Revisional surgery after failed gastric banding: results of one-stage conversion to RYGB in 195 patients

Dec 3, 2014Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

One-step surgery to convert failed stomach bands to gastric bypass in 195 patients

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Abstract

A total of 195 patients underwent a one-stage conversion from a gastric band to a Roux-en-Y gastric bypass (RYGB), with 91% of procedures performed without perioperative complications.

Only 8 (4%) patients required reoperation within 30 days following the procedure.
The mean follow-up period was 40 months after RYGB.
Excess weight loss (EWL) improved significantly from 25% to 60% by the end of the first postoperative year.
EWL percentages remained above 53% during the subsequent four years post-surgery.
Patient selection is crucial for the success of the conversion procedure.

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BACKGROUND: The most performed restrictive bariatric procedure is the laparoscopic adjustable gastric band (LAGB). With many patients still receiving a LAGB in Europe and the United States, inevitably, the number of complications also increases. For many complications revisional bariatric surgery is necessary. In this study, the outcomes of one-stage LAGB conversion to a Roux-en-Y gastric bypass (RYGB) at our institution are presented. The objective of this study was to investigate the safety and efficiency of RYGB performed as a one-stage procedure after failed LAGB.

METHODS: Patients were retrospectively selected using a prospectively collected database. The gastric band had to be in situ for at least 1 year and minimum postoperative follow-up was 12 months. The revisional RYGB had to be performed as a 1-step procedure.

RESULTS: A total of 195 patients were included while 3 were lost to follow up. Overall, 178 (91%) procedures were performed without perioperative complications, and only 8 (4%) patients required reoperation within 30 days. The mean follow-up was 40 months (±24) after RYGB. Mean excess weight loss (EWL) increased from 25% (±26/-50- 120%) to 60% (±21.2/0- 130), 65% (±23.5/0- 131), 63% (±24.2/2- 132), 60% (±24.1/0- 111) and 53% (±28.7/-39- 109) in the first 5 postoperative years.

CONCLUSION: Converting a gastric band to a RYGB in a one-stage procedure is safe and feasible, with acceptable complication rates when performed in a specialized institution. The RYGB conversion results in a good EWL of 65% after 2 years. However, proper patient selection is of the utmost importance.

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Revisional surgery after failed gastric banding: results of one-stage conversion to RYGB in 195 patients

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