Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes

Jun 13, 2013Surgical endoscopy

Outcomes of Using Sleeve Gastrectomy or Gastric Bypass for Second-Time Weight Loss Surgery

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Abstract

Out of 693 bariatric procedures, 42 revisional sleeve gastrectomies (r-SG) and 53 revisional Roux-en-Y gastric bypasses (r-RYGB) were performed.

Patients who underwent r-SG had a lower median preoperative weight (107.7 kg) and body mass index (BMI) (38.5 kg/m²) compared to those who underwent r-RYGB (117.7 kg and 43.2 kg/m², respectively).
The mean operative time was shorter for r-SG (108.4 minutes) than for r-RYGB (161.2 minutes), and the median hospital stay was also reduced for r-SG (2 days vs. 3 days for r-RYGB).
The reoperation rate was lower in r-SG (0.0%) compared to r-RYGB (3.8%).
The overall complication rate was significantly lower for r-SG patients (7.1%) compared to r-RYGB patients (20.8%).
There was no significant difference in mean postoperative BMI or percentage excess weight loss (%EWL) at one year between the two groups.

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BACKGROUND: A considerable number of patients require revisional surgery after laparoscopic adjustable gastric banding (LAGB). Studies that compared the outcomes of revisional sleeve gastrectomy (r-SG) and revisional Roux-en-Y gastric bypass (r-RYGB) after failed LAGB are scarce in the literature. Our objective was to determine whether significant differences exist in outcomes between r-SG and r-RYGB after failed LAGB.

METHODS: From 2005 to 2012, patients who underwent laparoscopic r-SG and r-RYGB after failed LAGB were retrospectively compared and analyzed. Data included demographics, indication for revision, operative time, hospital stay, conversion rate, percentage excess weight loss (%EWL), and morbidity and mortality.

RESULTS: Out of 693 bariatric procedures, 42 r-SG and 53 r-RYGB were performed. The median preoperative weight (107.7 and 117.7 kg, respectively, p = 0.02) and body mass index (BMI) (38.5 vs. 43.2 kg/m(2), respectively, p = 0.01) were statistically significantly lower in r-SG than in r-RYGB. The mean operative time and median hospital stay were significantly shorter in r-SG than in r-RYGB (108.4 vs. 161.2 min, p < 0.01) (2 vs. 3 days, p = 0.02), respectively. One patient underwent conversion to open surgery after r-RYGB (p = 0.5). The reoperation rate was lower in r-SG than in r-RYGB (0.0 vs. 3.8 %, p = 0.5). There was one postoperative leak in the r-RYGB, and the overall complication rate was significantly lower in r-SG patients than in r-RYGB patients (7.1 vs. 20.8 %, p = 0.05). The mean follow-up was significantly shorter in the r-SG group (9.8 vs. 29.3 months, p < 0.01). However, the mean postoperative BMI was not different at 1 year (32.3 vs. 34.7, p = 0.29) as well as mean %EWL was (47.4 vs. 45.6 %, p = 0.77).

CONCLUSIONS: Both r-SG and r-RYGB are safe procedures with similar outcomes in terms of %EWL. As a result of the long-term potential nutritional complication of r-RYGB, r-SG may be a better option in this group of patients. Longer follow-up is needed.

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Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes

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