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Laparoscopic Roux-EN-Y Gastric Bypass As Revisional Surgery Compared to Primary Gastric Bypass At 12 Month Follow up
Louise Yeung*, Cary Kraft, Allison M. Barrett, Scott a. Cunneen, Miguel Burch
Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
Introduction: Revisional surgery is becoming more common for complications and failures of laparoscopic adjustable gastric banding (LABG). Removal of the band and conversion to laparoscopic roux-en-y gastric bypass (LRYGB) can be done as a single-stage procedure, but long-term data is still limited on safety and weight loss outcomes.
Methods: Retrospective review of cases performed from 2010-2013. From the primary LRYGB group, a control group was matched in a 1:1 ratio.
Results: 32 patients underwent single-stage revision from LAGB to LRYGB, with a matched control. The most common indication for revision was insufficient weight loss (84%) with the other 16% for reflux or motility issues. Operative time for revision and control groups was 224 and 130 minutes respectively (p<0.0001). Hospital stay was 3 and 2.5 days respectively (p=0.14). Overall 30-day complication rate for revision and control patients was 15.63% and 9.38% respectively (p=0.45). There were two leaks (6.25%), one reoperation for bleeding (3.13%), one aspiration pneumonia (3.13%) and one reoperation for obstruction in the revision group (3.13%) within 30 days, with a total of four complications Grade 3 or higher in the first 12 months as determined according to the Clavien-Dindo scale. There were no leaks, three GI bleeds (9.38%), two bowel obstructions (6.25%) and one readmit for abdominal pain (3.13%) in the primary bypass group within 30 days, and a total of four complications 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 11.12 and 10.24 respectively (p=0.55).
Conclusion: Single-stage revision to LRYGB can be performed with minimal increases in hospital stay but with higher rates of leak. Weight loss is comparable in those who undergo primary bypass compared to those who undergo bypass as revision. The leaks observed in the revision group were not correlated to operative time or intraoperative blood loss, although both leaks occurred in patients who had BMIs lower than the average at time of revision. Increased precautions against leaks must be taken in patients undergoing revision to LRYGB including careful tissue handling, meticulous hemostasis, close inspection of staple lines with oversewing if indicated, and low threshold for consideration of staged procedure if tissue quality is questionable at time of band removal.
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