Davis Waller1, Angel Farinas, MD2, Christian Cruz Pico, MD2, Angelina Postoev, MD2, Christopher Ibikunle, MD2, Aliu Sanni, MD2. 1MCG/UGA Medical Partnership, 2Georgia Surgicare
Despite its appealing short-term outcomes and simplicity, laparoscopic adjustable gastric banding (LAGB) requires revisional surgery in up to 30% of patients due to insufficient weight loss and associated complications. Considering the increasing usage of single-stage revisional laparoscopic sleeve gastrectomy (rLSG) as a revisional procedure, this review evaluates whether it is a feasible alternative to revisional laparoscopic roux-en-y gastric bypass (rLRYGB) in terms of perioperative clinical outcomes.
A systematic review was conducted using relevant studies at PubMed from 2010-2015 with comparative data on single-stage revision of LAGB to either rLSG or rLRYGB. The primary outcomes were percentage of estimated weight loss (%EWL) at 12 months , operative time (min.), hospital stay (days), mean complications, reoperations and intraoperative blood loss. Results are expressed as standard difference in means with standard error. Statistical analysis was done using random-effects meta-analysis to compare the mean value of the two groups (Comprehensive Meta Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ).
Three retrospective studies were quantitatively assessed and included for meta-analysis. Among the three studies, 134 were rLSG and 124 were rLRYGB. There was an increased operative time (-0.521±0.259, p=0.0), length of stay (-0.341±0.258, p=0.009), and operative blood loss (-0.381±0.333, p=0.025) in the rLRYGB group when compared to the rLSG patients. %EWL at 12 months (-0.285±0.34, p=0.102), post-operative complications (-0.309±0.326, p=0.063), and reoperations (-0.221±0.292, p=0.136) were similar in both groups.
Single-stage rLSG presents similar outcomes to rLRYGB for LAGB revisional bariatric surgery. It is associated with reduced operative time, length of stay, and blood loss.