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Huang BW, Shahul SS, Ong MKH, Fisher OM, Chan DL, Talbot ML. Medium Term Outcomes of Revision Laparoscopic Sleeve Gastrectomy after Gastric Banding: A Propensity Score Matched Study. Obes Surg 2023; 33:2005-2015. [PMID: 37212965 PMCID: PMC10289990 DOI: 10.1007/s11695-023-06629-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Revision bariatric surgery may be undertaken after weight loss failure and/or complications following primary bariatric surgery. This study aims to compare the efficacy and safety of revision laparoscopic sleeve gastrectomy (RLSG) after gastric banding (GB) to those of primary laparoscopic sleeve gastrectomy (PLSG). MATERIALS AND METHODS A retrospective, propensity-score matched study was conducted to compare between PLSG (control) patients and RLSG after GB (treatment) patients. Patients were matched using 2:1 nearest neighbor propensity score matching without replacement. Patients were compared on weight loss outcomes and postoperative complications for up to five years. RESULTS 144 PLSG patients were compared against 72 RLSG patients. At 36 months, PLSG patients had significantly higher mean %TWL than RLSG patients (27.4 ± 8.6 [9.3-48.9]% vs. 17.9 ± 10.2 [1.7-36.3]%, p < 0.01). At 60 months, both groups had similar mean %TWL (16.6 ± 8.1 [4.6-31.3]% vs. 16.2 ± 6.0 [8.8-22.4)]%, p > 0.05). Early functional complication rates were slightly higher with PLSG (13.9% vs. 9.7%), but late functional complication rates were comparatively higher with RLSG (50.0% vs. 37.5%). The differences were not statistically significant (p > 0.05). Both early (0.7% vs 4.2%) and late (3.5% vs 8.3%) surgical complication rates were lower in PLSG patients compared to RLSG patients but did not reach statistical significance (p > 0.05). CONCLUSION RLSG after GB has poorer weight loss outcomes than PLSG in the short-term. Although RLSG may carry higher risks of functional complications, the safety of RLSG and PLSG are overall comparable.
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Affiliation(s)
- Brenda W Huang
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia.
| | - Sarfraz S Shahul
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
| | - Marcus K H Ong
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
| | - Oliver M Fisher
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
- Upper Gastrointestinal Surgery Unit, Department of Surgery, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
| | - Daniel L Chan
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
- Upper Gastrointestinal Surgery Unit, Department of Surgery, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
- School of Medicine, Western Sydney University, Narellan Rd & Gilchrist Dr, Campbelltown, NSW, 2560, Australia
| | - Michael L Talbot
- Faculty of Medicine, University of New South Wales, 18 High St, Kensington, NSW, 2052, Australia
- Upper Gastrointestinal Surgery Unit, Department of Surgery, St George Hospital, Gray St, Kogarah, NSW, 2217, Australia
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One-Stage Versus Two-Stage Gastric Bypass as Redo Surgery After Failed Adjustable Gastric Banding-Observation Comparative Multicenter Study. J Gastrointest Surg 2022; 26:1596-1606. [PMID: 35610533 DOI: 10.1007/s11605-022-05358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/13/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND This study investigates the outcome of one-stage and two-stage Roux-Y gastric bypass (RYGB) as a revision procedure after failed adjustable gastric banding (AGB). MATERIAL AND METHODS Data of patients who underwent a one-stage RYGB (OS-RYGB) or a two-stage RYGB (TS-RYGB) revision procedure after failing AGB between 2005 and 2019 were analyzed. Outcome criteria were perioperative complications, operating time, change in weight and BMI, and remission of comorbidities at 1-year follow-up. RESULTS Data from 230 patients after OS-RYGB and 197 after TS-RYGB were analyzed. The total perioperative complication rates were not significantly different between the two groups (overall p > 5%). In the category of other complications, there was a significant difference between the two groups, with a lower rate in TS-RYGB than in OS-RYGB (p = 0.020). Wound infections occurred more frequently after TS-RYGB than after OS-RYGB (p = 0.015). Mean operating time differed significantly between the two groups (OS-RYGB (149.9 min) and TS-RYGB 191 min; p < 0.001). The change in hypertension was significantly higher in OS-RYGB (37.9 vs. 21.1%; p = 0.007). Other comorbidities showed no significant change within 1 year after surgery. Regarding the change in BMI, %TWL, and %EWL, there were no significant benefits for either group (p = 0.574, 0.762, and 0.378, respectively). CONCLUSION Removing a failed AGB using the OS- or TS-RYGB is safe and feasible. The decision between OS- and TS-RYGB is still individual and depends on the patient's general condition, the desired goal of the procedure, and the personal competence of the surgeon. Further studies are needed to clarify long-term outcome and effect of both procedures.
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A C, N C, A I. Postoperative morbidity and weight loss after revisional bariatric surgery for primary failed restrictive procedure: A systematic review and network meta-analysis. Int J Surg 2022; 102:106677. [PMID: 35589051 DOI: 10.1016/j.ijsu.2022.106677] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND revisional bariatric surgery is gaining increasing interest as long term follow-up studies demonstrate an elevated failure rate of primary surgery due to insufficient weight loss, weight regain or complications. This particularly concerns restrictive bariatric surgery which has been widely adopted from the '80s till present through different procedures, notably vertical banded gastroplasty, laparoscopic adjusted gastric banding and sleeve gastrectomy. The aim of this study is to define which revisional bariatric procedure performs the best after failure of primary restrictive surgery. METHODS a systematic review and network meta-analysis of 39 studies was conducted following the PRISMA guidelines and the Cochrane protocol. RESULTS biliopancreatic diversion with duodenal switch guarantees the best results in terms of weight loss (1 and 3-years %TWL MD: 12.38 and 28.42) followed by single-anastomosis duodenoileal bypass (9.24 and 19.13), one-anastomosis gastric bypass (7.16 and 13.1), and Roux-en-Y gastric bypass (4.68 and 7.3) compared to re-sleeve gastrectomy. Duodenal switch and Roux-en-Y gastric bypass are associated to an increased risk of late major morbidity (OR: 3.07 and 2.11 respectively) compared to re-sleeve gastrectomy while no significant difference was highlighted for the other procedures. Re-sleeve gastrectomy is the revisional intervention most frequently burdened by weight recidivism; compared to it, patients undergoing single-anastomosis duodenoileal bypass have the lowest risk of weight regain (OR: 0.07). CONCLUSION considering the analyzed outcomes altogether, single-anastomosis duodenoileal bypass and one-anastomosis gastric bypass are the most performing revisional procedures after failure of restrictive surgery due to satisfying short and mid-term weight loss and low early and late morbidity. Moreover, single-anastomosis duodenoileal bypass has low risk of weight recidivism.
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Affiliation(s)
- Chierici A
- Service de Chirurgie Digestive, Centre Hospitalier D'Antibes Juan-les-Pins, 107, av. de Nice, 06600, Antibes, France
| | - Chevalier N
- Inserm U1065, C3M, Nice, France; Université Côte D'Azur, Nice, France; Service D'Endocrinologie, Diabétologie et Médecine de la Reproduction, Archet 2 Hospital, Nice, France
| | - Iannelli A
- Université Côte D'Azur, Nice, France; Centre Hospitalier Universitaire de Nice - Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Nice, France; Inserm, U1065, Team 8 "Hepatic complications of Obesity and alcohol", France.
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Xie J, Dreifuss NH, Schlottmann F, Cubisino A, Mangano A, Vanetta C, Baz C, Valle V, Bianco FM, Gangemi A, Masrur MA. Minimally Invasive Revisional Bariatric Surgery in a MBSAQIP Accredited High-Volume Center. Front Surg 2022; 9:880044. [PMID: 35433802 PMCID: PMC9010615 DOI: 10.3389/fsurg.2022.880044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background With the rising number of bariatric surgeries performed annually, there has also been an increase in revisional bariatric surgeries (RBS). The aim of this study is to evaluate the safety and postoperative outcomes of RBS performed with a minimally invasive approach. Methods Retrospective analysis on a prospectively collected database of patients who underwent minimally invasive RBS between 2012 and 2019. Primary endpoints were conversion rate, major morbidity, mortality, and 30-day reoperation rate. Comparative analysis of laparoscopic adjustable gastric banding (LAGB) conversion to sleeve gastrectomy (SG) vs. conversion to Roux-en-Y gastric bypass (RYGB) was performed. Results A total of 221 patients underwent minimally invasive RBS, 137 (62%) laparoscopically and 84 (38%) robotically. The most common RBS were LAGB to SG (59.3%) and LAGB to RYGB conversions (16.7%). The main indication was weight loss failure (88.7%). Conversion rate, major morbidity, and mortality were 0.9, 3.2, and 0.4%, respectively. Urgent reoperation was required in 3.2% of cases. Total weight loss at 1 and 2-years follow- were 14.3 and 17.3%, respectively. Comparative analysis of LAGB conversion to SG vs. RYGB showed similar major morbidity (SG: 2.3% vs. RYGB 0%, p = 1). Greater total weight loss was achieved in LAGB to RYGB conversions at 1-year (SG: 14.8% vs. RYGB 25.3%, p < 0.001). Conclusions Minimally invasive RBS can be performed safely in a broad patient population with low conversion and complication rates, and improved weight loss outcomes. LAGB to RYGB conversions are associated with greater weight loss. Further randomized trials are needed to draw more conclusive recommendations.
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Kamocka A, Parmar C, Kurzatkowski K, Chidambaram S, Goh EL, Erridge S, Small P, Purkayastha S, McGlone ER, Khan O. Outcomes of bariatric surgery in extreme obesity: results from the United Kingdom National Bariatric Surgery Registry for patients with a body mass index >70 kg/m 2. Surg Obes Relat Dis 2021; 17:1732-1738. [PMID: 34266776 DOI: 10.1016/j.soard.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/29/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bariatric and metabolic surgery (BMS) is an established safe, effective, and durable treatment for obesity and its complications. However, there is still a paucity of evidence on surgery outcomes in patients suffering from extreme obesity. OBJECTIVES This study aimed to evaluate outcomes of BMS in weight loss and the resolution of co-morbidities in patients with a body mass index (BMI) ≥70kg/m2. SETTING National Health Service and private hospitals in the United Kingdom. METHODS This cohort study analyzed prospectively collected records from the UK National Bariatric Surgery Registry of patients with a BMI ≥70 kg/m2 undergoing Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or adjustable gastric band (AGB) between January 2009 and June 2014. RESULTS There were 230 patients (64% female) eligible for inclusion in the study: 22 underwent AGB; 102 underwent SG, and 106 underwent RYGB. Preoperative weight and BMI values were comparable (76 ± 7 kg/m2 for AGB; 75 ± 5 kg/m2 for SG; 74 ± 5 kg/m2 for RYGB). The median postoperative follow-up was 13 months for AGB (10-22 mo), 18 for SG (6-28 mo), and 15 for RYGB (6-24 mo). Patients undergoing RYGB and SG exhibited the greatest postoperative total body weight loss (35 ± 13% and 31 ± 15%, respectively; P = .14), which led to postoperative BMIs of 48 ± 10 kg/m2 and 51 ± 11 kg/m2, respectively (P = .14). All procedures conferred a reduction in the incidence of co-morbidities, including type 2 diabetes, and led to improved functional statuses. The overall complication rate was 7%, with 3 deaths (1%) within 30 days of surgery. CONCLUSION This study found that primary BMS in patients with a BMI >70kg/m2 has an acceptable safety profile and is associated with good medium-term clinical outcomes. RYGB and SG are associated with better weight loss and great improvements in co-morbidities than AGB. Given the noninferiority of SG outcomes and SG's potential for further conversion to other BMS procedures if required, SG may be the best choice for primary BMS in patients with extreme obesity.
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Affiliation(s)
- Anna Kamocka
- Department of Metabolism, Digestion and Reproduction, Hammersmith Hospital, Imperial College London, London, United Kingdom.
| | - Chetan Parmar
- Department of Upper Gastrointestinal and Bariatric Surgery, The Whittington Hospital NHS Trust, London, United Kingdom
| | | | | | - En Lin Goh
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Simon Erridge
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Peter Small
- Department of Bariatric Surgery, Sunderland Royal Hospital, Kayll Road, Sunderland, London, United Kingdom
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Emma Rose McGlone
- Department of Metabolism, Digestion and Reproduction, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Omar Khan
- Department of Bariatric Surgery, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
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Schwartz RL, Sill AM, Averbach A. Is Staple Line Reinforcement Necessary in Conversion From Laparoscopic Adjustable Band to Laparoscopic Sleeve Gastrectomy? Obes Surg 2021; 31:4070-4075. [PMID: 34184185 DOI: 10.1007/s11695-021-05532-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/13/2021] [Accepted: 06/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Once a common bariatric procedure, laparoscopic adjustable gastric band (LAGB) is more frequently the subject of conversion procedures, particularly to laparoscopic sleeve gastrectomy (LSG), due to failure of weight loss, weight regain, and band intolerance. Staple line reinforcement (SLR) in primary LSG has been studied extensively, but has not been evaluated in revision procedures. The aim of this study is to investigate commonly used SLR techniques and their effects on morbidity and mortality in single-stage bands converted to sleeves. METHODS The Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program (MBSAQIP) Participant Use Data Files (PUF) for 2015-2016 were utilized to assess data for single-stage bands converted to sleeves based on CPT codes, and records were stratified by technique of staple line reinforcement. The database contained all the defined variables utilized for analysis with the exception of leak rate and overall morbidity, which had to be derived. Thirty-day outcomes were analyzed using multiple bivariate analyses and Bonferroni corrections were applied. RESULTS Of the 6,286 patients who underwent single-stage bands converted to sleeves for whom SLR data is available, 56.9% of surgeons utilized SLR only, 21.3% chose no reinforcement technique (No SLR), 13.4% chose SLR plus over-sewing of the staple line (SLR+OSL), and 8.4% chose OSL alone. There were no statistically significant differences in rates of death, reoperation, readmission, reintervention, number of bleeding events, and staple line leaks across groups. CONCLUSION Choice of SLR does not affect number of bleeding events or staple line leak rate.
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Affiliation(s)
- Rebecca L Schwartz
- Department of Surgery, Ascension Saint Agnes Hospital, 900 Caton Avenue, Baltimore, MD, 21229, USA.
| | - Anne M Sill
- Department of Surgery, Ascension Saint Agnes Hospital, 900 Caton Avenue, Baltimore, MD, 21229, USA
| | - Andrew Averbach
- Department of Surgery, Ascension Saint Agnes Hospital, 900 Caton Avenue, Baltimore, MD, 21229, USA
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Petrucciani N, Etienne JH, Sebastianelli L, Iannelli A. Roux-en-Y gastric bypass as revisional surgery. Minerva Surg 2021; 76:8-16. [PMID: 33754587 DOI: 10.23736/s2724-5691.20.08493-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Roux-en-Y gastric bypass (RYGB) is a worldwide-performed procedure as primary surgery, and as conversional procedure after complications and/or failure of other bariatric procedures. RYGB can be performed as revisional surgery after adjustable gastric banding, vertical banded gastroplasty, sleeve gastrectomy and one anastomosis gastric bypass. Each of these revisional procedures may be technically challenging, and accurate preoperative work-up and operative planning is required. If correctly performed, RYGB as revisional procedure is associated with satisfying outcomes and is indicated in the treatment of insufficient weight loss and postoperative complications of a primary bariatric procedure - such as chronic leak or gastroesophageal reflux after sleeve gastrectomy. The present article analyzes the most important indications, technical points and tips and tricks to safely perform RYGB as a secondary procedure.
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Affiliation(s)
- Niccolò Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy
| | - Jean H Etienne
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.,Université Côte d'Azur, Nice, France
| | - Lionel Sebastianelli
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St. Andrea Hospital, Sapienza University, Rome, Italy.,Université Côte d'Azur, Nice, France
| | - Antonio Iannelli
- Université Côte d'Azur, Nice, France - .,Unit of Digestive Surgery and Liver Transplantation, University Hospital of Nice, Nice, France.,Inserm U1065, Nice, France
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Fiorani C, Coles SR, Kulendran M, McGlone ER, Reddy M, Khan OA. Long-Term Quality of Life Outcomes After Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass-a Comparative Study. Obes Surg 2021; 31:1376-1380. [PMID: 33064260 PMCID: PMC7920888 DOI: 10.1007/s11695-020-05049-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have been shown to improve metabolic comorbidities as well as quality of life (QoL) in the obese population. The vast majority of previous studies have investigated the metabolic effects of bariatric surgery and there is a dearth of studies examining long-term QoL outcomes post bariatric surgery. The outcomes of 43 patients who underwent bariatric surgery were prospectively assessed, using BAROS questionnaires to quantify QoL and metabolic status pre-operatively, at 1 year and at 8 years. Total weight loss and comorbidity resolution were similar between RYGB and SG. The RYGB cohort experienced greater QoL improvement from baseline and had higher BAROS scores at 8 years. RYGB may provide more substantial and durable long-term benefits as compared to SG.
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Affiliation(s)
- Cristina Fiorani
- St George’s University Hospital, Blackshaw Road Tooting,, London, SW17 0QT UK
| | - Sophie R. Coles
- St George’s University Hospital, Blackshaw Road Tooting,, London, SW17 0QT UK
| | - Myutan Kulendran
- St George’s University Hospital, Blackshaw Road Tooting,, London, SW17 0QT UK
| | - Emma Rose McGlone
- St George’s University Hospital, Blackshaw Road Tooting,, London, SW17 0QT UK
| | - Marcus Reddy
- St George’s University Hospital, Blackshaw Road Tooting,, London, SW17 0QT UK
| | - Omar A. Khan
- St George’s University Hospital, Blackshaw Road Tooting,, London, SW17 0QT UK
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McGlone ER, Carey I, Veličković V, Chana P, Mahawar K, Batterham RL, Hopkins J, Walton P, Kinsman R, Byrne J, Somers S, Kerrigan D, Menon V, Borg C, Ahmed A, Sgromo B, Cheruvu C, Bano G, Leonard C, Thom H, le Roux CW, Reddy M, Welbourn R, Small P, Khan OA. Bariatric surgery for patients with type 2 diabetes mellitus requiring insulin: Clinical outcome and cost-effectiveness analyses. PLoS Med 2020; 17:e1003228. [PMID: 33285553 PMCID: PMC7721482 DOI: 10.1371/journal.pmed.1003228] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 10/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Although bariatric surgery is well established as an effective treatment for patients with obesity and type 2 diabetes mellitus (T2DM), there exists reluctance to increase its availability for patients with severe T2DM. The aims of this study were to examine the impact of bariatric surgery on T2DM resolution in patients with obesity and T2DM requiring insulin (T2DM-Ins) using data from a national database and to develop a health economic model to evaluate the cost-effectiveness of surgery in this cohort when compared to best medical treatment (BMT). METHODS AND FINDINGS Clinical data from the National Bariatric Surgical Registry (NBSR), a comprehensive database of bariatric surgery in the United Kingdom, were extracted to analyse outcomes of patients with obesity and T2DM-Ins who underwent primary bariatric surgery between 2009 and 2017. Outcomes for this group were combined with data sourced from a comprehensive literature review in order to develop a state-transition microsimulation model to evaluate cost-effectiveness of bariatric surgery versus BMT for patients over a 5-year time horizon. The main outcome measure for the clinical study was insulin cessation at 1-year post-surgery: relative risks (RR) summarising predictive factors were determined, unadjusted, and after adjusting for variables including age, initial body mass index (BMI), duration of T2DM, and weight loss. Main outcome measures for the economic evaluation were total costs, total quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) at willingness-to-pay threshold of GBP£20,000. A total of 2,484 patients were eligible for inclusion, of which 1,847 had 1-year follow-up data (mean age of 51 years, mean initial BMI 47.2 kg/m2, and 64% female). 67% of patients no longer required insulin at 1-year postoperatively: these rates persisted for 4 years. Roux-en-Y gastric bypass (RYGB) was associated with a higher rate of insulin cessation (71.7%) than sleeve gastrectomy (SG; 64.5%; RR 0.92, confidence interval (CI) 0.86-0.99) and adjustable gastric band (AGB; 33.6%; RR 0.45, CI 0.34-0.60; p < 0.001). When adjusted for percentage total weight loss and demographic variables, insulin cessation following surgery was comparable for RYGB and SG (RR 0.97, CI 0.90-1.04), with AGB having the lowest cessation rates (RR 0.55, CI 0.40-0.74; p < 0.001). Over 5 years, bariatric surgery was cost saving compared to BMT (total cost GBP£22,057 versus GBP£26,286 respectively, incremental difference GBP£4,229). This was due to lower treatment costs as well as reduced diabetes-related complications costs and increased health benefits. Limitations of this study include loss to follow-up of patients within the NBSR dataset and that the time horizon for the economic analysis is limited to 5 years. In addition, the study reflects current medical and surgical treatment regimens for this cohort of patients, which may change. CONCLUSIONS In this study, we observed that in patients with obesity and T2DM-Ins, bariatric surgery was associated with high rates of postoperative cessation of insulin therapy, which is, in turn, a major driver of overall reductions in direct healthcare cost. Our findings suggest that a strategy utilising bariatric surgery for patients with obesity and T2DM-Ins is cost saving to the national healthcare provider (National Health Service (NHS)) over a 5-year time horizon.
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Affiliation(s)
- Emma Rose McGlone
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Iain Carey
- Population Health Research Institute, St George’s Hospital, University of London, London, United Kingdom
| | - Vladica Veličković
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall in Tirol, Austria
| | - Prem Chana
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Kamal Mahawar
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Rachel L. Batterham
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
- UCL Centre for Obesity Research, Division of Medicine, Rayne Building, University College London, London, United Kingdom
- National Institute of Health Research, UCLH Biomedical Research Centre, London, United Kingdom
| | - James Hopkins
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Peter Walton
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Robin Kinsman
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - James Byrne
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Shaw Somers
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - David Kerrigan
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Vinod Menon
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Cynthia Borg
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Ahmed Ahmed
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Bruno Sgromo
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Chandra Cheruvu
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Gul Bano
- St George’s Hospital, London, United Kingdom
| | - Catherine Leonard
- Medtronic Ltd, Croxley Green Business Park, Hatters Lane, Watford, United Kingdom
| | - Howard Thom
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Marcus Reddy
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Richard Welbourn
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Peter Small
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Omar A. Khan
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
- Population Health Research Institute, St George’s Hospital, University of London, London, United Kingdom
- St George’s Hospital, London, United Kingdom
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Wu C, Song M. In Reply to the Letter to the Editor Concerning: Clinical Outcomes of Sleeve Gastrectomy Versus Roux-En-Y Gastric Bypass After Failed Adjustable Gastric Banding. Obes Surg 2020; 30:3208-3209. [PMID: 32399848 DOI: 10.1007/s11695-019-04196-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Chang Wu
- Department of General Surgery, Tiantan Hospital, Capital Medical University, No.119, South West Ring Road, Fengtai District, Beijing, China
| | - Maomin Song
- Department of General Surgery, Tiantan Hospital, Capital Medical University, No.119, South West Ring Road, Fengtai District, Beijing, China.
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Clinical Outcomes of Sleeve Gastrectomy Versus Roux-En-Y Gastric Bypass After Failed Adjustable Gastric Banding. Obes Surg 2020; 29:3252-3263. [PMID: 31292884 DOI: 10.1007/s11695-019-03988-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Over recent decades, laparoscopic adjustable gastric banding (LAGB) has been among the most common bariatric surgeries. Nowadays, many patients require revision surgery due to insufficient weight loss and band-related complications. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the two most common revision surgeries for failed LAGB, but the conclusions about their efficacy and safety have been inconsistent. This meta-analysis aimed to review the clinical outcomes of SG and RYGB after failed LAGB. METHODS In accordance with the PRISMA guidelines, the PubMed, Embase, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched for articles that had studied the efficacy and safety of SG and RYGB. The most appropriate effects model was chosen based on the heterogeneity of the articles included in this meta-analysis. Statistical analysis was conducted using Stata 14.0. RESULTS Of 586 articles that were retrieved, 16 articles which examined 2141 SG and 2990 RYGB patients met the inclusion criteria. The patients in RYGB groups showed increased percent excess weight loss (%EWL) at 12 and 24 months after revision surgery but no statistically significant change was found about %EWL after 3, 6, or 36 months. In addition, RYGB was associated with a higher rate of complications, interventions, and readmission in addition to being of more operative time. CONCLUSIONS This review suggested that RYGB was more effective at demonstrating weight loss after 12 and 24 months, but comparisons of the long-term efficacy of RYGB with that of SG remain inconclusive. In addition, RYGB was accompanied by a greater number of post-operative complications, interventions, and readmissions. Thus, surgeons should consider the overall status of the patients and their comorbidities as crucial factors when selecting a form of revision surgery. Additional high-quality randomized controlled studies are required to further compare the efficacy and safety of these treatments with longer follow-up times.
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Conversion from laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) to one anastomosis gastric bypass (OAGB): preliminary data from a multicenter retrospective study. Surg Obes Relat Dis 2019; 15:1332-1339. [PMID: 31272866 DOI: 10.1016/j.soard.2019.05.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/19/2019] [Accepted: 05/19/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure, while laparoscopic adjustable gastric banding (LAGB) has been for a decade one of the most popular interventions for weight loss. After LSG and LAGB, some patients may require a second surgery due to weight regain or late complications. One anastomosis gastric bypass (OAGB) is a promising bariatric procedure, which provides effective long-term weight loss and has a favorable effect on type 2 diabetes. OBJECTIVES To retrospectively analyze data from 10 Italian centers on conversion from LAGB and LSG to OAGB. SETTING High-volume centers for bariatric surgery. METHODS Prospectively collected data from 10 high-volume centers were retrospectively reviewed. Body mass index (BMI), percentage of excess BMI loss, reasons for redo, remission from co-morbidities (hypertension, diabetes, gastroesophageal reflux, and dyslipidemia), and major complications were recorded. RESULTS Three hundred patients were included in the study; 196 patients underwent conversion from LAGB to OAGB and 104 were converted from LSG. BMI was 45.1 ± 7 kg/m2 at the time of first intervention, 41.8 ± 6.3 kg/m2 at redo time, and 30.5 ± 5.5 kg/m2 at last follow-up appointment. Mean percentage of excess BMI loss was 13.2 ± 28.2 at conversion and 73.4 ± 27.5 after OAGB. Remission rates from hypertension, diabetes, gastroesophageal reflux, and dyslipidemia were 40%, 62.5%, 58.7% and 52%, respectively. Mean follow-up was 20.8 (range, 6-156) months and overall complications rate was 8.6%. CONCLUSION Our data show that OAGB is a safe and effective revisional procedure after failed restrictive bariatric surgery.
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Dear Editor. Surg Obes Relat Dis 2018; 14:1789-1790. [PMID: 30509360 DOI: 10.1016/j.soard.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 11/23/2022]
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Magouliotis DE, Tasiopoulou VS, Zacharoulis D. Comment on: Single-stage conversions from failed gastric band to sleeve gastrectomy versus Roux-en-Y gastric bypass: a closer look. Surg Obes Relat Dis 2018; 14:1788. [PMID: 30205940 DOI: 10.1016/j.soard.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Dimitrios E Magouliotis
- Department of Surgery, University Hospital of Larissa, Biopolis, Larissa, Greece; Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Vasiliki S Tasiopoulou
- Department of Surgery, University Hospital of Larissa, Biopolis, Larissa, Greece; Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | - Dimitris Zacharoulis
- Department of Surgery, University Hospital of Larissa, Biopolis, Larissa, Greece; Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
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