Outcomes of Two-Step Revisional Bariatric Surgery: Reasons for the Gastric Banding Explantation Matter

Aug 25, 2017Obesity surgery

Results of Two-Step Follow-Up Weight Loss Surgery Depend on Why the First Stomach Band Was Removed

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Abstract

In a cohort of 171 patients, those undergoing revisional Roux-en-Y gastric bypass (RYGB) for failed weight loss exhibited a significantly lower percentage excess weight loss (%EWL) at 2 years compared to those undergoing sleeve gastrectomy (SG) for the same reason.

Band-related complications were the cause of 55% of gastric band explantations.
Of the cohort, 56% underwent revisional RYGB and the remainder underwent SG.
There was no significant difference in age or gender regarding reasons for band explantation or choice of revisional surgery.
Morbidity rates were similar between patients undergoing SG (2.6%) and RYGB (4.2%).
At 2 years, patients who had RYGB for failed weight loss had a lower %EWL compared to those who had SG for failed weight loss (p = .014) or RYGB for band-related complications (p = .021).

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PURPOSE: The purpose of this study is to determine whether the reason for gastric band explantation would influence percentage excess weight loss (%EWL) following revisional Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).

MATERIALS & METHODS: This is a retrospective cohort study, whose data are maintained in a prospective surgical database. The study period was from January 2012 to March 2017. Revisional surgeries were performed in a two-step manner, namely, first surgery LAGB explantation and second surgery (RYGB or SG). Two-way between-groups analysis of variance was used to examine effects of reason for band explantation (failed versus complication) and type of revisional surgery (RYGB versus SG) on %EWL at 10 months, 1 and 2 years.

RESULTS: Cohort included 171 patients-146 women (85.4%) and 25 men, median age 51 years (range 22-76). Band-related complications accounted for 55% of explantations. Overall, 95 patients (56%) underwent a revisional RYGB, and 76 patients underwent a revisional SG. There was no difference in age or gender in terms of reason for band explantation or choice of revisional surgery. There was no difference in morbidity between the two groups (SG 2.6% versus RYGB 4.2%; p = .464). Patients undergoing revisional RYGB for failed weight loss had a significantly lower %EWL at 2 years compared to patients undergoing an SG for failed weight loss (p = .014) or an RYGB for band-related complications (p = .021).

CONCLUSION: Patients undergoing revisional RYGB following band explantation for failed weight loss have a significantly lower %EWL at 2 years compared to patients undergoing an SG for failed weight loss or an RYGB for band-related complications.

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Outcomes of Two-Step Revisional Bariatric Surgery: Reasons for the Gastric Banding Explantation Matter

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