Perioperative outcomes of single-stage revision of laparoscopic adjustable gastric band to laparoscopic sleeve gastrectomy versus laparoscopic gastric bypass

Davis Waller1, Angel Farinas, MD2, Christian Cruz Pico, MD2, Angelina Postoev, MD2, Christopher Ibikunle, MD2, Aliu Sanni, MD2. 1MCG/UGA Medical Partnership, 2Georgia Surgicare

INTRODUCTION

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.

METHODS

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).

RESULTS

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.

CONCLUSIONS

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. 

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