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Hany M, Zidan A, Ibrahim M, Sabry A, Agayby ASS, Mourad M, Torensma B. Revisional One-Step Bariatric Surgical Techniques After Unsuccessful Laparoscopic Gastric Band: A Retrospective Cohort Study with 2-Year Follow-up. Obes Surg 2024; 34:814-829. [PMID: 38231451 PMCID: PMC10899297 DOI: 10.1007/s11695-023-07039-7] [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: 08/26/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) has high reported rates of revision due to poor weight loss (WL) and high complication rates. Yet, there is yet to be a consensus on the best revisional procedure after unsuccessful LAGB, and studies comparing different revisional procedures after LAGB are still needed. METHODS This was a retrospective cohort study that compared the outcomes of one-step revisional Roux-en-Y gastric bypass (rRYGB), one-anastomosis gastric bypass (rOAGB), or laparoscopic sleeve gastrectomy (rLSG) after LAGB. WL, complications, resolution of associated medical conditions, and food tolerance were assessed with a post hoc pairwise comparison one-way analysis of variance (ANOVA) throughout a 2-year follow-up. RESULTS The final analysis included 102 (rRYGB), 80 (rOAGB), and 70 (rLSG) patients. After 2 years, an equal percentage of excess weight loss was observed in rOAGB and rRYGB (both >90%; p=0.998), significantly higher than that in rLSG (83.6%; p<0.001). In our study, no leaks were observed. rRYGB had higher complication rates according to the Clavien-Dindo classification (10.8% vs. 3.75% and 5.7% in rOAGB and rLSG, respectively, p=0.754), and re-operations were not statistically significant. Food tolerance was comparable between rOAGB and rRYGB (p = 0.987), and both had significantly better food tolerance than rLSG (p<0.001). The study cohorts had comparable resolution rates for associated medical problems (p>0.60). CONCLUSION rOAGB and rRYGB had better outcomes after LAGB than rLSG regarding WL, feasibility, food tolerance, and safety. rOAGB had significantly higher rates of nutritional deficiencies.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
- Consultant of Bariatric Surgery at Madina Women's Hospital, Alexandria, Egypt.
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Ahmed Sabry
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ann Samy Shafiq Agayby
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt
| | - Mohamed Mourad
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Bart Torensma
- Clinical Epidemiologist, Leiden University Medical Center (LUMC), Leiden, the Netherlands
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Dang JT, Clapp B, Ahmad M, Ghanem OM, Parmar C, Kroh M, English W. One- versus two-stage conversions of adjustable gastric bands: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Surg Obes Relat Dis 2023; 19:735-741. [PMID: 37076320 DOI: 10.1016/j.soard.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/08/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Laparoscopic adjustable gastric bands (AGB) are converted at high rates to secondary bariatric procedures. The available literature on the safety of converting in 1- versus 2-stage processes has not included large databases. OBJECTIVE To evaluate the safety of a 1- versus 2-stage conversion of AGB. SETTING Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), United States. METHODS The MBSAQIP database for the years 2020 and 2021 was evaluated. One-stage AGB conversions were identified using Current Procedural Terminology codes and database variables. Multivariable analysis was performed to determine whether 1- or 2-stage conversions were associated with 30-day serious complications. RESULTS There were 12,085 patients who underwent conversion from previous AGB to sleeve gastrectomy (SG) (63.0%) or Roux-en-Y gastric bypass (RYGB) (37.0%), of whom 41.0% underwent conversion in 1 stage and 59.0% in 2 stages. Patients who underwent 2-stage conversions had higher body mass indexes. Rates of serious complications were higher for patients undergoing RYGB compared with SG (5.2% versus 3.3%, P < .001) but were similar between 1-stage and 2-stage conversions in both cohorts. In both cohorts, there were similar rates of anastomotic leaks, postoperative bleeding, reoperation, and readmissions. Mortality was rare and similar between conversion groups. CONCLUSIONS There was no difference in outcomes or complications in 30 days between 1- and 2-stage conversions of AGB to RYGB or SG. Conversions to RYGB have higher complication and mortality rates than to SG, but there was no statistically significant difference between staged procedures. One- and 2-stage conversions from AGB are equivalent in safety.
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Affiliation(s)
- Jerry T Dang
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Benjamin Clapp
- Department of Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Maria Ahmad
- Department of Surgery, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Omar M Ghanem
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, United Kingdom
| | - Matthew Kroh
- Digestive Disease & Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wayne English
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Dowgiałło-Gornowicz N, Janik M, Lech P, Kowalski G, Major P. Revisional bariatric surgery after adjustable gastric band: a multicenter Polish Revision Obesity Surgery Study (PROSS). BMC Surg 2023; 23:94. [PMID: 37081459 PMCID: PMC10120208 DOI: 10.1186/s12893-023-02002-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Adjustable gastric band (AGB) hadbeen the preferred treatment for morbid obesity because it is minimally invasive and reversible. But now it seems to be slowly becoming a historic procedure due to the disappointing effects. The aim of the study was to systematize and present the available data on revisional bariatric surgery (RBS) after AGB among Polish patients. METHODS It is a multicenter, retrospective analysis of patients undergoing laparoscopic RBS after AGB in 12 Polish bariatric centers. The database included patient demographics, comorbidities and surgical outcomes. RESULTS The group consisted of 234 patients who underwent AGB, which accounted for 29% of revisional cases recorded in the Polish Revisional Obesity Surgery Study (PROSS). 195 were women (83%), and 39 were men (17%). One hundred seventy-five patients after AGB experienced a weight regain (74.5%), 36 patients a gastric band slippage (15.0%), 14 patients had gastric band intolerance (6.0%). Types of RBS included 116 sleeve gastrectomies (SG) (49.4%), 86 Roux-en Y gastric by-passes (RYGB) (36.6%), 20 one anastomosis gastric by-passes (OAGB) (8,5%). The highest weight loss expressed as %EBMIL was observed after OAGB (63.5 ± 32.4%). CONCLUSIONS The main indication for RBS after AGB was weight regain. SG was the most frequently chosen type of RBS after AGB. RBS after AGB leads to weight loss and improvement in type 2 diabetes and hypertension with an acceptable low risk of complications. TRIAL REGISTRATION NCT05108532.
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Affiliation(s)
- Natalia Dowgiałło-Gornowicz
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
| | - Michał Janik
- Department of Surgery, Military Institute of Aviation Medicine, Warsaw, Poland
| | - Paweł Lech
- Department of General, Minimally Invasive and Elderly Surgery, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Cracow, Poland
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Hany M, Sayed IE, Zidan A, Ibrahim M, Agayby ASS, Torensma B. Propensity score matching analysis comparing outcomes between primary and revision Roux-en-Y gastric bypass after adjustable gastric banding: a retrospective record-based cohort study. Surg Endosc 2023; 37:1303-1315. [PMID: 36197519 PMCID: PMC9944734 DOI: 10.1007/s00464-022-09675-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/24/2022] [Indexed: 10/10/2022]
Abstract
BACKGROUND One-stage revision Roux-en-Y gastric bypass (RRYGB) after Laparoscopic adjustable gastric banding (LAGB) is widely adopted, but its safety is still debated. OBJECTIVE This study aimed to compare outcomes between primary Roux-en-Y gastric bypass (PRYGB and RRYGB after LAGB. METHOD A retrospective record-based cohort study of patients who underwent PRYGB and RRYGB for failed LAGB and completed at least 2 years of follow-up from 2008 to 2019. Propensity score matching (PSM) analysis was conducted to obtain a balanced sample of patients with RRYGB and PRYGB interventions by adjusting for baseline covariates including age and sex. RESULTS Patients with PRYGB (n = 558) and RRYGB (n = 156) were included. PSM identified 98 patients for RRYGB and 98 patients for PRYGB. Both cohorts exhibited significant reductions in BMI compared to baseline values (p < 0.001), but reductions were significantly higher in PRYGB compared to those in RRGYB at 6 months (- 10.55 ± 8.54 vs. - 8.38 ± 5.07; p = 0.032), 1-year (- 21.50 ± 8.19 vs. 16.14 ± 6.93; p < 0.001), and 2 years (- 24.02 ± 7.85 vs. - 18.93 ± 6.80; p < 0.001), respectively. A significant improvement in food tolerance from the 1st to the 2nd year was seen after RYGB (p < 0.001). The rates of early and late complications were similar in both cohorts (p = 0.537, p = 1.00). Overall re-intervention rates were 5.1 and 3.1% for RRYGB and PRYGB p = 0.721). Both cohorts exhibited significant improvement in comorbidities after 2 years (p < 0.001). CONCLUSIONS One-stage RRYGB for failed LAGB is safe and effective with comparable rates of complications, re-interventions, and resolution of associated comorbid conditions compared to PRYGB.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561, Egypt.
| | - Iman El Sayed
- grid.7155.60000 0001 2260 6941Biomedical Informatics and Medical Statistics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ahmed Zidan
- grid.7155.60000 0001 2260 6941Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561 Egypt
| | - Mohamed Ibrahim
- grid.7155.60000 0001 2260 6941Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561 Egypt
| | - Ann Samy Shafiq Agayby
- grid.7155.60000 0001 2260 6941Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, Alexandria, 21561 Egypt
| | - Bart Torensma
- grid.10419.3d0000000089452978Clinical Epidemiologist, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Perry ZH, Zioni T, Netz U, Avital I, Atias S, Chorny A, Kirshtein B. A Comparison of One- and Two-Stage Laparoscopic Sleeve Gastrectomy Following Failed Laparoscopic Adjustable Gastric Banding Using the BAROS Score. Obes Surg 2022; 32:1243-1250. [PMID: 35143013 DOI: 10.1007/s11695-022-05944-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Revision of a failed band can be done by laparoscopic sleeve gastrectomy (LSG). It can be performed synchronously with band removal or during two separate procedures. AIM Comparing single- and two-staged LSG following a failed LAGB in terms of short- and mid-term outcomes, with an emphasis on postoperative quality of life. METHODS A retrospective cohort study comparing revisional LSG's safety and efficacy after failed LAGB removal. Data included patients' medical files, as telephone interviews. We compared demographics, weight loss, complications, long-term outcomes, and quality-of-life measures, including the Bariatric Analysis and Reporting Outcome System (BAROS). RESULTS Ninety-three patients were enrolled, of which 68 (73.1%) underwent a single-stage revisional LSG. Of these, 40 were males (35.1%) with a mean age of 44.9 years (± 12.9). The two-staged group were older. The reasons for band removal differed between the groups: whereas in the two-stage surgery, the common causes were slippage (29.2%) or band intolerance (25%); in the single-stage group, it was weight gain (51%). There were no differences in short- and mid-term complications, weight loss, and quality of life. CONCLUSION In selected cases, laparoscopic sleeve gastrectomy as a revision of failed gastric banding in one stage is as safe as a two-stage procedure in terms of short- and mid-term complications, weight loss, and quality of life. We believe that there is little benefit in performing elective surgery in two stages unless there are clinical indications. Exceptions for two-stage revision should include cases of band erosion and acute slippage with patient preference for band removal.
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Affiliation(s)
- Zvi H Perry
- Department of Surgery A, Soroka University Medical Center, P.O Box 151, 64101, Beer Sheva, Israel.
| | - Tammy Zioni
- Department of Surgery, Assuta Medical Center, Ashdod, Israel
| | - Uri Netz
- Department of Surgery A, Soroka University Medical Center, P.O Box 151, 64101, Beer Sheva, Israel
| | - Itzhak Avital
- Department of Surgery A, Soroka University Medical Center, P.O Box 151, 64101, Beer Sheva, Israel
| | - Shahar Atias
- Department of Surgery A, Soroka University Medical Center, P.O Box 151, 64101, Beer Sheva, Israel
| | - Alexander Chorny
- Department of Ophthalmology, Soroka University Medical Center, Beer Sheva, Israel
| | - Boris Kirshtein
- Department of Surgery A, Soroka University Medical Center, P.O Box 151, 64101, Beer Sheva, Israel
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Petrucciani N, Martini F, Benois M, Kassir R, Boudrie H, Van Haverbeke O, Hamid C, Juglard G, Costa G, Debs T, Liagre A. Revisional One Anastomosis Gastric Bypass with a 150-cm Biliopancreatic Limb After Failure of Adjustable Gastric Banding: Mid-Term Outcomes and Comparison Between One- and Two-Stage Approaches. Obes Surg 2021; 31:5330-5341. [PMID: 34609712 PMCID: PMC8595146 DOI: 10.1007/s11695-021-05728-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/08/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Laparoscopic adjustable gastric banding (LAGB) was a common procedure worldwide but associated with a high rate of long-term failure. This study aims to evaluate the safety and effectiveness of conversion to one anastomosis gastric bypass (OAGB) after failed LAGB. MATERIALS AND METHODS We undertook a retrospective analysis of a prospectively maintained database in a tertiary referral center for bariatric surgery. All cases of revisional OAGB with a biliopancreatic limb (BPL) of 150 cm after failed LAGB performed between 2010 and 2016 were analyzed. RESULTS Overall, 215 patients underwent conversion from LAGB to OAGB. Indication for surgery was primary weight loss (WL) failure in 30.7% of cases and long-term complications in the remaining patients, with or without associated weight regain. At the time of OAGB, the mean age was 43.2 ± 10.5 years and the mean BMI was 42 ± 6.9. Overall postoperative morbidity was 13.5%. The postoperative abscess ± leak rate was 5.9% in the overall population. Two years after OAGB, 9.7% of patients were lost to follow-up, % excess weight loss (EWL) was 88.2 ± 23.9, and % total weight loss (TWL) was 38.7 ± 9.3. At 5 years, 16.6% of patients were lost to follow-up, %EWL was 82.4 ± 25, and %TWL was 36.1 ± 10. There was no statistical difference in complication rates or WL results between the one-stage and two-stage approaches. CONCLUSION OAGB with a 150-cm BPL represents a safe and effective option after failed LAGB. Both synchronous OAGB and two-step revisional OAGB guarantee satisfying results in terms of postoperative morbidity and WL outcomes.
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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, via di Grottarossa 1035-9, 00189, Rome, Italy.
| | - Francesco Martini
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Marine Benois
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Radwan Kassir
- Department of Digestive Surgery, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Hubert Boudrie
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Olivier Van Haverbeke
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Celine Hamid
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Gildas Juglard
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
| | - Gianluca Costa
- Division of General Surgery, Campus Bio-Medico Hospital, Rome, Italy
| | - Tarek Debs
- Division of Digestive Surgery and Liver Transplantation, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
| | - Arnaud Liagre
- Bariatric Surgery Unit, Clinique des Cedres, Ramsay Générale de Santé, Cornebarrieu, France
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Safety and effectiveness of 1-stage conversion of adjustable gastric band-to-sleeve gastrectomy: a single-institution case-control study. Surg Obes Relat Dis 2021; 18:95-101. [PMID: 34666948 DOI: 10.1016/j.soard.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients are increasingly referred for conversion of laparoscopic adjustable gastric band (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (SG). The safety of a 1- versus 2-stage approach to this revision is debated. OBJECTIVES We examined the safety and efficacy of 1-stage conversion of LAGB to SG at our institution. SETTING University hospital. METHODS An institutional database was used to retrospectively identify patients who underwent single-stage LAGB-to-SG conversion between 2010 and 2018. Patients were matched 1:1 for age, sex, and body mass index with primary SG patients during this same period. Primary endpoints were operative time, complication rate, length of hospital say, and weight loss 12 months from surgery. RESULTS Two-hundred and twenty-nine patients undergoing conversion of LAGB to SG were identified. Median postoperative length of hospital stay was 2 days. Two patients (.8%) developed surgical site infection. One patient (.4%) developed a postoperative myocardial infarction. There were 4 total readmissions (1.7%) and 1 reoperation within 30 days (.4%). There were no statistically significant differences in 30-day complication rates between groups. Weight loss at 12 months was significantly different: Median body mass index loss for conversion patients was 5.1 kg/m2 compared with 8.85 kg/m2 for patients in the primary SG group (P < .0001). CONCLUSION Single-stage conversion of LAGB to SG is safe and effective. Patients may not experience the same extent of weight loss as those with primary SG. Our findings represent the largest single-institutional experience to date and support a 1-stage approach whenever feasible.
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Stogryn S, Johnson GGRJ, Okrainec A, Jackson T, Vergis A. Outcomes from Explantation of Laparoscopic Adjustable Gastric Band: Experience from a Canadian Bariatric Center of Excellence. Obes Surg 2021; 31:4933-4938. [PMID: 34427867 DOI: 10.1007/s11695-021-05676-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Laparoscopic adjustable gastric banding (LAGB) has declined in popularity due to poor weight loss and high revision rates. The study aim was to evaluate complication rates following LAGB removals, including conversions to other bariatric procedures. MATERIALS AND METHODS This was a retrospective cohort study of patients who underwent LAGB removal, identified from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from the Toronto Western Hospital site. Patients were filtered using principal procedure and concurrent procedural terminology (CPT) codes. Patients converted to other bariatric procedures were also included. Outcomes were evaluated for 30-day morbidity, mortality, readmissions, and costs. RESULTS From 2012 to 2018, 93 patients met inclusion. 96.77% had elective surgery, and 3.23% were emergent. Thirty-day postoperative complication rate was 11.83%, with 4.30% readmissions and no deaths. Surgical site infections accounted for 81.82% of complications (54.55% superficial, 27.27% deep). Thirty-day complication rate for LAGB removal alone was 17.50% and 33.33% following emergent explantation. 56.99% LAGBs were converted to other bariatric procedures: 48.39% laparoscopic Roux-en-Y gastric bypass (LRYGB) and 8.6% sleeve gastrectomy (LSG). Conversion to LSG had a significantly higher 30-day complication rate (all Clavien-Dindo class I-II) compared to conversion to LRYGB (37.50% versus 2.22%, p < 0.009). Direct costs of LAGB explantation to the healthcare system were $665,443, amounting to $7,155 per patient. CONCLUSION Thirty-day complication rates for LAGB explantation and conversion to other bariatric procedures are significant and may be higher than previously reported for LAGB removal alone. Conversion to LSG may have the highest complication rate, amounting to significant costs.
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Affiliation(s)
- Shannon Stogryn
- Department of Surgery, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Garrett G R J Johnson
- Department of Surgery, Section of General Surgery, University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada.,Clinician Investigator Program, University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Allan Okrainec
- Department of Surgery, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Timothy Jackson
- Department of Surgery, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Ashley Vergis
- Department of Surgery, Section of General Surgery, University of Manitoba, 409 Tache Avenue, Winnipeg, MB, R2H 2A6, Canada. .,St. Boniface General Hospital, Z3039-409 Tache Avenue, Winnipeg, Manitoba, R2H 2A6, Canada.
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Super J, Charalampakis V, Tahrani AA, Kumar S, Bankenahally R, Raghuraman G, Jambulingam PS, Kelly J, Ammori BJ, Singhal R. Safety and feasibility of revisional bariatric surgery following Laparoscopic Adjustable Gastric Band - Outcomes from a large UK private practice. Obes Res Clin Pract 2021; 15:381-386. [PMID: 34147378 DOI: 10.1016/j.orcp.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Revisional bariatric surgery is unavoidable in a proportion of patients. Despite its need, the development of this speciality has been hampered by its complexity and preferred delivery in institutional set ups. Although primary bariatric surgery can be delivered in the private sector; safety and feasibility of revisional bariatric surgery remains unexplored in this setting. MATERIALS AND METHODS Patients undergoing revisional bariatric surgery following previous Laparoscopic Adjustable Gastric Band (LAGB) between 2008 and 2019 at a single private bariatric unit with a minimum follow up of at least 6 months were included. The primary aim was safety outcomes and 30-day morbidity. RESULTS 178 patients with BMI of 45.6 ± 8.2 kg/m2 underwent revisional bariatric surgery. One stage conversion was performed for 86.5% of the cases. At 9.5 ± 5.3 months follow up, BMI and percentage excess BMI loss were 31.8 ± 6.2 kg/m2 and 62.6 ± 40% respectively. There was no mortality, and the major complication rate was 2.8%. There was no statistically significant difference in the incidence of complications based on one-stage vs. two-stage conversion (p = 0.52). There were no differences in weight loss outcomes post-revisional surgery according to the indication for revision (p = 0.446) or weight loss following primary surgery (p = 0.12). CONCLUSION Revisional bariatric surgery can be delivered safely in the private sector with good outcomes. One-stage conversions are feasible and do not detrimentally affect the morbidity of the procedure or the weight loss outcomes. More importantly, success following revisional surgery is independent of the indication for revision and weight loss outcomes following primary surgery.
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Affiliation(s)
- Jonathan Super
- Department of Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, UK
| | - Vasileios Charalampakis
- Department of General and GI Surgery, Warwick Hospital, South Warwickshire NHS Foundation Trust, UK; Healthier Weight, UK
| | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; Diabetes and Weight Management, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Healthier Weight, UK
| | - Sajith Kumar
- Department of Anaesthesia, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Healthier Weight, UK
| | - Rajneesh Bankenahally
- Department of Anaesthesia, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Healthier Weight, UK
| | - Govindan Raghuraman
- Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital King's Lynn, UK; Healthier Weight, UK
| | - P S Jambulingam
- Department of Upper GI & Bariatric Surgery, Bedfordshire Hospitals NHS Foundation Trust, Luton and Dunstable University Hospital, UK; Healthier Weight, UK
| | - Jamie Kelly
- Dept. of Surgery, University Hospital Southampton, UK; Healthier Weight, UK
| | - Basil J Ammori
- Department of Surgery, Salford Royal Hospital, Manchester, UK; Burjeel Hospital, Abu Dhabi, United Arab Emirates; Healthier Weight, UK
| | - Rishi Singhal
- Department of Bariatric Surgery, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Healthier Weight, UK.
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Perry Z, Romano-Zelekha O, Sakran N, Avital I, Atias S, Netz U, Kirshtein B. Laparoscopic Sleeve Gastrectomy Following Failed Laparoscopic Adjustable Gastric Banding-a Comparison Between One- and two-Stage Procedures, an Israeli National Database Study. Obes Surg 2021; 31:2364-2372. [PMID: 33660151 DOI: 10.1007/s11695-021-05312-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE The optimal revisional bariatric surgery procedure following a previous failed gastric band surgery is yet to be determined. The aim of our study was to compare single- and two-stage laparoscopic sleeve gastrectomy (LSG) following laparoscopic adjustable gastric banding (LAGB) in terms of short- and mid-term outcomes. MATERIALS AND METHODS Patients who underwent LSG after a failed LAGB in Israel during 2014-2017 were included. Data were obtained from the Israeli National Bariatric Surgery Registry. Data analyzed included comorbidities, postoperative complications, and anthropometric outcomes. RESULTS Of 595 patients included in the data analysis, 381 (64%) underwent one-stage and 214 (36%) had two-stage LSG. No differences were observed between the groups in complication rates (5.0 vs. 5.1%, p=0.93). Percent of total weight loss was lower following one-stage than two-stage procedure at both 6 months (19.3±9.3 vs. 21.5±8.1%; p=0.02) and 1 year postoperative (24.9±10.4 vs. 27.8±9.9%; p=0.02). No difference was observed in the percent excess weight loss (51 vs. 56%; p=0.34 and 66 vs. 72%; p=0.38, at 6 months and 12 months postoperative, respectively). In a regression analysis, percent excess weight loss was greater in the two-stage procedure (p=0.02), with no difference in the complication rates (p=0.98). CONCLUSION Single-step LSG had a similar safety profile as two-stage LSG following a failed LAGB. Better weight loss was seen following two-stage LSG. Further prospective studies should investigate long-term follow-up after one- and two-stage procedure.
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Affiliation(s)
- Zvi Perry
- Department of Surgery A, Soroka University Medical Center, P.O Box 151, 64101, Beer-Sheva, Israel.
| | | | - Nasser Sakran
- Departments of Surgery A, Emek Medical Center, Afula, Israel.,Technion - Israel Institute of Technology, Haifa, Israel
| | - Itzhak Avital
- Department of Surgery A, Soroka University Medical Center, P.O Box 151, 64101, Beer-Sheva, Israel
| | - Shahar Atias
- Department of Surgery A, Soroka University Medical Center, P.O Box 151, 64101, Beer-Sheva, Israel
| | - Uri Netz
- Department of Surgery A, Soroka University Medical Center, P.O Box 151, 64101, Beer-Sheva, Israel
| | - Boris Kirshtein
- Department of Surgery A, Soroka University Medical Center, P.O Box 151, 64101, Beer-Sheva, Israel
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Gagner M. Comment on: Safety of adjustable gastric band conversion surgery: a systematic review and meta-analysis of the leak rate in 1- and 2-stage procedures. Surg Obes Relat Dis 2020; 16:e27-e28. [PMID: 32075779 DOI: 10.1016/j.soard.2020.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/12/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Michel Gagner
- Herbert Wertheim School of Medicine, Florida International University, Miami, Florida; Hôpital du Sacre Coeur, Montreal, Canada
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