Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Fai
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ORIGINAL CONTRIBUTIONS
Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Failed Gastric Banding Michał Janik 1,2
&
Christopher Ibikunle 3,4 & Ahad Khan 4 & Amir H. Aryaie 1,4
Received: 21 May 2020 / Revised: 8 September 2020 / Accepted: 11 September 2020 # The Author(s) 2020
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 = preoperative BMI.
• [only LSG patients] Reported bougie size below 30 or over 60 French. Bougie size range described in the literature is between 30 and 60 French. [14] • [only LSG patients] Reported distance from pylorus exceeding 9 cm. Distance >10 cm was not described in the literature. [15] Observations with missing data were excluded from the analysis. Finally, all observations with at least one code for AGB removal [43,774, 43,772] listed as “Other CPT” or Concurrent CPT codes” were identified as cases of adjustable gastric band removal (AGB) with one stage conversion to Laparoscopic Sleeve Gastrectomy (Conv-LSG) or Laparoscopic Roux-Y Gastric Bypass (Conv-LRYGB). Conv-LRYGB cases were matched (1:1) with Conv-LSG patients using propensity scoring to control for potential confounding.
Outcomes The primary outcome of the study was all-cause mortality. Secondary outcomes included: • Operative time (OR). • Length of hospital stay (LoS). • Emergency department (ED) visits within 30 days postoperative. • 30-day readmission. • 30-day intervention. • 30-day reoperation. • Leak rate (defined as drain present >30 days, organ space surgical site infection, leak-related 30-day readmission, or leak-related 30-day reoperation or intervention), • Bleeding event (defined as bleed-related 30-day readmission, bleed-related 30-day reoperation, or transfusion required within 72 h postoperatively), • 30-day morbidity. • Including unplanned admission rate to the Intensive Ca
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