Alice Wang, MD, Shanna Sprinkle, MD, Dana Portenier, MD, Chan Park, MD, Jin Yoo, MD, Ranjan Sudan, MD, Keri Seymour, DO. Duke University Medical Center
Background: The adjustable gastric band (AGB) has decreased in popularity due to complications and weight loss failure. Many patients seek revision surgery to improve their outcome despite increased surgical risk. We thus aim to assess the safety and efficacy of revision roux-en-y gastric bypass (RGB) after AGB compared to sleeve gastrectomy (SG) after AGB.
Methods: After IRB approval, retrospective review from September 2004 to December 2014 at a single institution was performed for AGB to RGB (n=66) and AGB to SG (n=17). All surgeries were performed by 8 surgeons laparoscopically. Continuous variables were compared with t-tests and categorical variables were compared with Fisher’s exact test or McNemar’s chi-squared test. Effect of procedure on percent weight loss (%WL) was determined using multivariate linear regression with model selection using Akaike information criterion.
Results: Average age was 47 +/- 11 years, 61% of patients were Caucasian and 82% female. Average length of hospital stay for AGB to RGB was 2.7 (SD 3.0) compared to 1.9 (SD 0.8) in the AGB to SG group (p = 0.052, CI -0.007-1.636). There were no difference in 30-day readmission (6 vs 0, p=0.34, CI 0-3.33) or reoperation (3 vs 0, p=1.0, CI 0-9.6) between AGB to RGB and AGB to SG. There were no 30-day mortality, pulmonary embolism, or leak in either groups. Among patients with 1-year follow up, there was a significant decrease in BMI after revision RGB (n=51, 44.0 vs 37.2, p<0.0001, CI 5.2-9.1) and revision SG (n=14, 44.9 vs 39.4, p=0.003, CI 2.2-8.7). After controlling for sex, age, height, and %WL from index surgery, there was no effect of revision procedure on %WL 1 year after revision. There was no significant difference in DMII after revision in either groups. In patients who received RGB after AGB, there was a significant decrease in the average number of HTN medications at 1 year (0.86 vs 0.66, p=0.04, CI 0.01-0.42) that was not seen among patients who received SG after AGB.
Conclusions: Both groups had significantly lower BMI at 1 year and type of revision surgery did not affect %WL. Revisional RGB did result in a greater decrease in number of HTN medications at 1 year but had trends toward longer hospital stay though this was not statistically significant.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80082
Program Number: S125
Presentation Session: Bariatric surgery – Sleeves, Conversions and More
Presentation Type: Podium