From Bands to Bypasses: Navigating Safety of Band Conversions to Roux-en-Y Gastric Bypass and Single Anastomosis Duodenoileostomy Versus Sleeve Gastrectomy

Jun 5, 2024Obesity surgery

Safety of Changing Weight Loss Surgeries from Bands to Roux-en-Y Bypass, Single-Loop Bypass, or Sleeve Gastrectomy

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Abstract

A total of 19,335 adjustable gastric band conversions were analyzed, with the majority converted to sleeve gastrectomy.

Most conversions were to sleeve gastrectomy (SG, n = 11,736), followed by Roux-en-Y gastric bypass (RYGB, n = 7442) and single anastomosis duodenoileostomy (SADI, n = 157).
Conversions to RYGB were more frequently performed for gastroesophageal reflux disease (18.7%) compared to SG (7.92%) and SADI (5.10%).
Conversion to RYGB was associated with significantly higher odds of 30-day major complications, with an odds ratio of 1.75.
Reoperation rates were also significantly higher for RYGB conversions (OR 2.08) compared to SG.
Readmission and emergency department visit rates were increased for RYGB conversions, with odds ratios of 1.69 and 1.50, respectively.
No significant differences in risks were observed between conversions to SADI and SG.

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INTRODUCTION: Revisional bariatric surgery is associated with higher perioperative complications over primary procedures. Adjustable gastric bands (AGB) continue to be the most frequently converted bariatric configuration. This study examines trends in current clinical indication and safety profile of the most frequently pursued AGB conversions.

MATERIALS AND METHODS: MBSAQIP data from 2020 to 2022 was retrospectively analyzed in a cohort study examining 30-day postoperative outcomes after AGB conversion to sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or single anastomosis duodenoileostomy (SADI). Descriptive statistics were used, including multivariable and 2:1 nearest neighbor matching analysis.

RESULTS: This study included 19,335 AGB conversions, of which most were to SG (n = 11,736) followed by RYGB (n = 7442) and SADI (n = 157). While a majority were completed for weight loss, there were differences in distribution of primary indication for each conversion cohort, such as higher proportion of RYGB conversion for gastroesophageal reflux disease (18.7%) compared to SG (7.92%) and SADI (5.10%). Multivariable analysis demonstrates conversion to RYGB has significantly higher odds of 30-day major complications (OR 1.75, p < 0.001), reoperation (OR 2.08; p = 0.001), readmission (OR 1.69; p = 0.001), and emergency department visits (OR 1.50; p = 0.001) over SG. These risks and odds of reintervention (OR 1.75; p < 0.001) remained significantly higher after conversion to RYGB versus SG on matched analysis. None of these risks is significantly different between conversions to SADI versus SG in either multivariable or matched analysis.

CONCLUSIONS: Compared to AGB conversion to SG, single-stage conversion to RYGB had increased odds of perioperative complications while risks of conversion to SADI were not significantly different.

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From Bands to Bypasses: Navigating Safety of Band Conversions to Roux-en-Y Gastric Bypass and Single Anastomosis Duodenoileostomy Versus Sleeve Gastrectomy

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