Background

In recent years, use of laparoscopic adjustable gastric banding(LAGB) has decreased but revisional bariatric surgery has become more common. The optimal approach to this patient population is unclear. Compare outcomes of LAGB patients who undergo conversion to sleeve gastrectomy(SG) or Roux-en-Y gastric bypass(RYGB)

Methods

Retrospective review of a prospectively collected database of 138 revisional procedures,performed by a single surgeon between 2015-2019.Groups were compared using SPSS software.

Results

Forty-eight patients(35%) underwent LAGB revision,mean age 47 years,85.4% female.Average pre-band BMI was 46.6,lowest achieved BMI–33.4(EWL 62%).All patients had weight re-gain(pre-revision BMI 43.4) and half of the patients also had a band-related complication.Twenty-three percent of revisions were robot-assisted and the remaining were laparoscopic; in 52% the band removal and revision were staged. There were 29 patients in the SG group(60%) and 19 patients(40%) in the RYGB group. The groups did not differ in demographics including age,gender,BMI and comorbidities. Compared to RYGB, SG patients had shorter procedure duration(126min vs 185min), shorter LOS(2 days vs 4 days). Two patients in the RYGB group had a major complication(1 vertical staple line leak and 1 bleeding) and none in the SG group.Weight loss one year post-revision was inferior after SG compared to RYGB–EWL 53% v 77%, TWL 20% vs 29%, delta BMI 8.66 v 13.51;this was statistically significant.

Conclusions

Conversion of LAGB to RYGB results in superior weight loss compared to SG at the expense of longer OR time and LOS.