Conversion of Adjustable Gastric Banding to Roux-en-Y Gastric Bypass in One or Two Steps: What Is the Best Approach? Analysis of a Multicenter Database Concerning 832 Patients

Abstract

Background Roux-en-Y gastric bypass (RYGB) is often the preferred conversion procedure for laparoscopic adjustable gastric banding (LAGB) poor responders. However, there is controversy whether it is better to convert in one or two stages. This study aims to compare the outcomes of one and two-stage conversions of LAGB to RYGB. Methods Retrospective review of a multicenter prospectively collected database. Data on conversion in one and two stages was compared. Results Eight hundred thirty-two patients underwent LAGB conversion to RYGB in seven specialized bariatric centers. Six hundred seventy-three (81%) were converted in one-stage. Patients in the two-stage group were more likely to have experienced technical complications, such as slippage or erosions (86% vs. 37%, p = 0.0001) and to have had a higher body mass index (BMI) (41.6 vs. 39.9 Kg/m 2 , p = 0.005). There were no differences in postoperative complications and mortality rates between the onestage and two-stage groups (13.5% vs. 10.8%, and 0.7% vs. 0.0% respectively, p = ns). Mean final BMI and %total weight loss (%TWL) for the one-stage and the two-stage groups were 31.6 vs. 32.4 Kg/m 2 (p = ns) and 30.4 vs. 26.8 (p = 0.017) after a mean follow-up of 33 months. Follow-up at 1, 3, and 5 years was 98%, 75%, and 54%, respectively. Conclusions One-stage conversion of LAGB to RYGB is safe and effective. Two-stage conversion carries low morbidity and mortality in the case of band slippage, erosion, or higher BMI patients. These findings suggest the importance of patient selection when choosing the appropriate conversion approach.

The Long-Term Association between Physical Activity and Weight Regain, Metabolic Risk Factors, Quality of Life and Sleep after Bariatric Surgery

“…Our results show that all the dimensions of quality of life are inversely related to weight regain and directly associated with physical activity ( Table 3 ). This aligns with previously published work reporting improvements in the quality of life of bariatric surgery patients that involved social life and work related with the practice of physical activity [ 39 ]. The sleep quality questionnaire indicated that the majority of these patients have poor sleep quality.…”

Adjustable Gastric Banding Conversion to One Anastomosis Gastric Bypass: Data Analysis of a Multicenter Database

“…The pooled data were merged in a single electronic database which managed to contain more than 1219 revisional procedures after LAGB, 189 of which (15.5%) underwent conversion to OAGB. 16,17 The aforementioned database includes demographic and medical data such as patient's age, gender, height, preoperative weight (before LAGB), date of LAGB placement, cause of conversion, date of LAGB removal, revisional procedure date, weight immediately before conversion to OAGB, and last weight recorded during follow-up.…”

Propensity score matching analysis comparing outcomes between primary and revision Roux-en-Y gastric bypass after adjustable gastric banding: a retrospective record-based cohort study

“…In our experience, we prefer the one-stage conversion of LAGB to RYGB. Conversion to RYGB has been advocated by many authors to be safe and effective for insufficient weight loss and band after LAGB [4,[11][12][13][14][15][16]. Also, data from systematic reviews have endorsed RRYGB for failed LAGB, and reported better and more sustained weight loss, and lower reoperation rates after RRYGB [7,19].…”

“…Options for revision surgery usually included band removal, and conversion to laparoscopic RYGB or laparoscopic sleeve gastrectomy (LSG) [7]. RYGB has been endorsed by many authors as a safe and effective option for revision surgery after failed LAGB [4,[11][12][13][14][15][16]. Also, metaanalyses have shown the safety and effectiveness of RYGB after failed LAGB [7,[17][18][19][20][21].…”

“…The one-stage approach could minimize episodes of anesthesia, prevent second hospital admission, and reduce subsequent costs. Several single- and multi-center studies, and meta-analyses have supported the safety of the one-stage approach [ 4 , 12 , 13 , 15 , 22 , 23 ].…”