From Bands to Bypasses: Navigating Safety of Band Conversions to Roux-en-Y Gastric Bypass and Single Anastomosis Duodenoileostomy Versus Sleeve Gastrectomy

Overview

Journal Obes Surg

Date 2024 Jun 5

PMID 38837020

Authors

Thomas H Shin

Pourya Medhati

Jerry Dang

Katherine Wasden

Eric G Sheu

Ali Tavakkoli

Affiliations

Soon will be listed here.

Abstract

Introduction: Revisional bariatric surgery is associated with higher perioperative complications over primary procedures. Adjustable gastric bands (AGB) continue to be the most frequently converted bariatric configuration. This study examines trends in current clinical indication and safety profile of the most frequently pursued AGB conversions.

Materials And Methods: MBSAQIP data from 2020 to 2022 was retrospectively analyzed in a cohort study examining 30-day postoperative outcomes after AGB conversion to sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or single anastomosis duodenoileostomy (SADI). Descriptive statistics were used, including multivariable and 2:1 nearest neighbor matching analysis.

Results: This study included 19,335 AGB conversions, of which most were to SG (n = 11,736) followed by RYGB (n = 7442) and SADI (n = 157). While a majority were completed for weight loss, there were differences in distribution of primary indication for each conversion cohort, such as higher proportion of RYGB conversion for gastroesophageal reflux disease (18.7%) compared to SG (7.92%) and SADI (5.10%). Multivariable analysis demonstrates conversion to RYGB has significantly higher odds of 30-day major complications (OR 1.75, p < 0.001), reoperation (OR 2.08; p = 0.001), readmission (OR 1.69; p = 0.001), and emergency department visits (OR 1.50; p = 0.001) over SG. These risks and odds of reintervention (OR 1.75; p < 0.001) remained significantly higher after conversion to RYGB versus SG on matched analysis. None of these risks is significantly different between conversions to SADI versus SG in either multivariable or matched analysis.

Conclusions: Compared to AGB conversion to SG, single-stage conversion to RYGB had increased odds of perioperative complications while risks of conversion to SADI were not significantly different.

References

Altieri M, Yang J, Telem D, Meng Z, Frenkel C, Halbert C . Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York. Surg Endosc. 2015; 30(5):1725-32. DOI: 10.1007/s00464-015-4402-8. View

Dang J, Hage K, Corbett J, Abi Mosleh K, Kroh M, Ghanem O . Third time's a charm: band to sleeve to bypass. Surg Endosc. 2023; 38(1):419-425. DOI: 10.1007/s00464-023-10534-8. View

Dang J, Clapp B, Ahmad M, Ghanem O, Parmar C, Kroh M . One- versus two-stage conversions of adjustable gastric bands: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Surg Obes Relat Dis. 2023; 19(7):735-741. DOI: 10.1016/j.soard.2023.02.026. View

Clapp B, Ponce J, DeMaria E, Ghanem O, Hutter M, Kothari S . American Society for Metabolic and Bariatric Surgery 2020 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2022; 18(9):1134-1140. DOI: 10.1016/j.soard.2022.06.284. View

Angrisani L, Vitiello A, Santonicola A, Hasani A, De Luca M, Iovino P . Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy as Revisional Procedures after Adjustable Gastric Band: 5-Year Outcomes. Obes Surg. 2016; 27(6):1430-1437. DOI: 10.1007/s11695-016-2502-8. View

Janik M, Ibikunle C, Khan A, Aryaie A . Safety of Single Stage Revision Laparoscopic Sleeve Gastrectomy Compared to Laparoscopic Roux-Y Gastric Bypass after Failed Gastric Banding. Obes Surg. 2020; 31(2):588-596. PMC: 7847865. DOI: 10.1007/s11695-020-04975-6. View

Kapur A, Thodiyil P . Primary laparoscopic sleeve gastrectomy versus gastric bypass: a propensity-matched comparison of 30-day outcomes. Surg Obes Relat Dis. 2021; 17(7):1369-1382. DOI: 10.1016/j.soard.2021.01.022. View

Weinstein A, Marascalchi B, Spiegel M, Saunders J, Fagerlin A, Parikh M . Patient preferences and bariatric surgery procedure selection; the need for shared decision-making. Obes Surg. 2014; 24(11):1933-9. DOI: 10.1007/s11695-014-1270-6. View

Senturk J, Sharma R, Tavakkoli A, Vernon A, Spector D, Robinson M . Safety and effectiveness of 1-stage conversion of adjustable gastric band-to-sleeve gastrectomy: a single-institution case-control study. Surg Obes Relat Dis. 2021; 18(1):95-101. DOI: 10.1016/j.soard.2021.09.010. View

10.

Pujol-Rafols J, Al Abbas A, Devriendt S, Guerra A, Herrera M, Himpens J . 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. Obes Surg. 2020; 30(12):5026-5032. DOI: 10.1007/s11695-020-04951-0. View

11.

Spaniolas K, Yang J, Zhu C, Maria A, Bates A, Docimo S . Conversion of Adjustable Gastric Banding to Stapling Bariatric Procedures: Single- or Two-stage Approach. Ann Surg. 2019; 273(3):542-547. DOI: 10.1097/SLA.0000000000003332. View

12.

Pearlstein S, Sabrudin S, Shayesteh A, Tecce E, Roslin M . Outcomes After Laparoscopic Conversion of Failed Adjustable Gastric Banding (LAGB) to Laparoscopic Sleeve Gastrectomy (LSG) or Single Anastomosis Duodenal Switch (SADS). Obes Surg. 2019; 29(6):1726-1733. DOI: 10.1007/s11695-019-03729-3. View

13.

Dang J, Vaughan T, Mocanu V, Mubashir H, Barajas-Gamboa J, Codina R . Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Indications, Prevalence, and Safety. Obes Surg. 2023; 33(5):1486-1493. PMC: 10017068. DOI: 10.1007/s11695-023-06546-x. View

14.

Matar R, Monzer N, Jaruvongvanich V, Abusaleh R, Vargas E, Maselli D . Indications and Outcomes of Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: a Systematic Review and a Meta-analysis. Obes Surg. 2021; 31(9):3936-3946. DOI: 10.1007/s11695-021-05463-1. View

15.

Chao G, Canner J, Hamid S, Ying L, Ghiassi S, Schwartz J . Outcomes of SADI and OAGB Compared to RYGB from the Metabolic and Bariatric Surgery Quality Improvement Program: The North American Experience. Obes Surg. 2024; 34(2):337-346. DOI: 10.1007/s11695-023-07019-x. View

16.

Medhati P, Saleh O, Nimeri A, Apovian C, Thompson C, Jirapinyo P . Outcomes and Management of Re-Establishing Bariatric Patients. J Am Coll Surg. 2024; 238(6):1035-1043. DOI: 10.1097/XCS.0000000000001062. View