable rates of 30-day complications to primary sleeve gastrectomy. Complications did not correlate with operative time, estimated blood loss, reason for band revision or BMI at time of surgery. Weight loss and reduction of medications are greater in those who undergo primary sleeve gastrectomy as compared to those who undergo sleeve gastrectomy as revision, from the time of conversion up to 12 months of follow up. Patients should be counseled as to realistic outcome expectations after revisional surgery.
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