Caitlin D Lesh, MD, W. Cameron Maclellan, Muhammad Nadeem, MD, Neha L Lad, MD, John L Butsch, MD, Alan Posner, MD, Steven D Schwaitzberg, MD, Aaron Hoffman, MD. University at Buffalo
Introduction: As laparoscopic gastric band (LAGB) falls out of favor, a significant number of patients will require revisional surgery including laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-y gastric bypass (LRYGB). Multiple small sample sized retrospective studies show promising results favoring revisional surgery towards LSG after LAGB.
Purpose: The aim of this study was to evaluate a large volume, multi surgeon bariatric surgery center producing the largest sample size to date proving efficacy (% weight loss) and safety of sleeve gastrectomy following band removal in one or two step procedures.
Methods: All patients undergoing conversion of LAGB to LRYGB (33) and LSG (291) regardless of one step vs two step conversion from January 2006 to January 2017 were included. A retrospective analysis of our prospectively maintained database was performed to compare outcomes in patients undergoing conversion to LRYBG vs LSG after LAGB to identify the outcomes.
Results: A total of 324 patients with LAGB underwent conversional surgery. Median age was 46±10.4, 277 (93.7%) were female. Of these, 33 patients underwent conversion to LRYGB and 291 underwent conversion to LSG. On univariate analysis of LRYGB showed statistically significant (p<0.05) higher incidence of DM (42% vs 26%), HTN (58% vs 53%), longer length of stay (LOS) (3.1±2.6 vs 1.7±2.1days), presence of any post-operative complications (27% vs 9%) & clavien-dindo class >3 (21% vs 8%) than the LSG group. Median weight loss was similar in LRYGB & LSG (16.0±9.1kg vs 19.6 ±27.7kg) (p=0.09). Median LRYGB follow up was 700 days, whereas LSG follow up was 500 days. Multivariate analysis for presence of any complication, showed only LRYGB vs LSG the only statistically significant factor (p=0.014) despite increased comorbidities in that group . Sixteen LAGB to LRYGB were performed in a single stage (5 complications) (31.2%). Sixteen LAGB to LRYGB were in a single stage (5 complications) (29.4%). 162/ 291 LSB to LSG were performed in a single stage resulting in 15 complications (9.2) %, whereas 129/291 completed in a two-step procedure resulted in 12 complications (9.3%).
Conclusion: Revisional surgery from LAGB to LSG has comparable weight loss but lower incidence of complications and shorter length of stay as compared to LRYGB. In a center with a high number of patients and experienced surgeons revision to laparoscopic sleeve gastrectomy can be safely performed in one stage procedure
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87083
Program Number: P582
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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