Efficiency of Laparoscopic One-Step Revision of Failed Adjusted Gastric Banding to Gastric Sleeve: a Retrospective Review of 101 Consecutive Patients

Jul 7, 2019Obesity surgery

Success of Single-Step Laparoscopic Surgery to Replace Failed Adjustable Gastric Band with Gastric Sleeve in 101 Patients

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Abstract

In a study of 101 patients, the mean percentage of excess weight loss (%EWL) after converting from laparoscopic adjustable gastric banding to laparoscopic sleeve gastrectomy was 53.2%.

Fifteen patients (15%) required a second revisional surgery due to weight loss failure.
Ten patients (10%) experienced long-term complications, leading to additional surgical interventions.
The cohort had a mean follow-up of 4.3 years.
Single-stage conversion from laparoscopic adjustable gastric banding to laparoscopic sleeve gastrectomy is associated with good long-term weight loss outcomes.

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BACKGROUND: Until recently, laparoscopic adjustable gastric banding (LAGB) was one of the most commonly performed bariatric surgeries worldwide. Today, its high rate of complications and failure rates up to 70% requires revisional surgery. The one-stage conversion from LAGB to laparoscopic sleeve gastrectomy (LSG) has been shown to be safe, although there are some concerns on efficacy and long-term weight loss.

OBJECTIVES: To demonstrate that one-step revision of LAGB to another restrictive procedure, such as LSG, might have efficient long-term outcomes.

METHODS: The charts from 133 revisional LSGs for failed or complicated LAGB were retrospectively reviewed for the period between January 2010 and August 2017. Thirty-two patients were excluded for loss to follow-up. Demographics, complications, and percentage of excess weight loss (%EWL) were determined.

RESULTS: One hundred one patients were included (85 women and 16 men), with a mean age of 48.5 years, and a mean body mass index of 47.1 kg/m. During the follow-up, 15 patients (15%) underwent a second revisional surgery for weight loss failure (8 Roux-en-Y gastric bypass (RYGBP), 3 biliopancreatic diversion, 3 single anastomosis duodenal-ileal bypass, 1 revisional LSG). Ten patients (10%) had long-term complications (8 severe reflux and 2 stenosis) during this period and underwent a second revisional surgery (10 RYGBP). The remaining 76 had a mean follow-up of 4.3 years and a mean %EWL of 53.2%. 2

CONCLUSION: Single-stage conversion to LSG is a safe and appropriate solution for failed or complicated LAGB with good long-term weight loss.

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Efficiency of Laparoscopic One-Step Revision of Failed Adjusted Gastric Banding to Gastric Sleeve: a Retrospective Review of 101 Consecutive Patients

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