What to Propose After Failed Adjustable Gastric Banding: One- or Two-step Procedure?
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SCIENTIFIC REVIEW
What to Propose After Failed Adjustable Gastric Banding: Oneor Two-step Procedure? Yoann Marion1 • Yassine Eid1,2,3 • Benjamin Menahem1,2,3 • Adrien Lee Bion1 Alexandre Thobie1,2,3 • Arnaud Alves1,2,3
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) can be proposed in case of failed laparoscopic adjustable gastric band (LAGB). The main question is whether the revisional procedure is carried out in one or two stages. Objective Postoperative outcomes between the one-step approach and the two-step approach of conversion of failed LAGB to RYGB or SG were, respectively, compared. Methods A systematic review of the literature published until June 2019 was conducted. All studies comparing onestep and two-step approaches after failed LAGB were included. Primary outcomes include both mortality and morbidity at 30 days postoperatively according to Dindo–Clavien classification. Among the studies included, a random effect model was used with Review Manager 5.3 (Cochrane Collaboration, Oxford, UK). Results A total of 3895 patients had conversion of failed LAGB to RYGB (n = 3214) or SG (n = 681), respectively. The conversion was carried out in one-step (n = 2767) or two-step (n = 1128) approaches. Meta-analysis did not show statistical difference for overall morbidity rate (OR = 1.01, 95%CI = 0.78–1.30, p = 0.96) whether it is for SG (OR = 1.25, 95%CI = 0.73–2.14, p = 0.42) or RYGB (OR = 0.94, 95%CI = 0.71–1.26, p = 0.69) and for major postoperative morbidity (OR = 0.96, 95%CI = 0.59–1.56, p = 0.87) whether it is for SG (OR = 0.66, 95%CI = 0.22–1.97, p = 0.46) or RYGB (OR = 1.05, 95%CI = 0.61–1.81, p = 0.86). Moreover, there was no statistical difference for specific morbidity rate including reoperation, leak, abscess, postoperative bleeding, and late postoperative complications. Limitations Given the retrospective nature of the studies, these results should be interpreted with caution. Conclusion This updated meta-analysis suggests that conversion of failed LAGB to RYGB or SG can be safely performed in one-step or two-step approaches.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05610-2) contains supplementary material, which is available to authorized users. & Yassine Eid [email protected] 1
Department of Digestive Surgery, University Hospital of Caen, Avenue de La Coˆte de Nacre, 14032 Caen Cedex, France
2
Team «Ligue Contre Le Cancer», Centre Franc¸ois Baclesse, ANTICIPE’’ U1086 INSERM-University of Caen Normandy, Caen, France
3
Department of Research, University Hospital of Caen, Normandy, France
123
World J Surg
Introduction Laparoscopic adjustable gastric band (LAGB) remains a simple and safe surgery with few complications. However, the necessity for reoperation is common [1]. At 10 years postoperatively, one out of two patients will require revisional bariatric surgery due to either insufficient weight loss and/or complications specific to the LAGB (i
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