Conversion of Laparoscopic Adjustable Gastric Banding to Gastric Bypass: a Comparison to Primary Gastric Bypass

Dec 6, 2017Obesity surgery

Changing from Adjustable Stomach Band to Stomach Bypass Compared to First-Time Stomach Bypass

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Abstract

Mean operative time for revisional LRYGB was 137.7 minutes, significantly longer than the 112.7 minutes for primary LRYGB (P < 0.001).

Early complication rates were similar between revisional and primary LRYGB patients, at 7.5% and 11.8%, respectively (P = 0.16).
Revisional LRYGB patients experienced less weight loss, achieving 61.5% excess weight loss compared to 73.5% in primary patients (P = 0.004).
Improvement of comorbidities was slightly lower in the revisional group, with 75.0% showing improvement compared to 85.7% in the primary group (P = 0.09).
The late complication rate was identical for both groups at 8.1% (P = 1.0).
Revising LAGB to LRYGB is associated with longer operative times but comparable safety and complication rates to primary LRYGB.

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INTRODUCTION: Laparoscopic adjustable gastric banding (LAGB) has a considerable failure rate. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the rescue options. This study aims to compare the complication rates and outcomes between LAGB converted to LRYGB and primary LRYGB.

MATERIALS AND METHODS: A retrospective analysis was performed in all patients converted from LAGB to LRYGB between January 2007 and March 2017. This group was compared to a matched cohort of primary LRYGB patients operated during the same period. Early and late complications, weight loss, and improvement of comorbidities were analyzed.

RESULTS: One hundred sixty-one revisional LRYGB patients were compared to a similar number of primary LRYGB patients. Preoperative age, gender distribution, weight, and BMI were comparable. Mean operative time was longer in the revisional group (137.7 vs. 112.7 min, respectively, P < 0.001). The overall early complication rates were comparable between the groups (7.5 vs. 11.8%, P = 0.16), including postoperative leak rate (0.62%). Follow-up of at least 6 months was attained in 78% of the patients. Revisional cases demonstrated less weight loss (61.5 vs. 73.5%EWL, respectively, P = 0.004) and slightly less improvement of comorbidities (75.0 vs. 85.7%, respectively, P = 0.09). The late complication rate was comparable (8.1 vs. 8.1%, P = 1.0).

CONCLUSION: Albeit longer operating time, revision of LAGB to LRYGB is a safe procedure, with similar complication rates when compared to primary LRYGB. Although revisional LRYGB does result in less weight loss than primary LRYGB, the procedure's safety makes it a very plausible option as a rescue operation for failed LAGB.

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Conversion of Laparoscopic Adjustable Gastric Banding to Gastric Bypass: a Comparison to Primary Gastric Bypass

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