Two-step conversion surgery after failed laparoscopic adjustable gastric banding. Comparison between laparoscopic Roux-en-Y gastric bypass and laparoscopic gastric sleeve

Jul 29, 2014Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery

Two-step surgery after failed adjustable stomach band: comparing bypass and sleeve stomach removals

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Abstract

A total of 108 patients underwent conversion from failed laparoscopic adjustable gastric banding, with 68.5% converting to laparoscopic Roux-en-Y gastric bypass and 31.5% to laparoscopic sleeve gastrectomy.

Postoperative complications occurred in 16.2% of laparoscopic Roux-en-Y gastric bypass patients compared to 2.9% in the laparoscopic sleeve gastrectomy group.
Mean percentage of excess weight loss at 12 months was 59.9% for laparoscopic Roux-en-Y gastric bypass and 52.2% for laparoscopic sleeve gastrectomy.
At 24 months, excess weight loss increased to 70.2% for laparoscopic Roux-en-Y gastric bypass and 59.9% for laparoscopic sleeve gastrectomy.
The mean body mass index prior to laparoscopic Roux-en-Y gastric bypass was 45.6, while it was 47.5 for laparoscopic sleeve gastrectomy.

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BACKGROUND: Despite its worldwide popularity, laparoscopic adjustable gastric banding (LAGB) requires revisional surgery for failures or complications, in 20-60% of cases. The purpose of this study was to compare in terms of efficacy and safety, the conversion of failed LAGB to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy. (LSG).

METHODS: The bariatric database of our institution was reviewed to identify patients who had undergone conversion of failed LAGB to LRYGB or to LSG, from November 2007 to June 2012.

RESULTS: A total of 108 patients were included. Of these, 74 (68.5%) underwent conversion to LRYGB and 34 to LSG. All of the procedures were performed in 2-stage and laparoscopically. The mean follow-up for the LRYGB group was 29.1±17.9 months while for the LSG patients was 24.2±14.3 months. The mean body mass index (BMI) prior LRYGB and LSG was 45.6±7.8 and 47.5±5.6 (P = .09), respectively. Postoperative complications occurred in 16.2% of the LRYGB patients and in 2.9% of the LSG group (P = .04). Mean percentage of excess weight loss was 59.9%±16.2% and 70.2%±16.7% in LRYGB, and it was 52.2%±11.4% and 59.9%±14.4% in LSG at 12 months (P = .007) and 24 months (P = .01) after conversion.

CONCLUSION: In this series, LRYGB and LSG are both effective and adequate revisional procedure after failure of LAGB. While LRYGB seems to ensure greater weight loss at 24 months follow-up, LSG is associated with a lower postoperative morbidity.

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Two-step conversion surgery after failed laparoscopic adjustable gastric banding. Comparison between laparoscopic Roux-en-Y gastric bypass and laparoscopic gastric sleeve

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