Conversion of Adjustable Gastric Banding to Roux-en-Y Gastric Bypass in One or Two Steps: What Is the Best Approach? Ana
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Conversion of Adjustable Gastric Banding to Roux-en-Y Gastric Bypass in One or Two Steps: What Is the Best Approach? Analysis of a Multicenter Database Concerning 832 Patients J. Pujol-Rafols 1 & A. I. Al Abbas 2 & S. Devriendt 3 & A. Guerra 4 & M. F. Herrera 5 & J. Himpens 3 & E. Pardina 6 & S. Pouwels 7 & A. Ramos 8 & R. J. Ribeiro 9 & B. Safadi 2 & H. Sanchez-Aguilar 5 & C. de Vries 10 & B. Van Wagensveld 11 Received: 3 May 2020 / Revised: 21 August 2020 / Accepted: 26 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Roux-en-Y gastric bypass (RYGB) is often the preferred conversion procedure for laparoscopic adjustable gastric banding (LAGB) poor responders. However, there is controversy whether it is better to convert in one or two stages. This study aims to compare the outcomes of one and two-stage conversions of LAGB to RYGB. Methods Retrospective review of a multicenter prospectively collected database. Data on conversion in one and two stages was compared. Results Eight hundred thirty-two patients underwent LAGB conversion to RYGB in seven specialized bariatric centers. Six hundred seventy-three (81%) were converted in one-stage. Patients in the two-stage group were more likely to have experienced technical complications, such as slippage or erosions (86% vs. 37%, p = 0.0001) and to have had a higher body mass index (BMI) (41.6 vs. 39.9 Kg/m2, p = 0.005). There were no differences in postoperative complications and mortality rates between the onestage and two-stage groups (13.5% vs. 10.8%, and 0.7% vs. 0.0% respectively, p = ns). Mean final BMI and %total weight loss (%TWL) for the one-stage and the two-stage groups were 31.6 vs. 32.4 Kg/m2 (p = ns) and 30.4 vs. 26.8 (p = 0.017) after a mean follow-up of 33 months. Follow-up at 1, 3, and 5 years was 98%, 75%, and 54%, respectively. Conclusions One-stage conversion of LAGB to RYGB is safe and effective. Two-stage conversion carries low morbidity and mortality in the case of band slippage, erosion, or higher BMI patients. These findings suggest the importance of patient selection when choosing the appropriate conversion approach. Keywords LAGB . Gastric banding . Gastric bypass . RYGB . Revision . Revisional surgery . Conversion
Introduction Laparoscopic adjustable gastric banding (LAGB), firstly performed by Cadière in 1992, became widely performed during
* J. Pujol-Rafols [email protected]
the 1990s. Its technical simplicity, reversibility, and low acute complication rate were major factors in its popularity. Despite losing prominence over the past two decades, LAGB remains the third most performed technique worldwide, only
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Departament de Bioquímica i Biomedicina Molecular, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
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Department of Intensive Care Medicine, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
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Clínica Mi Tres Torres, Barcelona, Spain
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American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
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Gastro-Ob
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