Comparative Study of Laparoscopic Revision of Failed Gastric Banding to Sleeve Gastrectomy Versus Roux-En-Y Gastric Bypass

Rodrigo Gonzalez, MD, Edwin Bran, MD, Fernando Montufar, MD

Las Americas Private Hospital

BACKGROUND: Successful weight following bariatric surgery is defined as losing 50% of the excess body weight at long-term follow-up. All types of bariatric operations have a percentage of failure due to inadequate weight loss or weight regain. Revisional bariatric surgery is an alternative to induce further weight loss in these patients. However, it is still unclear which is the appropriate operation following failed gastric banding, either another restrictive procedure like the sleeve gastrectomy (SG) or a combined restrictive and malabsorptive procedure like the Roux-en-Y gastric bypass (RYGB). The aim of this study is to review outcomes between converting a failed gastric banding to SG versus RYGB.

METHODS: We reviewed prospectively collected data of 916 patients undergoing gastric banding since the year 2000. Data from patients undergoing revisional surgery for failed gastric banding due to inadequate weight loss or weight regain were included in this study. The decision of the type revisional surgery to perform was made by the patients after our multidisciplinary team explained them all the details of each operation. Demographics including age, gender, and weight were analyzed. Comparisons between operative results, complications, and postoperative weight loss were performed. Continuous data were evaluated using either Student’s t-test or Mann-U Whitney and ordinary data were evaluated using Fisher’s exact test. Results are reported as mean+/-SD or median (range), as appropriate. A p<0.05 was considered statistically significant.

RESULTS: Of the 42 (4.6%) patients undergoing revisional bariatric surgery for failed gastric banding, 22 (52%) underwent conversion to SG and 20 (48%) underwent conversion to RYGB. All patients underwent laparoscopic surgery. Weight at the time of the revisional surgery was 236+-26 and 257+/-45 lb in patients undergoing revision to SG and RYGB, respectively (p=NS). There was no difference in age (35 +/-11 vs 43+/-14 years), gender ratio (73% vs 60% male patients), estimated blood loss (163 [50-600] vs 180 [50-800] ml), rate of conversion to open surgery (9% vs 5%), intraoperative complications (9% vs 10%), postoperative complications (14% vs 20%) between patients undergoing conversion to SG and RYGB, respectively. However, there was a significant difference in operative time (155+/-26 vs 208+/-45 min), length of hospital stay (2+/0.5 vs 4+/2 days), and return to normal activities (7+/2 vs 11+/4 days) between patients undergoing conversion to SG and RYGB, respectively. Follow-up was similar between patients in the SG (58+/-28 months) and RYGB (51+/21 months) groups. Weight loss was 66+/-24 and 80+/-33 lb in patients undergoing conversion to SG and RYGB, respectively (p=NS).

CONCLUSIONS: Revisional bariatric surgery through laparoscopic approach in patients with inadequate weight loss following gastric banding is safe and effective. Both procedures result in significant weight loss at long-term follow-up with low complication rates. Results of conversion to both sleeve gastrectomy and Roux-en-Y gastric bypass are comparable. However, the more demanding technical aspects of converting a gastric band to RYGB results in increased operative times, length of hospital stay and length to return to normal activities. Further analysis to determine which is the best procedure should be addressed with a prospective randomized trial.

Session: Podium Presentation

Program Number: S014

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