Gastric band conversion to Roux-en-Y gastric bypass shows greater weight loss than conversion to sleeve gastrectomy: 5-year outcomes

Nov 20, 2018Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Switching from gastric band to gastric bypass leads to more weight loss than switching to sleeve gastrectomy over 5 years

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Abstract

At 24 months post-surgery, patients who converted from LAGB to RYGB lost 23.4% of their weight, significantly more than the 12.6% lost by those who converted to LSG.

The average body mass index (BMI) at 24 months was significantly lower in the RYGB group (32.93) compared to the LSG group (38.34).
Percent excess BMI lost was significantly higher in the RYGB group (57.8%) than in the LSG group (29.3%).
The rate of reoperation was significantly higher for the RYGB group (7.3%) compared to the LSG group (1.4%).
Patients undergoing RYGB had a longer operating room time (120.1 minutes) than those undergoing LSG (115.5 minutes).
Length of hospital stay was significantly longer for the RYGB group (3.33 days) compared to the LSG group (2.11 days).
The readmission rate was higher in the RYGB group (7.3%) than in the LSG group (3.5%), although this difference was not statistically significant.

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BACKGROUND: Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are often used as revisional surgeries for a failed laparoscopic adjustable gastric band (LAGB). There is debate over which procedure provides better long-term weight loss.

OBJECTIVE: To compare the weight loss results of these 2 surgeries.

SETTING: University hospital, United States.

METHODS: A retrospective review was conducted of all LAGB to RYGB and LAGB to LSG surgeries performed at a single institution. Primary outcomes were change in body mass index (BMI), percent excess BMI lost, and percent weight loss. Secondary outcomes included 30-day complications and reoperations.

RESULTS: The cohort included 192 conversions from LAGB to RYGB and 283 LAGB to LSG. The baseline age and BMI were similar in the 2 groups. Statistical comparisons made between the 2 groups at 24 months postconversion were significant for BMI (RYGB = 32.93, LSG = 38.34, P = .0004), percent excess BMI lost (RYGB = 57.8%, LSG = 29.3%, P < .0001), and percent weight loss (RYGB = 23.4%, LSG = 12.6%, P < .0001). However, the conversion to RYGB group had a higher rate of reoperation (7.3% versus 1.4%, P = .0022), longer operating room time (RYGB = 120.1 min versus LSG = 115.5 min, P < .0001), and longer length of stay (RYGB = 3.33 d versus LSG = 2.11 d, P < .0001) than the LAGB to LSG group. Although not significant, the conversion to RYGB group had a higher rate of readmission (7.3% versus 3.5%, P = .087).

CONCLUSION: Weight loss is significantly greater for patients undergoing LAGB conversion to RYGB than LAGB to LSG. However, those undergoing LAGB conversion to RYGB had higher rates of reoperation and readmission. Patients looking for the most effective weight loss surgery after failed LAGB should be advised to have RYGB performed, while also understanding the increased risks of the procedure.

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Gastric band conversion to Roux-en-Y gastric bypass shows greater weight loss than conversion to sleeve gastrectomy: 5-year outcomes

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