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

Abstract

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.

Revisional One Anastomosis Gastric Bypass with a 150-cm Biliopancreatic Limb After Failure of Adjustable Gastric Banding: Mid-Term Outcomes and Comparison Between One- and Two-Stage Approaches

“…The second question is the timing between AGB removal and the revisional procedure. The surgeries may be performed in one step or during two different operations with a variable delay [ 27 , 28 ].…”

“…The mean %EWL was 64.5% at 1-year follow-up, and no differences were reported between synchronous and two-step cases. Schäfer et al [ 28 ] analyzed the timing of conversion from LAGB to RYGB in a series of 165 patients, reporting a major complication rate of 15.3% for one-stage surgeries versus 16.9% for two-step procedures and no significant differences.…”

Linear or circular: Anastomotic ulcer after gastric bypass surgery

“…In this study, we also included patients with revisional surgery after laparoscopic Adjustable Gastric Banding (LAGB): They received a revisional GBP (RYGB or OAGB) either in a one-stage procedure with simultaneous band removal or a two-stage procedure with GBP after previous band removal [ 19 ].…”

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 2011, LAGB was the second most commonly performed procedure in the USA after Roux-en-Y gastric bypass (RYGB) [2]. LAGB was a simple, easy-to-do, reversible, restrictive laparoscopic procedure with expected rapid weight loss and low morbidity [3,4]. Unfortunately, there have been high failure rates regarding weight loss, whereby 30-50% of patients who underwent LAGB suffered from inadequate weight loss or weight regain and required a revision procedure within 7 years [4][5][6][7][8][9][10].…”

“…LAGB was a simple, easy-to-do, reversible, restrictive laparoscopic procedure with expected rapid weight loss and low morbidity [3,4]. Unfortunately, there have been high failure rates regarding weight loss, whereby 30-50% of patients who underwent LAGB suffered from inadequate weight loss or weight regain and required a revision procedure within 7 years [4][5][6][7][8][9][10]. Combined with the fact that and Other Interventional Techniques long-term weight loss was unsatisfactory, various complications as reflux esophagitis, esophageal dilatation, band slippage, and band erosions caused a considerable number of patients who underwent LAGB to seek corrective procedures [5][6][7][8][9].…”