A one-step conversion from gastric banding to laparoscopic Roux-en-Y gastric bypass is as safe as a two-step conversion: A comparative analysis of 885 patients

Debergh, Isabelle; Defoort, Barbara; Visschere, Marieke De; Flahou, Silke; Cauwenberge, Sebastiaan Van; Mulier, J. P.; Dillemans, Bruno

doi:10.1080/00015458.2016.1255005

Cited by 28 publications

(15 citation statements)

References 26 publications

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“…The present study entailed a major complication rate of 15.2%, which is comparable to the literature, where major complication rates are reported from 0 to 23% [5,8,9,11,12,14] in R-LRYGB. Our complication rate is even comparable to that for primary LRGBY: a review of 3464 cases with primary LRYGB reported a major complication rate of 11.7% [25].…”

Section: Discussionsupporting

confidence: 85%

“…The same applies for our longer LOS as compared to that in the literature [11,14,15,24], which can also be explained by the Austrian health economics system not having the same pressure to discharge patients early, as compared to other countries.…”

Section: Discussionsupporting

confidence: 76%

“…Finally, we believe that a one-stage procedure is preferable in R-LRYGB after failed LAGB. This is also confirmed by study data from high-volume centers where a one-stage procedure is recommended from banding to R-LRYGB [6,11,12,14,15] in selected patients. However, the indication will always be a matter of the patient's wishes and the surgeon's preference.…”

Section: Discussionsupporting

confidence: 59%

“…Band channel removal, mobilization of the fundus, and adhesiolysis to recreate the Bnormal^anatomy are more complex and demanding than in primary LRYGB. Compared to highvolume centers [11,14,15,22], we had longer operating times, as our institution is a teaching hospital with a mixed team of bariatric surgeons having varied experience and training levels.…”

Section: Discussionmentioning

confidence: 99%

“…Good results have been demonstrated in both one-stage procedures (band removal, R-LRYGB in one procedure) and in the two-stage procedure (band removal as first procedure followed by R-LRYGB as second procedure) [6,12,[14][15][16] with an acceptable major complication rate of 0-23%. However, whether a one-stage procedure or a two-stage procedure is preferable is still the subject of discussion.…”

Section: Introduction/purposementioning

confidence: 98%

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Revisional Gastric Bypass After Failed Adjustable Gastric Banding—One-Stage or Two-Stage Procedure?

et al. 2018

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Background Revisional laparoscopic Roux-en-Y gastric bypass (R-LRYGB) is the preferred procedure after failed adjustable gastric banding. Little is known about whether a one-stage procedure (one surgery for band removal and R-LRYGB) or a twostage procedure (first band removal and later R-LRYGB) is superior. Aim of this study is to compare early-and long-term results of both methods at our institution. Methods Retrospective analysis of 165 (m 26/f 139) consecutive patients (98 one-stage, 67 two-stage) with R-LRYGB. Mean follow-up time was 50.1 ± 38.8 months. Indications for one-stage vs. two-stage procedures, operating time, peri-and postoperative complications, morbidity, mortality, and length of stay (LOS) were analyzed. Data are reported as total numbers (%) and mean ± standard deviation.Results Mean age at R-LRYGB was 43.9 ± 10.7 vs. 44.3 ± 10.7 years with a BMI of 37.1 ± 6.8 vs. 39.8 ± 7.1 (one-stage vs. twostage). In the one-stage group, the main indication for revisional surgery was weight regain (57.1%), followed by dilatation of the esophagus or pouch (37.7%) and gastroesophageal reflux disease (GERD) (36.7%), whereas in the two-stage group, it was band erosion (52.2%) and dilatation of the esophagus or pouch (17.9%) and GERD (11.9%). There was no significant difference in operative time (208.5 ± 61.2 vs. 206.3 ± 73.5 min), LOS (8.6 ± 3.4 vs. 9.3 ± 5.7 days) or mortality (0% overall). Major complications (Clavien-Dindo ≥ IIIa) occurred similarly often in both groups: 15.3% vs. 16.9% (one-stage vs. two-stage). Conclusion Both approaches achieve good results. However, the one-stage R-LRYGB is the preferable procedure because it reduces costs and LOS by doing without an additional surgical procedure.

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