Comparison of One Anastomosis Gastric Bypass and Sleeve Gastrectomy for Revision of Laparoscopic Adjustable Gastric Banding: 5-Year Outcomes

Apr 12, 2023Obesity surgery

Five-Year Outcomes of Two Weight-Loss Surgery Options to Fix Adjustable Gastric Banding: One-Anastomosis Bypass vs Sleeve Gastrectomy

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Abstract

In a study of 276 patients converted from laparoscopic adjustable gastric banding, outcomes were compared for one anastomosis gastric bypass and sleeve gastrectomy.

At 5 years post-revision, patients who underwent one anastomosis gastric bypass had a lower average body mass index (31.9 kg/m2) compared to those who had sleeve gastrectomy (34.5 kg/m2).
Total weight loss was greater in the one anastomosis gastric bypass group (25.1%) than in the sleeve gastrectomy group (18.8%).
Resolution of type 2 diabetes occurred in 93.3% of one anastomosis gastric bypass patients, while 66.6% of sleeve gastrectomy patients experienced similar outcomes.
Major early complication rates were comparable between the two procedures, with 2.4% in the one anastomosis gastric bypass group and 4% in the sleeve gastrectomy group.
Revision due to delayed complications was required in 4% of one anastomosis gastric bypass patients compared to 8.6% of sleeve gastrectomy patients.

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PURPOSE: Laparoscopic adjustable gastric banding (LAGB) is in continuous decline due to low effectiveness and high reoperation rates. This study aims to evaluate outcomes of converting LAGB to one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) for insufficient weight loss or weight regain.

MATERIALS AND METHODS: Retrospective comparative study, based on prospective registry database of a tertiary center (2012-2019).

RESULTS: In all, 276 LAGB patients were converted to OAGB (n = 125) and SG (n = 151). Body mass index (BMI) at revision was 41.3 ± 6.6 and 42.3 ± 9.6 kg/m2 (P = 0.34) in OAGB and SG patients, respectively. Time interval was longer in OAGB patients (p < 0.001). Major early complication rates were comparable (2.4% and 4%; p = 0.46). At 5-years, OAGB patients had lower BMI (31.9 vs. 34.5 kg/m2; p = 0.002), and a higher total weight loss (25.1% vs. 18.8%; p = 0.003), compared with SG patients. Resolution of type 2 diabetes was higher in OAGB patients (93.3% vs. 66.6%; p = 0.047), while resolution of hypertension was not significantly different (84.6% and 80.5%; p = 0.68). Revision due to delayed complications was required in five (4%) OAGB patients and nine (8.6%) SG patients (p = 0.14).

CONCLUSION: OAGB for revision after LAGB due to insufficient weight loss or weight regain is safe, and has better effectiveness in weight reduction and resolution of type 2 diabetes than SG.

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Comparison of One Anastomosis Gastric Bypass and Sleeve Gastrectomy for Revision of Laparoscopic Adjustable Gastric Banding: 5-Year Outcomes

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