Single stage conversion from adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass: an analysis of 4875 patients

Aug 12, 2017Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Single-step switch from adjustable stomach band to sleeve gastrectomy or gastric bypass: analysis of 4,875 patients

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Abstract

Of the 4865 patients undergoing single-stage conversion from adjustable gastric banding, 69.1% had laparoscopic sleeve gastrectomy.

Laparoscopic sleeve gastrectomy (SG) had significantly lower rates of 30-day reoperation compared to gastric bypass (RYGB) at 1.6% versus 2.7%.
Readmission rates were lower for SG at 4% compared to 5.7% for RYGB.
Reintervention rates were 1.7% for SG and 2.7% for RYGB.
Overall morbidity was significantly lower in the SG group at 2.9% compared to 6.5% for RYGB.
RYGB was linked to higher odds of 30-day reoperation, readmission, reintervention, and overall morbidity after accounting for baseline characteristics.

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BACKGROUND: The previous popularity of adjustable gastric banding (AGB), along with inconsistent long-term results, has resulted in the need for conversion to other procedures. The perioperative safety of laparoscopic sleeve gastrectomy (SG) and gastric bypass (RYGB) as single-stage conversion procedures is unclear.

OBJECTIVES: To compare the early safety of SG and RYGB when performed as single-stage conversion procedures at the time of AGB removal.

SETTING: Nationwide analysis of accredited centers.

METHODS: The Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program public use file for 2015 was queried for all patients who underwent single-stage conversion to SG or RYGB. Multivariable logistic regression was performed to control for baseline differences, and odds ratios (ORs) with 95% confidence intervals are reported.

RESULTS: There were 4865 patients who underwent a single-stage AGB conversion. SG was performed in 3364 (69.1%). The 30-day reoperation (1.6% versus 2.7%, P = .008), readmission (4% versus 5.7%, P = .006), reintervention (1.7% versus 2.7%, P = .024), and overall morbidity (2.9% versus 6.5%, P<.0001) were significantly less common in the SG group. After controlling for baseline characteristics, RYGB was independently associated with higher overall 30-day reoperation (OR 1.81, 1.19-2.75), readmission (OR 1.42, 1.07-1.88), reintervention (OR 1.59, 1.06-2.4), and overall morbidity (OR 2.17, 1.62-2.9).

CONCLUSIONS: AGB conversions are associated with low overall 30-day event rates. Patients undergoing RYGB as a single-stage conversion experience higher complication rates and the need for additional early procedures compared with SG.

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Single stage conversion from adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass: an analysis of 4875 patients

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