Conversion to Gastric Bypass After Either Failed Gastric Band or Failed Sleeve Gastrectomy

Jun 5, 2016Obesity surgery

Switching to Gastric Bypass After Failed Gastric Band or Sleeve Gastrectomy

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Abstract

A total of 178 patients were included, with 31.6% total body weight loss observed in both adjustable gastric banding and sleeve gastrectomy conversions after two years.

Main reasons for conversion included weight regain or insufficient weight loss in 48.4% of cases and dysphagia or reflux complaints in 39.9%.
Surgical complications occurred in 19 patients, with no significant difference between those converted from adjustable gastric banding and those from sleeve gastrectomy.
Infectious complications were reported in 13 patients, again with no significant difference between the two groups.
Weight loss outcomes were statistically similar between patients converted from adjustable gastric banding and those converted from sleeve gastrectomy.

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BACKGROUND: Roux-en-Y gastric bypass (RYGB) is still considered the gold standard in bariatric surgery. Before, adjustable gastric banding (AGB) was regarded as an alternative; nowadays, sleeve gastrectomy (SG) is a more favorable alternative. In case of unsatisfactory results, RYGB is often performed as a secondary procedure. Conversion of an AGB is associated with a high risk of complications; the hypothesis was that this would be less after conversion of an SG.

METHODS: All patients undergoing conversion to RYGB after AGB or SG between 2005 and 2012 were included for retrospective analysis. Patient characteristics, operative details, postoperative complications, the relief of complaints, weight loss, reasons for failure, and evolution of known comorbidities up to 2 years were analyzed.

RESULTS: A total of 178 patients were included (79.8 % female): AGB 110 (61.8 %) versus SG 68 (38.2 %). Main reasons for conversion were weight regain/insufficient weight loss (48.4 %) or dysphagia/reflux complaints (39.9 %). Surgical complications were found in 19 patients (AGB 13 vs SG 6; p = 0.530). Infectious complications occurred in 13 patients (AGB 11 vs SG 2; p = 0.135). Total body weight loss was equal between groups after 2 years (AGB 31.6 ± 11.0 % vs SG 31.6 ± 12.0 %; p = 0.998). Similar results were found in a subgroup analysis on patients undergoing conversion for additional weight loss (AGB 31.7 ± 11.7 % vs SG 27.0 ± 13.1 %; p = 0.173).

CONCLUSIONS: Conversion to RYGB after failed AGB or SG showed comparable short-term results in terms of postoperative complications and weight loss.

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Conversion to Gastric Bypass After Either Failed Gastric Band or Failed Sleeve Gastrectomy

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