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Carbonaro J, McLaughlin T, Seip R, Staff I, Wu Y, Santana C, Bond D, Tishler D, Benbrahim A, Papasavas P. Five-year outcomes of revisional bariatric surgery: gastric band to sleeve gastrectomy or to Roux-en-Y gastric bypass. Surg Endosc 2024:10.1007/s00464-024-10764-4. [PMID: 38532050 DOI: 10.1007/s00464-024-10764-4] [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: 10/11/2023] [Accepted: 02/21/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Revisional bariatric surgery after an index adjustable gastric band (AGB) may be indicated to remedy weight relapse or band-related complications. We examined outcomes five years following revision from AGB to laparoscopic sleeve gastrectomy (AGB-LSG) or to Roux-en-Y gastric bypass (AGB-RYGB). METHODS We conducted a retrospective review to identify patients (men and women, age 18-80) who underwent one revisional bariatric procedure with AGB as the index procedure at two medical centers in our healthcare system between January 2012 and February 2017. We only included patients with a pre-revision BMI > 30 kg/m2 for whom 5-year follow-up data were available. We compared 5-year weight loss and remission of comorbidities in patients undergoing AGB-LSG and AGB-RYGB conversion. RESULTS A total of 114 patients met inclusion criteria (65 AGB-LSG, 49 AGB-RYGB). At 5-year post-revision, percent total weight loss (3.4% vs 19.9%; p < 0.001), percent excess weight loss (7.0% vs 50.8%; p < 0.001) and decrease in BMI (1.5 vs 8.8; p < 0.001) was greater in AGB-RYGB vs. AGB-LSG. No significant difference in remission or development of new comorbidities was observed. CONCLUSION Conversion of AGB to RYGB is associated with superior intermediate-term weight loss compared to conversion of AGB to LSG. Future multicenter studies with larger sample sizes are necessary to further describe the intermediate-term outcomes of revisional bariatric surgery.
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Affiliation(s)
- Joseph Carbonaro
- Hartford Healthcare Surgical Weight Loss Center, Hartford, CT, 06102, USA
| | - Tara McLaughlin
- Department of Surgery, Hartford Hospital, Hartford, CT, 06102, USA
| | - Richard Seip
- Hartford Healthcare Surgical Weight Loss Center, Hartford, CT, 06102, USA
| | - Ilene Staff
- Hartford Healthcare Research Program, Hartford, CT, 06102, USA
| | - Yin Wu
- Hartford Healthcare Research Program, Hartford, CT, 06102, USA
| | - Connie Santana
- Hartford Healthcare Surgical Weight Loss Center, Hartford, CT, 06102, USA
| | - Dale Bond
- Hartford Healthcare Research Program, Hartford, CT, 06102, USA
| | - Darren Tishler
- Hartford Healthcare Surgical Weight Loss Center, Hartford, CT, 06102, USA
| | - Aziz Benbrahim
- Medical Group Department of Bariatrics, Hartford Healthcare, Meriden, CT, 06450, USA
| | - Pavlos Papasavas
- Hartford Healthcare Surgical Weight Loss Center, Hartford, CT, 06102, USA.
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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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Handojo K, Ismaeil A, Van Huele A, Van Neste C, Debergh I, Dillemans B. Roux-en-Y Gastric Bypass as Conversion Procedure of Failed Gastric Banding: Short-Term Outcomes of 1295 Patients in One Single Center. Obes Surg 2023; 33:2963-2972. [PMID: 37548925 PMCID: PMC10514178 DOI: 10.1007/s11695-023-06746-5] [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: 02/19/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Laparoscopic adjustable gastric band (LAGB) has high technical and weight loss failure rates. We evaluate here the 1-year morbidity, mortality, and weight loss of laparoscopic Roux-en-Y-gastric bypass (LRYGB) as a feasible conversion strategy. METHODS Patients with a failed primary LAGB who underwent LRYGB from July 2004 to December 2019 were selected from an electronic database at our center. Patients had a conversion to LRYGB at the same time (one-stage approach) or with a minimum of 3 months in between (two-stage approach). Primary outcomes included 30-day morbidity and mortality. Secondary outcomes were body mass index (BMI), percent excess weight loss (%EWL), and percent excess BMI lost (%EBMIL) at 1 year postoperatively. RESULTS A total of 1295 patients underwent a conversion from LAGB to LRYGB at our center: 1167 patients (90.1%) in one stage and 128 patients (9.9%) in two stages. There was no mortality. An early (30-day) postoperative complication occurred in 93 patients (7.2%), with no significant difference found between groups. Hemorrhage was the most common complication in 39 patients (3.0%), and the reoperation was required in 19 patients (1.4%). At 1 year postoperatively, the mean BMI was 28.0 kg/m2, the mean %EWL 72.8%, and the mean %EBMIL 87.0%. No statistically significant difference was found between the groups. CONCLUSION Conversion to LRYGB can be considered as a safe and effective option with low complication rate and good weight loss outcomes at 1 year. One-stage conversion provides the same early outcome as two-step surgery with a competent surgeon.
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Affiliation(s)
- Karen Handojo
- Department of General Surgery, AZ Sint Jan Brugge-Oostende AV, Campus Henri Serruys, 8400 Oostende, Belgium
| | - Aiman Ismaeil
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of General Surgery, Faculty of Medicine, Aswan University, Aswan, 81528 Egypt
| | - Andries Van Huele
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Isabelle Debergh
- Department of General Surgery, AZ Delta Hospital, Sint-Rembertlaan 21, 8820, Torhout, Belgium
| | - Bruno Dillemans
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
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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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Park YS. Revisional Surgery After Adjustable Gastric Banding: Sleeve Gastrectomy or Gastric Bypass? JOURNAL OF METABOLIC AND BARIATRIC SURGERY 2022; 11:49-53. [PMID: 36926677 PMCID: PMC10011676 DOI: 10.17476/jmbs.2022.11.2.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
Adjustable gastric banding was the most common type of bariatric surgery performed in Korea prior to 2019. Many patients that have undergone this procedure require revisional bariatric surgery while removing the gastric band, and it is important to select an appropriate revisional procedure. If reoperation is performed owing to insufficient weight loss or weight regain, a 1-step procedure can be considered. However, a 2-step procedure is preferred when complications such as band erosion or stomach perforation have occurred. Previous studies from Western countries have shown that revisional Roux-en-Y gastric bypass (RYGB) can achieve more effective postoperative weight loss than revisional sleeve gastrectomy, although this procedure may also carry a higher risk of morbidity, reoperation, and readmission to hospital. In Korea, the short-term outcomes of the 2 procedures may be similar. However, the potential risk of gastric cancer in the remnant stomach after RYGB must also be considered. The type of revisional surgery should be selected following discussions with the patient regarding the advantages and disadvantages associated with each procedure.
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Affiliation(s)
- Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Hornock S, Grasso S, Hamdan M, Bader J, Ahnfeldt E, Clapp B. Does endoscopy at the time of revisional bariatric surgery decrease complication rates? an analysis of the NSQIP database. Surg Endosc 2022:10.1007/s00464-022-09648-2. [PMID: 36315283 DOI: 10.1007/s00464-022-09648-2] [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: 04/24/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Endoscopy is performed routinely during bariatric surgery. It is often used for provocative testing and intraluminal inspection during Roux-en-Y gastric bypass (RNYGB) and sleeve gastrectomy (SG). Recent publications would indicate about one-quarter of bariatric cases are performed with concurrent endoscopy, resulting in a slight increase in time but no increase in complications within 30 days compared with cases where no endoscopy is performed. Do these results persist for endoscopy during revisional bariatric surgery (RBS)? METHODS An analysis of the American College of Surgeons National Surgical Quality Initiative Program (NSQIP) was conducted for the years 2005-2017. Seventeen postoperative outcomes were analyzed in this database. A 1:1 propensity score matching analysis was completed for 13 patient comorbidities and demographics. A McNemar's test for paired categorical variables and a paired t-test for continuous variables were completed, with a significant P value of 0.05. The results were reported as the frequency and percentage for categorical variables and the mean (± standard deviation) for continuous variables. RESULTS A total of 7249 RBS cases were identified. After propensity score matching for patient comorbidities and demographics 2329 cases remained. Esophagogastroduodenoscopy (EGD) was performed in 375 (16%) of these patients. There were no differences in complication rates between the two groups. CONCLUSIONS Similar to non-revisional bariatric surgery, there is no difference in 30-day postoperative complications when endoscopy is performed in RBS. Endoscopy is performed in about one-sixth of RBS cases.
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Affiliation(s)
- Sasha Hornock
- Department of Surgery, William Beaumont Army Medical Center, 18511 Highlander Medics St., El Paso, TX, 79918, USA.
| | - Samuel Grasso
- Department of Surgery, William Beaumont Army Medical Center, 18511 Highlander Medics St., El Paso, TX, 79918, USA
| | - Marah Hamdan
- Department of Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Julia Bader
- Department of Surgery, William Beaumont Army Medical Center, 18511 Highlander Medics St., El Paso, TX, 79918, USA
| | - Eric Ahnfeldt
- Department of Surgery, Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Benjamin Clapp
- Department of Surgery, Texas Tech Health Sciences Center, El Paso, TX, USA
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Bariatric Surgery Conversions in MBSAQIP Centers: Current Indications and Outcomes. Obes Surg 2022; 32:3248-3256. [PMID: 35918597 DOI: 10.1007/s11695-022-06229-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The demand for revisional bariatric surgery has increased, and bariatric conversions (BC) to a different procedure represent most of the revisional cases. The 2020 Metabolic and Bariatric Surgery Accreditfnation and Quality Improvement Program (MBSAQIP) database was expanded to include additional variables on BC. This study aims to analyze the indications and outcomes of BC. METHODS A retrospective analysis of the 2020 MBSAQIP database was performed. Patients who underwent BC were included in the analysis. Index procedures, rates, and indications for BC of the different bariatric operations were described. Outcomes of the most frequent BC were analyzed. RESULTS A total of 168,548 bariatric surgeries were done; 20,387 (12.1%) were revisional, and from those 15,031 (73.7%) were BC. The most converted index operations were sleeve gastrectomy (SG) (49.3%) and adjustable gastric banding (AGB) (45.9%). The most frequent conversions were SG to Roux-en-Y gastric bypass (RYGB) (40.3%) for gastroesophageal reflux disease (GERD) (54.2%) and weight loss failure (WLF) (35.8%), AGB to SG (27%) or RYGB (16.2%) for WLF (67% and 61.3%, respectively), and SG to biliopancreatic diversion with duodenal switch (3.2%) or single anastomosis duodeno-ileal bypass (2%) for WLF (91.2% and 92.4%, respectively). Postoperative overall morbidity, serious morbidity, reoperation, and mortality rates ranged from 5.3 to 20.8%, 2.3 to 19.2%, 1.5 to 10%, and 0 to 0.8%, respectively. CONCLUSIONS BC represents the most frequent revisional bariatric procedure. GERD and WLF are the main causes for BC. Further research is needed to define the ideal BC according to the index procedure and indication.
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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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Abstract
BACKGROUND The MBSAQIP has been used to evaluate risk and create risk models. Previous studies have determined what complications matter most. STUDY DESIGN This study was a registry-based analysis of patients who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) between January 1, 2015, and December 31, 2019, at centers participating in MBSAQIP. Cases were identified using Current Procedural Terminology. Patients less than 18 years old were excluded. A chi-square test was used to assess differences in the prevalence of complications and effects across years. Using a multivariable Poisson regression model with a link log and robust estimation, prevalence ratio estimates and 95% CI were obtained. RESULTS A total of 690,770 observations met the inclusion criteria. Mean (SD) age was 44.5 (±12.0) years, and mean (SD) BMI was 45.2 kg/m2 (±7.9). SG cases accounted for 73.45% of all observations. There was a significant relative reduction in readmissions, end-organ dysfunction, and all-cause mortality from 2015 to 2019 in the SG subgroup. There were also noticeable reductions in 30-day readmission, ICU admission, and end-organ dysfunction in the RYGB subgroup. For complications, bleeding, postoperative pneumonia, and stroke were significantly decreased in the RYGB subgroup, but only bleeding was significantly decreased in the SG subgroup during the 5-year study period. CONCLUSIONS There has been a continuous improvement in several (but not all) outcomes through the years that the MBSAQIP has been collecting data. Different outcomes were reduced between the SG and RYGB subgroups, and the decrease in all-cause mortality was only noted in the SG subgroup.
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Akpinar EO, Nienhuijs SW, Liem RS, Greve JWM, Marang- van de Mheen PJ. Conversion to RYGB versus OAGB after a failed primary gastric band: matched nationwide study. Surg Obes Relat Dis 2022; 18:948-956. [DOI: 10.1016/j.soard.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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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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Thaher O, Driouch J, Hukauf M, Köckerling F, Stroh C. Feasibility and Short-Term Outcomes of One-Step and Two-Step Sleeve Gastrectomy as Revision Procedures for Failed Adjustable Gastric Banding Compared With Those After Primary Sleeve Gastrectomy. Front Surg 2021; 8:752319. [PMID: 34631787 PMCID: PMC8493029 DOI: 10.3389/fsurg.2021.752319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The practice of bariatric surgery was studied using the German Bariatric Surgery Registry (GBSR). The focus of the study was to evaluate whether revision surgery One-Step (OS) or Two-Step (TS) sleeve gastrectomy (SG) has a large benefit in terms of perioperative risk in patients after failed Adjustable Gastric Banding (AGB). Methods: The data collection includes patients who underwent One-Step SG (OS-SG) or Two-Step SG (TS-SG) as revision surgery after AGB and primary SG (P-SG) between 2005 and 2019. Outcome criteria were perioperative complications, comorbidities, 30-day mortality, and operating time. Results: The study analyzed data from 27,346 patients after P-SG, 320 after OS-SG, and 168 after TS-SG. Regarding the intraoperative complication, there was a significant difference in favor of P-SG and TS-SG compared to OS-SG (p < 0.001). The incidence of pulmonary complications was significantly higher in the OS-SG (p < 0.001). There was also a significant difference in occurrence of staple line stenosis in favor of TS-SG (p = 0.005) and the occurrence of sepsis (p = 0.008). The mean operating time was statistically longer in the TS-SG group than in the OS-SG group (p < 0.001). The 30-day mortality was not significantly different between the three groups (p = 0.727). Conclusion: In general, our study shows that converting a gastric band to a SG is safe and feasible. However, lower complications were obtained with TS-SG compared to OS-SG. Despite acceptable complication and mortality rates of both procedures, we cannot recommend any surgical method as a standard procedure. Proper patient selection is crucial to avoid possible adverse effects.
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Affiliation(s)
- Omar Thaher
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - Jamal Driouch
- Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Herne, Germany
| | - Martin Hukauf
- StatConsult Society for Clinical and Health Services Research GmbH, Magdeburg, Germany
| | - Ferdinand Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | - Christine Stroh
- Department of General, Abdominal and Pediatric Surgery, Municipal Hospital, Gera, Germany
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Spaniolas K, Yang J, Zhu C, Maria A, Bates AT, Docimo S, Talamini M, Pryor AD. Conversion of Adjustable Gastric Banding to Stapling Bariatric Procedures: Single- or Two-stage Approach. Ann Surg 2021; 273:542-547. [PMID: 30998539 DOI: 10.1097/sla.0000000000003332] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to compare the safety of single- versus two-stage conversion of adjustable gastric band (AGB) to gastric bypass (RYGB) or sleeve gastrectomy (SG). SUMMARY BACKGROUND DATA AGB patients often present for conversion to RYGB or SG. The impact of single- or two-stage approach of such conversion remains unclear. METHODS A statewide database was used to identify all patients who underwent AGB removal and concurrent (single-stage) or interval (two-stage) RYGB or SG. Propensity score matching schemes were constructed to account for differences in baseline comorbidities and demographics, allowing for matched pairs available for comparisons. RESULTS A total of 4330 patients underwent AGB conversion. Complications, readmissions, and ED visits were noted in 394 (9.1%), 278 (6.42%), and 589 (13.6%) patients, respectively. Three hundred sixty-seven matched pairs underwent RYGB; single-stage patients experienced shorter length of stay (LOS) (median difference -1 d, P < 0.0001), less complications [risk difference (RD): -8.4%, 95% confidence interval (CI), -13.4% to -3.5%], readmissions (RD: -5.2%, 95% CI, -9.6% to -0.8%), and ED visits (RD: -5.7%, 95% CI, -11.3% to -0.2%). Eight hundred seventy-five matched pairs underwent SG; single-stage patients experienced improved outcomes in all measures examined. For single-stage procedures (809 pairs), RYGB was associated with longer LOS, and more complications (RD: 3.3%, 95% CI, 0.9%-5.8%), with similar readmissions, and ED visits. CONCLUSIONS AGB conversion procedures have low morbidity. Single-stage conversion is associated with lower morbidity compared with the two-stage approach. Conversion to SG seems to be safer than RYGB.
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Affiliation(s)
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Chencan Zhu
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Altieri Maria
- Section of Minimally Invasive Surgery, Washington University, St Louis, MO
| | - Andrew T Bates
- Department of Surgery, Stony Brook University, Stony Brook, NY
| | | | - Mark Talamini
- Department of Surgery, Stony Brook University, Stony Brook, NY
| | - Aurora D Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY
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14
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Sun Y, Liu B, Snetselaar LG, Wallace RB, Shadyab AH, Kroenke CH, Haring B, Howard BV, Shikany JM, Valdiviezo C, Bao W. Association of Major Dietary Protein Sources With All-Cause and Cause-Specific Mortality: Prospective Cohort Study. J Am Heart Assoc 2021; 10:e015553. [PMID: 33624505 PMCID: PMC8174240 DOI: 10.1161/jaha.119.015553] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Dietary recommendations regarding protein intake have been focused on the amount of protein. However, such recommendations without considering specific protein sources may be simplistic and insufficient. Methods and Results We included 102 521 postmenopausal women enrolled in the Women’s Health Initiative between 1993 and 1998, and followed them through February 2017. During 1 876 205 person‐years of follow‐up, 25 976 deaths occurred. Comparing the highest with the lowest quintile, plant protein intake was inversely associated with all‐cause mortality (hazard ratio [HR], 0.91 [0.86, 0.96]), cardiovascular disease mortality (HR, 0.88 [0.79, 0.97]), and dementia mortality (HR, 0.79 [0.67, 0.94]). Among major protein sources, comparing the highest with the lowest quintile of consumption, processed red meat (HR, 1.06 [1.01, 1.10]) or eggs (HR, 1.14 [1.10, 1.19]) was associated with higher risk of all‐cause mortality. Unprocessed red meat (HR, 1.12 [1.02, 1.23]), eggs (HR, 1.24 [1.14, 1.34]), or dairy products (HR, 1.11 [1.02, 1.22]) was associated with higher risk of cardiovascular disease mortality. Egg consumption was associated with higher risk of cancer mortality (HR, 1.10 [1.02, 1.19]). Processed red meat consumption was associated with higher risk of dementia mortality (HR, 1.20 [1.05, 1.32]), while consumption of poultry (HR, 0.85 [0.75, 0.97]) or eggs (HR, 0.86 [0.75, 0.98]) was associated with lower risk of dementia mortality. In substitution analysis, substituting of animal protein with plant protein was associated with a lower risk of all‐cause mortality, cardiovascular disease mortality, and dementia mortality, and substitution of total red meat, eggs, or dairy products with nuts was associated with a lower risk of all‐cause mortality. Conclusions Different dietary protein sources have varying associations with all‐cause mortality, cardiovascular disease mortality, and dementia mortality. Our findings support the need for consideration of protein sources in future dietary guidelines.
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Affiliation(s)
- Yangbo Sun
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Buyun Liu
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Linda G Snetselaar
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Robert B Wallace
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health School of Medicine University of California, San Diego La Jolla CA
| | - Candyce H Kroenke
- Division of Research Kaiser Permanente Northern California Oakland CA
| | - Bernhard Haring
- Department of Medicine I/Cardiology University of Würzburg Germany
| | - Barbara V Howard
- MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Science Washington DC
| | - James M Shikany
- Division of Preventive Medicine School of Medicine University of Alabama at Birmingham Birmingham AL
| | - Carolina Valdiviezo
- Medstar Washington Hospital Center and Georgetown University School of Medicine Washington DC
| | - Wei Bao
- Department of Epidemiology College of Public Health University of Iowa Iowa City IA.,Obesity Research and Education Initiative University of Iowa Iowa City IA.,Fraternal Order of Eagles Diabetes Research Center University of Iowa Iowa City IA
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15
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Lee Bion A, Le Roux Y, Alves A, Menahem B. Bariatric revisional surgery: What are the challenges for the patient and the practitioner? J Visc Surg 2020; 158:38-50. [PMID: 32958433 DOI: 10.1016/j.jviscsurg.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Bariatric revisional surgery represents an important new issue for obese patients because of the considerable rate of failure and complications following bariatric surgery. As the frequency of bariatric procedures increases, so too does the incidence of revisional surgery, which has become becoming increasingly important. The surgeon must know the indications and the results of the various revisional procedures in order to best guide the therapeutic decision. The current challenge is to correctly select the patients for revisional surgery and to choose the appropriate procedure in each case. Multidisciplinary management is essential to patient re-assessment and to prepare the patient for a re- intervention. The objective of this update, based on data from all the most recent studies concerning revisional surgery, is to guide the surgeon in the choice of the revisional procedure, depending on patient characteristics, co-morbidities, the previously performed procedure, the type of failure or complication observed, but also on the surgeon's own habits and the center's expertise. The collected results show that revisional surgery is difficult, with higher complication rates and weight-loss results that are often lower than those of first-intent surgery. For these reasons, patient selection must be rigorous and multidisciplinary and the management in expert centers of these difficult situations must be encouraged.
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Affiliation(s)
- A Lee Bion
- Digestive surgery department, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - Y Le Roux
- Digestive surgery department, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - A Alves
- Digestive surgery department, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Unicaen, Inserm, Anticipe, université de Normandie, 14000 Caen, France
| | - B Menahem
- Digestive surgery department, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France; Unicaen, Inserm, Anticipe, université de Normandie, 14000 Caen, France
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16
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Janik M, Ibikunle C, Khan A, Aryaie AH. Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Failed Gastric Banding. Obes Surg 2020; 31:588-596. [PMID: 32946032 PMCID: PMC7847865 DOI: 10.1007/s11695-020-04975-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022]
Abstract
Background Reoperation, after failed gastric banding, is a controversial topic. A common approach is band removal with conversion to laparoscopic Roux-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in a single-step procedure. Objective This study aimed to assess the safety of revisional surgery to LSG compared to LRYGB after failed laparoscopic adjustable gastric banding (LAGB) based on MBSAQIP Participant User File from 2015 to 2018. Methods Patients who underwent a one-stage conversion of LAGB to LSG (Conv-LSG) or LRYGB (Conv-LRYGB) were identified in the MBSAQIP PUF from 2015 to 2017. Conv-LRYGB cases were matched (1:1) with Conv-LSG patients using propensity scoring to control for potential confounding. The primary outcome was all-cause mortality. Results A total of 9974 patients (4987 matched pairs) were included in the study. Conv-LRYGB, as compared with conv-SG, was associated with a similar risk of mortality (0.02% vs. 0.06%; relative risk [RR], 0.33; 95% confidence interval [CI], 0.03 to 3.20, p = 0.32). Conversion to LRYGB increased the risk for readmission (6.16% vs. 3.77%; RR, 1.63; 95%CI, 1.37 to 1.94, p < 0.01); reoperation (2.15% vs. 1.36%; RR, 1.57; 95%CI, 1.17 to 2.12, p = <0.01); leak (1.76% vs. 1.02%; RR, 1.57; 95%CI, 1.72 to 2.42, p < 0.01); and bleeding (1.66% vs. 1.00%; RR, 1.66; 95%CI, 1.7 to 2.34, p < 0.01). Conclusions The study shows that single-stage LRYGB and LSG as revisional surgery after gastric banding, are safe in the 30-day observation with an acceptable complication rate and low mortality. However, conversion to LRYGB increased the risk of perioperative complications.
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Affiliation(s)
- Michał Janik
- Bariatric Center of Excellence, Department of surgery, Texas Tech University Health Science Center, Lubbock, TX, USA. .,Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warszawa, Poland.
| | - Christopher Ibikunle
- Medical College of Georgia, Augusta, GA, USA.,Bariatric and Reflux Center, Georgia SurgiCare, Atlanta, GA, USA
| | - Ahad Khan
- Bariatric and Reflux Center, Georgia SurgiCare, Atlanta, GA, USA
| | - Amir H Aryaie
- Bariatric Center of Excellence, Department of surgery, Texas Tech University Health Science Center, Lubbock, TX, USA.,Bariatric and Reflux Center, Georgia SurgiCare, Atlanta, GA, USA
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Vallois A, Rebibo L, Le Roux Y, Dhahri A, Alves A, Regimbeau JM. Comparison of sleeve gastrectomy and Roux-en-Y gastric bypass after failure of gastric banding: a two-center study with a propensity score-matched analysis. Surg Endosc 2020; 35:3513-3522. [PMID: 32851467 DOI: 10.1007/s00464-020-07809-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/10/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Few studies on series comparing sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) after failure of gastric banding (GB) are available. The objective of this study was to compare the short- and medium-term outcomes of SG and RYGB after GB. MATERIALS AND METHODS Between January 2006 and December 2017, patients undergoing SG (n = 186) or RYGB (n = 107) for failure of primary GB were included in this two-center study. Propensity-score matching was performed based on preoperative factors with a 2:1 ratio. Primary endpoint was the weight loss at 2 years between the SG and RYGB groups. Secondary endpoints were overall mortality and morbidity, reoperation, correction of comorbidities and the rate of adverse events at 2 years follow-up. RESULTS In our propensity score matching analysis, operative time was significantly less in the SG group (95 min vs. 179 min; p < 0.001). Post-operative complications were lower in the SG group (9.5% vs. 35.4%; p = 0.003). At 2 years follow-up, the mean EWL was similar as same as comorbidities. There was a significant difference in favor of SG concerning the rate of adverse events at 2 years follow-up (p < 0.001). CONCLUSION Revision of GB by SG or RYGB is feasible, with a higher rate of early post-operative complications for RYGB. Weight loss at 2 years follow-up is similar; however, RYGB appears to result in a higher rate of adverse events than SG.
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Affiliation(s)
- Antoine Vallois
- Department of Digestive Surgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Lionel Rebibo
- Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, 46 rue Henri Huchard, 75018, Paris, France.,Université de Paris, Inserm UMR 1149, 75018, Paris, France.,SSPC (Simplification of Surgical Patients Care) - Clinical Research Unit, University of Picardie Jules Verne, 80054, Amiens, France
| | - Yannick Le Roux
- Department of Digestive Surgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033, Caen, France
| | - Abdennaceur Dhahri
- SSPC (Simplification of Surgical Patients Care) - Clinical Research Unit, University of Picardie Jules Verne, 80054, Amiens, France.,Department of Digestive Surgery, Amiens University Medical Center, 1 Rond-Point du Professeur Christian Cabrol, 80054, Amiens, France
| | - Arnaud Alves
- Department of Digestive Surgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033, Caen, France.,Anticipe, INSERM U1086, Pôle de recherche du CHU de Caen, Centre François Baclesse, Avenue du Général Harris, 14076, Caen Cedex 5, France
| | - Jean-Marc Regimbeau
- SSPC (Simplification of Surgical Patients Care) - Clinical Research Unit, University of Picardie Jules Verne, 80054, Amiens, France. .,Department of Digestive Surgery, Amiens University Medical Center, 1 Rond-Point du Professeur Christian Cabrol, 80054, Amiens, France. .,Service de Chirurgie Digestive, CHU Amiens-Picardie, Site Sud, 1 Rond-Point du Professeur Christian Cabrol, 80054, Amiens Cedex 1, France.
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Cheema F, Choi M, Moran-Atkin E, Camacho D, Choi J. Outcomes in revisional bariatric surgery: a high-volume single institution experience. Surg Endosc 2020; 35:3932-3939. [PMID: 32754827 DOI: 10.1007/s00464-020-07855-3] [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: 04/05/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aims to evaluate outcomes of adjustable gastric band (AGB) conversion to sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB), SG conversion to RYGB and RYGB revision procedures. METHODS Patients undergoing secondary bariatric surgery between 2009 and 2017 were retrospectively identified from a prospective database. Primary outcomes were weight loss and improvement in comorbidities. For weight loss, percent of total body weight loss (%TWL) and percentage of excess BMI loss (%EBMIL) were included. Comorbidities included were hemoglobin A1C (HbA1C), cardiovascular risk (CV) and hypertension. RESULTS 266 Secondary bariatric procedures were analyzed. There were four Grade IIIb complications within 30 days. There was greater %EBMIL at 12 and 24 months in the AGB to RYGB group, and in %TWL at 24 months compared to AGB to SG group (p < 0.05). Only AGB to RYGB had significantly continued improvement in these two parameters at 24 months compared to at 6 months post-operatively-%EBMIL and %TWL tapered off in the other procedures. There was significantly lower CV risk in dyslipidemic patients at 24 months in the AGB to RYGB compared to the AGB to SG group. In the SG to RYGB patients, there was significant improvement in CV risk in dyslipidemic patients at 24 months compared to baseline. There was significant improvement in HbA1C in diabetics in AGB to RYGB patients at 6 and 12 months, in AGB to SG patients at 12 months, and in SG to RYGB patients at 12 and 24 months compared to baseline. In RYGB revision and SG to RYGB patients, there was a relative increase in the number of patients being normotensive at 24 months compared to baseline. CONCLUSION Secondary bariatric surgery is a complex and challenging procedure that may improve weight loss and cardiovascular risk for certain procedures but further studies will be necessary.
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Affiliation(s)
- Fareed Cheema
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA.
| | - Michael Choi
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
| | - Erin Moran-Atkin
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
| | - Diego Camacho
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
| | - Jenny Choi
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, USA
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19
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Clapp B, Harper B, Dodoo C, Klingsporn W, Barrientes A, Cutshall M, Tyroch A. Trends in revisional bariatric surgery using the MBSAQIP database 2015-2017. Surg Obes Relat Dis 2020; 16:908-915. [DOI: 10.1016/j.soard.2020.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/13/2020] [Accepted: 03/03/2020] [Indexed: 01/24/2023]
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Sleeve gastrectomy as a rescue of failed gastric banding: comparison of 1- and 2-step approaches. Surg Obes Relat Dis 2020; 16:1045-1051. [PMID: 32402733 DOI: 10.1016/j.soard.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Series comparing gastric banding (GB) removal and sleeve gastrectomy (SG) when procedures are performed as a 1- or a 2-step approach are contradictory in their outcomes. No series comparing these approaches with midterm weight loss is available. OBJECTIVES Compare the outcomes and weight loss of SG performed as 1- and 2-step approaches as a revisional procedure for GB failure. SETTING University Hospital, France, public practice. METHODS Between February 2006 and January 2017, all patients undergoing SG with a previous history of implementation of GB (n = 358) were included in this 2-center, retrospective, observational study. Revisional surgery was proposed in patients with insufficient excess weight loss (excess weight loss ≤50%) or weight regain after GB. A 1-step (1-step group, n = 270) or 2-step (2-step group, n = 88) approach was decided depending on patient's choice and/or surgeon's preference. The primary efficacy endpoint was the comparison of weight loss in the 1- and 2-step groups at the 2-year follow-up. The secondary efficacy endpoints were short-term outcomes (overall mortality and morbidity at postoperative day 30, specific morbidity, reoperation, length of hospital stay, and readmission). RESULTS In the 1-step group, the mean preoperative body mass index before SG was 40.5 kg/m2 (27.0-69.0), while in the 2-step group, the mean preoperative body mass index was 43.5 kg/m2 (31.5-61.7). Mean operating time was 109 minutes (50-240) in the 1-step group and 78.7 minutes (40-175) in the 2-step group (P = .22). In the 1-step group, 6 conversions to laparotomy occurred, while in the 2-step group, 2 conversions to laparotomy occurred (P = .75). One death (.2%, in the 2-step group) and 39 complications (30 in the 1-step group [11.1%] and 9 in the 2-step group [10.2%]) also occurred. The mean length of hospital stay was 6.2 days in the 1-step group and 4.1 days in the 2-step group. At 2-year follow-up, mean body mass index was 32.4 kg/m2 in the 1-step group and 33.2 kg/m2 in the 2-step group (P = .15), representing excess weight losses of 61.9 and 50.1 (P = .05), respectively. The rates of revisional surgery were .7% and 2.2%, respectively. CONCLUSIONS SG after previous GB is efficient with similar outcomes depending on the 1- or 2-step approach. The 1-step approach seems to have increased weight loss compared with the 2-step approach.
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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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Gupta S, Beitner M, Skinner C, Hopkins G. Medium-term outcomes of converting laparoscopic adjustable gastric band to Roux-en-Y gastric bypass in patients with body mass index <35 kg/m2: a uniquely Australian perspective. Surg Obes Relat Dis 2020; 16:485-491. [DOI: 10.1016/j.soard.2019.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/19/2019] [Accepted: 11/02/2019] [Indexed: 12/15/2022]
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23
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Zadeh J, Le C, Ben-David K. 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; 16:437-444. [DOI: 10.1016/j.soard.2019.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/08/2019] [Accepted: 12/07/2019] [Indexed: 01/29/2023]
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Corcelles R, Barajas-Gamboa JS, Kroh M. Cirugía bariátrica de revisión: ¿estamos abriendo la caja de Pandora? Cir Esp 2019; 97:477-479. [DOI: 10.1016/j.ciresp.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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25
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Pędziwiatr M, Małczak P, Wierdak M, Rubinkiewicz M, Pisarska M, Major P, Wysocki M, Karcz WK, Budzyński A. Revisional Gastric Bypass Is Inferior to Primary Gastric Bypass in Terms of Short- and Long-term Outcomes-Systematic Review and Meta-Analysis. Obes Surg 2019; 28:2083-2091. [PMID: 29748735 PMCID: PMC6018598 DOI: 10.1007/s11695-018-3300-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose Although Roux-en-Y gastric bypass (RYGB) is the main primary bariatric procedure, it has also been utilized as revisional bariatric surgery. Our aim is to compare revisionary gastric bypass with primary gastric bypass through systematic review with meta-analysis. Methods Available literature was searched for eligible studies up to December 2017. Inclusion criteria were reports on morbidity, %EWL, or diabetes remission. Secondary outcomes involved mortality, anastomotic leakage, operative time, and length of hospital stay. Random effect meta-analyses were undertaken. Results Initial search yielded 1164 references. Final meta-analysis involved 21 studies and revealed significant differences in terms of morbidity (RR1.54, p < 0.001) and EWL (WMD-19.9, p < 0.001). There were no differences in diabetes remission. Conclusion Revisionary RYGB has worse weight loss effect with greater morbidity rate than primary RYGB. Electronic supplementary material The online version of this article (10.1007/s11695-018-3300-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland. .,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Mateusz Wierdak
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Pisarska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
| | - W Konrad Karcz
- Department of General-, Abdominal-, Vascular-, Thoracic- and Transplantation Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.,Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland
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Conversion of Adjustable Gastric Banding to Adjustable Banded Roux-en-Y Gastric Bypass: Should We Leave the Band in Place? Obes Surg 2019; 29:3912-3918. [DOI: 10.1007/s11695-019-04106-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Noyes K, Myneni AA, Schwaitzberg SD, Hoffman AB. Quality of MBSAQIP data: bad luck, or lack of QA plan? Surg Endosc 2019; 34:973-980. [DOI: 10.1007/s00464-019-06884-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/31/2019] [Indexed: 12/19/2022]
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Wilkinson KH, Helm M, Lak K, Higgins RM, Gould JC, Kindel TL. The Risk of Post-operative Complications in Super-Super Obesity Compared to Super Obesity in Accredited Bariatric Surgery Centers. Obes Surg 2019; 29:2964-2971. [DOI: 10.1007/s11695-019-03942-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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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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Laparoscopic extraction of gastric self-expandable metallic stent after migration in ileum: A case report. Int J Surg Case Rep 2018; 53:112-114. [PMID: 30391734 PMCID: PMC6216075 DOI: 10.1016/j.ijscr.2018.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/20/2018] [Indexed: 11/22/2022] Open
Abstract
Revisional surgery in bariatric patients can sometimes lead to life-threatening complications that need a fast diagnosis and treatment as well as a multidisciplinary approach. If left undiagnosed or untreated, this may lead to sepsis, multiple organ failure, and death. In this case report, we describe the management of a gastric perforation which occurred after conversion of a gastric banding to a sleeve gastrectomy.
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Khan OA, McGlone ER, Maynard W, Hopkins J, Dexter S, Finlay I, Hewin D, Sedman P, Walton P, Somers S, Reddy M, Small P, Adamo M, Welbourn R. Single-stage conversions from failed gastric band to sleeve gastrectomy versus Roux-en-Y gastric bypass: results from the United Kingdom National Bariatric Surgical Registry. Surg Obes Relat Dis 2018; 14:1516-1520. [DOI: 10.1016/j.soard.2018.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/07/2018] [Accepted: 06/18/2018] [Indexed: 11/26/2022]
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Al-Kurd A, Grinbaum R, Mizrahi I, Abubeih A, Indursky A, Abu Hamdan H, Mazeh H, Beglaibter N. A comparison between one- and two-stage revisional gastric bypass. Surg Endosc 2018; 33:1459-1464. [DOI: 10.1007/s00464-018-6427-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 09/05/2018] [Indexed: 01/19/2023]
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Conversion of Laparoscopic Adjustable Gastric Banding to Gastric Bypass: a Comparison to Primary Gastric Bypass. Obes Surg 2017; 28:1519-1525. [DOI: 10.1007/s11695-017-3047-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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