Gastric Band Removal in Revisional Bariatric Surgery, one-step or two-step? A Systematic Review and Meta-Analysis

Jerry T Dang1, Noah J Switzer1, Jeremy Wu1, Richdeep Gill2, Jeremie Thereaux3, Xinzhe Shi1, Christopher de Gara1, Daniel Birch1, Shahzeer Karmali1. 1University of Alberta, 2University of Calgary, 3Department of General, Digestive and Metabolic Surgery. La Cavale Blanche University Hospital, University of Bretagne Occidentale

INTRODUCTION: We aimed to systematically review the literature comparing the safety of one-step versus two-step revisional bariatric surgery from LAGB. Bariatric revisional surgery is becoming increasingly common. Weight regain, band slippage, and pouch dilatation are common patient presentations to a tertiary bariatric consultant for revision from a previous laparoscopic adjustable gastric band (LAGB). Normally converted to either a Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG), there is considerable debate in the literature as to the safety of removing the gastric band and performing revisional surgery immediately or in a delayed, two-step fashion. While one-step operations circumvent the need for a second surgery, potential higher anastomotic leak rates make one-step operations less appealing.

METHODS AND PROCEDURES: A comprehensive search of MEDLINE, EMBASE, SCOPUS, the Cochrane Library, and Web of Science from 1946 to July 2015 was completed. Title searching was restricted to the following keywords/terms: gastric band* AND revision*/ fail*/remov*/reoperation*. Included studies contained >5 adult patients comparing one-step and two-step revisional surgery from gastric banding to either RYGB or SG.

RESULTS: Eleven primary studies (1370 patients) were included.  1006 patients were converted to RYGB and 364 patients to LSG. The main indications for revision were: failed weight loss (59.5%), vomiting/dysphagia (22.3%) and pouch dilatation (14.2%). BMI change was not significantly different for one-step compared with two-step in the RYGB group (p = 0.99). Weighted mean leak/fistula rates did not vary between one-step versus two-step in the RYGB (1.9% versus 2.3% respectively, p=0.36) or SG groups (5.8% versus 2.8%, p=0.26). Overall weighted mean morbidity was also similar between one-step versus two-step in the RYGB (8.1% versus 8.9% respectively, p=0.76) or SG groups (9.7% versus 11.2%, p=0.81). There was no difference in mortality rates between the groups.

CONCLUSION: Immediate or delayed revisional bariatric surgeries are both safe options for the management of gastric band complications, with acceptable morbidity rates.

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