Long-term outcomes of sleeve gastrectomy as a revisional procedure after failed gastric band: a multicenter cross-matched cohort study

Abstract

Laparoscopic adjustable gastric band (LAGB) is the bariatric procedure most likely subject to revisional surgery. Both laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (LRYGB) represent viable options, but the long-term results are still lacking. In 2014, we published the 2-year follow-up of our multicenter cohort of revisional LSG after failed LAGB. Evaluate the long-term follow-up (median 9.3 years) of the same cohort of patients. University and primary-care hospitals, Italy. We retrospectively examined a prospectively maintained database of the previously published multicenter cohort of 56 patients who underwent LSG after failed LAGB between 2008–2011. The control group included cross-matched non-revisional LSGs. The primary endpoint was weight loss, secondary endpoints co-morbidities, and the need for further bariatric surgery. The study group included 44 patients and the control group 56. We found %EWL 53% Vs. 67% (p = .021), %EBMIL (54 Vs. 68%, p = .018), %TWL (26 Vs. 34%, p = .002). We also found more severe GERD (gastroesophageal reflux disease) symptoms in the revisional than in the primary group (9.0 vs. 1.8% mild and 23.0 vs. 3.0% severe). Ten patients from the revisional group (22.7%) vs. eight in the primary group (13%) underwent further bariatric surgery (LRYGB). Our results showed less favorable weight loss in revisional than primary LSG after LABG, higher prevalence of GERD, and a more frequent need for further revisional surgery. Despite the study’s limitations, the present data suggest that the long-term outcomes may offset the possible reduced short-term complication rate after revisional sleeve gastrectomy for a failed LABG.

Long-Term Matched Comparison of Primary and Revisional Laparoscopic Sleeve Gastrectomy

“…While Carandina et al’s study suggested that rLSG resulted in somewhat lower AMP remission/improvement than pLSG, our study more closely mirrored the findings of Kraljevic et al and De Angelis et al [ 37 – 39 ], which reported equally durable weight loss and AMP control between pLSG and rLSG patients. Kraljević et al’s study showed considerable AMP improvement in pLSG and rLSG patients combined: T2DM 61.0%, hypertension 60.5%, and hyperlipidemia 46.0%, findings comparable to our own study.…”

“…In addition to the three currently available long-term reports of post-LSG weight loss [ 37 – 39 ], the current study’s primary group EWL outcomes were > 50.0%, falling within the range of the four study results (51.0 to 67.0%). The current study’s revisional group EWL outcomes also fell within the range of the four studies (29.8 to 53.0% EWL).…”

“…At 8-year follow-up, as in our own and the other two investigations, weight loss was significantly greater in pLSG than in rLSG patients. In addition to the three currently available long-term reports of post-LSG weight loss [37][38][39], the current study's primary group EWL outcomes were > 50.0%, falling within the range of the four study results (51.0 to 67.0%). The The majority of our patients in both the primary and revisional groups (> 81.0%) experienced at least some weight regain.…”

“…Although some observational rLSG studies reported very high rates of weight loss reaching 70.0–75.0% EWL, these findings apply to results in the early and intermediate time frames (≤ 5 years) [ 35 , 36 ]. To our knowledge, the number of directly comparative studies of pLSG and rLSG in patients with severe obesity with long-term ≥ 5-year follow-up similar to the current study (combined mean 9.8 years) number only three: Carandina et al (6 years), Kraljevic et al (7.5 years), and de Angelis et al (8 years) [ 37 – 39 ].…”

“…At mean follow-up time of 7.5 ± 3.4 years, both pLSG and rLSG groups appeared to have lost relatively more weight than in the current study. De Angelis and colleagues compared 56 pLSG and 44 rLSG patients converted from AGB in a two-step process [ 39 ]. At 8-year follow-up, as in our own and the other two investigations, weight loss was significantly greater in pLSG than in rLSG patients.…”