Background

Outcomes after revision from adjustable gastric band (AGB) to laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) are not well described. In this study, we aim to evaluate outcomes at one year in patients that were converted from AGB versus those undergoing primary LSG or LRYGB.

Methods

A retrospective review was conducted of all adult patients undergoing LSG or LRYGB at our institution between 2007 and 2015. Patients undergoing either primary weight loss surgery or revision from AGB were included, and were divided into four groups: primary LSG (pLSG), revisional LSG (rLSG), primary LRYGB (pLRYGB), and revisional LRYGB (rLRYGB). Analysis was performed between primary and revisional groups within procedures. Demographics, body mass index (BMI), American Society of Anesthesiology (ASA) score, metabolic comorbidities, and operative details were collected. Post-operative complications were scored as major if ³ Clavien-Dindo class 3. Comorbidity resolution was measured by number of oral medications for diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia (HL). Percent total weight loss (%TWL) was also measured.

Results

Six hundred twenty-four patients met inclusion criteria: pLSG (n=288), rLSG (n=21), pLRYGB (n=303), and rLRYGB (n=12). These groups were well matched with respect to demographics, BMI, ASA score, and pre-operative metabolic comorbidities, with the exception that there was a higher rate of HL in the rLSG group than the pLSG group (p=0.04). AGB removals were staged in 71% of rLSG and 50% of rLRYGB. Revisional procedures were associated with greater operative time than primary procedures for both LSG and LRYGB (p<0.001). There were greater intra-operative blood losses (p<0.001), stricture rates (p=0.03), and leak rates (p=0.007) in the rLRYGB versus pLRYGB group (Table). There were no differences in post-operative length of stay, overall complication rates, or 90-day readmissions in either procedure. At one-year follow-up, patients undergoing conversion from AGB were associated with significantly less weight loss than those undergoing primary procedures: 29.1% vs 16.7% (pLSG vs rLSG, p=0.006) and 31.4% vs 18.7% (pLRYGB vs rLRYGB, p=0.002). However, there were no differences in comorbidity resolution for DM2, HTN, or HL.

Conclusions

LSG and LRYGB achieve less weight loss after AGB than as primary procedures, which should help guide patient and surgeon expectations post-operatively. Revisional LRYGB is associated with increased morbidity compared to primary LRYGB, whereas revisional LSG does not carry an increased complication rate over the primary procedure. Therefore, LSG may be a safer revisional procedure after AGB.