One-step short-stay conversion from gastric banding to sleeve gastrectomy. Safety and feasibility.

Tomas C Jakob, MD, Patricio Cal, MD, Luciano J Deluca, MD, Ezequiel Fernandez, MD. CRQO

Introduction: Bariatric surgery is the most effective treatment for morbid obesity. Laparoscopic adjustable gastric banding (LAGB) has few perioperative complications. However, many patients require a long term revisional surgery, either for weight regain, reflux, esophageal dilation, slippage or band erosion. Laparoscopic sleeve gastrectomy (LSG) has consolidated as a primary bariatric technique and also as a revisional procedure. The safety of a one step revision is a matter of debate. Also, because of its quick post-operatory recovery is disputed if patients benefit or not of a longer than 24 hours hospitalization when performing it as a revisional technique. Main benefits of early discharge are minimal loss of productivity, costs reduction and less risk of infections. 

Methods and procedures: The objective of this study was to evaluate the safety and feasibility of one-step short-stay conversion from LAGB to LSG. We prospectively collected data about hospital stay, readmission rate, early and mid-term term major complications and re-intervention rate on 39 conversions from LAGB to LSG performed between march 2010 and august 2015.

Results:, Mean age was 48.7 (35-62); mean BMI was 45.7 kg/m2 (26.8-71.5); 81.9% were women. Thirty eight patients were discharged in the first 24 hours. Only 1 (2.6%) required a longer admission for digestive intolerance. No reinterventions were required. No leaks, intra-abdominal hematomas or abdominal collections were observed. There was no mortality. 

Conclusions: Evidence suggests that one-step conversion from LAGB to LSG is a safe and feasible surgery. Hospital stay for more than 24 hours seems unnecessary in patients with no persistent vomiting or signs of bleeding or leaks. 

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