Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Failed Gastric Banding

Abstract

Background Reoperation, after failed gastric banding, is a controversial topic. A common approach is band removal with conversion to laparoscopic Roux-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in a single-step procedure. Objective This study aimed to assess the safety of revisional surgery to LSG compared to LRYGB after failed laparoscopic adjustable gastric banding (LAGB) based on MBSAQIP Participant User File from 2015 to 2018. Methods Patients who underwent a one-stage conversion of LAGB to LSG (Conv-LSG) or LRYGB (Conv-LRYGB) were identified in the MBSAQIP PUF from 2015 to 2017. Conv-LRYGB cases were matched (1:1) with Conv-LSG patients using propensity scoring to control for potential confounding. The primary outcome was all-cause mortality. Results A total of 9974 patients (4987 matched pairs) were included in the study. Conv-LRYGB, as compared with conv-SG, was associated with a similar risk of mortality (0.02% vs. 0.06%; relative risk [RR], 0.33; 95% confidence interval [CI], 0.03 to 3.20, p = 0.32). Conversion to LRYGB increased the risk for readmission (6.16% vs. 3.77%; RR, 1.63; 95%CI, 1.37 to 1.94, p < 0.01); reoperation (2.15% vs. 1.36%; RR, 1.57; 95%CI, 1.17 to 2.12, p = <0.01); leak (1.76% vs. 1.02%; RR, 1.57; 95%CI, 1.72 to 2.42, p < 0.01); and bleeding (1.66% vs. 1.00%; RR, 1.66; 95%CI, 1.7 to 2.34, p < 0.01). Conclusions The study shows that single-stage LRYGB and LSG as revisional surgery after gastric banding, are safe in the 30-day observation with an acceptable complication rate and low mortality. However, conversion to LRYGB increased the risk of perioperative complications.

Safety and short-term outcomes of sleeve gastrectomy and Roux-en-Y gastric bypass following removal of adjustable gastric banding

“…Several clinical studies analyzed 30-day mortality after R-SG and R-RYGB. Here, both procedures showed similar results in this regard [53,54].…”

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

“…Recent evidence supports that single-step and two steps approaches are both safe [16,17]. In both approaches, conversion to LSG might determine fewer short-term post-op complications than RYGB [4,17]. In 2014, we evaluated the short-term follow-up of a cohort that underwent revisional LSG after failed LAGB in a "2-step" approach; the results demonstrated a good weight loss at 24 months, associated with low major complications rate.…”

“…Recent evidence supports that single-step and two steps approaches are both safe [ 16 , 17 ]. In both approaches, conversion to LSG might determine fewer short-term post-op complications than RYGB [ 4 , 17 ].…”

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

“…and vomiting in up to 60.0% of patients increasingly necessitated revision of the AGB to RYGB or to LSG [18][19][20][21]. Revisional LSG (rLSG) has been found safe in both oneand two-step operative approaches to AGB conversion, with very low 30-day adverse event rates and good medium-term excess weight loss (EWL) between 59.9 and 78.5% [22][23][24][25][26][27].…”