Short-term results of one stage conversion of failed adjustable gastric band to gastric bypass or vertical sleeve gastrectomy

Pornthep D Prathanvanich, MD, FRCST, FACS, Bipan Chand, MD, FACS, FASMBS, FASGE. Loyola University Medical Center


All bariatric operations have the potential of inadequate weight loss and developing complications. The adjustable gastric band (AGB) has less short-term complications but often requires a revision. Surgical revisions include rebanding or more often a conversion to another bariatric operation. However, re-intervention has a three- to fivefold higher morbidity rate when compared to primary bariatric surgery. The aim of this study is to determine the feasibility and outcomes of a one-stage conversion of failed AGB to either gastric bypass or vertical sleeve gastrectomy.


This is a retrospective study of 15 patients who underwent conversion to LRYGB {N=12} and LSG {N=3} as a one stage procedure after failed AGB. Failures can be grouped into either weight recidivism (N=10) and a device-related complication (N=5; one port site infection and four gastric band slips). Weight recidivism can be classified into weight regain (gain of 20% of maximum weight lost){N=5} or inadequate weight loss (defined as %EWL < 50%) {N=5}.

All patients underwent preoperative preparation with counseling into etiology of failure, upper endoscopy and contrast imaging. Four patients had a type 3b slip without band erosion. All other patients had a normal upper endoscopy and contrast study. All patients had fluid removal from the system to allow for symptom improvement in patients with a band slip and regurgitation or dyspepsia in overtly tight systems. This maneuver also allowed the proximal gastric pouch to normalize in size and potentially offering better tissue characteristics. Preoperative weight loss was mandated and patients lost a mean of 6.3±0.98 kg before surgery.


Between April 2013 to July 2014, 15 consecutive patients (Female = 13, mean body mass index: BMI = 48.89±6.14 kg/m2) had a conversion from failed AGB to another bariatric operation. The technical difficulty often centered on gastric pouch creation during gastric bypass or gastric resection during sleeve gastrectomy. Each operation was planned as a one stage and all completed in this manner. This decision to proceed as a one stage was also determined intra-operatively. Factors affecting completion included gastric viability and adequate exposure. The gastric fundus required resection in 5/12 of LRYGB patients.

The mean operative time was 151 minutes with no intraoperative complications. Two post-op complications occurred early and included one port site hernia and one Peterson’s hernia. Mean follow up time was 7.73 months with an excess weight loss of 35.50±14.40%.


The conversion from AGB to LRYGB or LSG, as a one-stage procedure, is technically feasible and can safely be performed in select patients. Extensive preoperative planning and good intraoperative surgical judgment can minimize complications related to gastric pouch creation during gastric bypass and sleeve formation. Strategies must be employed to allow for adequate gastric tissue compliance and vascularity. Fundic resection may be required in select cases.

Demographic and outcome data
First visit BMI (kg/m2±SD)48.89±6.14
Presurgical BMI (kg/m2±SD)47.10±5.82
Last FU BMI (kg/m2±SD)39.47±5.89
Excess weight loss (%±SD)35.50±14.40

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