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Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes

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Abstract

Background

A considerable number of patients require revisional surgery after laparoscopic adjustable gastric banding (LAGB). Studies that compared the outcomes of revisional sleeve gastrectomy (r-SG) and revisional Roux-en-Y gastric bypass (r-RYGB) after failed LAGB are scarce in the literature. Our objective was to determine whether significant differences exist in outcomes between r-SG and r-RYGB after failed LAGB.

Methods

From 2005 to 2012, patients who underwent laparoscopic r-SG and r-RYGB after failed LAGB were retrospectively compared and analyzed. Data included demographics, indication for revision, operative time, hospital stay, conversion rate, percentage excess weight loss (%EWL), and morbidity and mortality.

Results

Out of 693 bariatric procedures, 42 r-SG and 53 r-RYGB were performed. The median preoperative weight (107.7 and 117.7 kg, respectively, p = 0.02) and body mass index (BMI) (38.5 vs. 43.2 kg/m2, respectively, p = 0.01) were statistically significantly lower in r-SG than in r-RYGB. The mean operative time and median hospital stay were significantly shorter in r-SG than in r-RYGB (108.4 vs. 161.2 min, p < 0.01) (2 vs. 3 days, p = 0.02), respectively. One patient underwent conversion to open surgery after r-RYGB (p = 0.5). The reoperation rate was lower in r-SG than in r-RYGB (0.0 vs. 3.8 %, p = 0.5). There was one postoperative leak in the r-RYGB, and the overall complication rate was significantly lower in r-SG patients than in r-RYGB patients (7.1 vs. 20.8 %, p = 0.05). The mean follow-up was significantly shorter in the r-SG group (9.8 vs. 29.3 months, p < 0.01). However, the mean postoperative BMI was not different at 1 year (32.3 vs. 34.7, p = 0.29) as well as mean %EWL was (47.4 vs. 45.6 %, p = 0.77).

Conclusions

Both r-SG and r-RYGB are safe procedures with similar outcomes in terms of %EWL. As a result of the long-term potential nutritional complication of r-RYGB, r-SG may be a better option in this group of patients. Longer follow-up is needed.

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Acknowledgments

The authors thank Dr. Joseph Longenecker for his help and support with the statistical analysis.

Disclosures

Dr. Mousa Khoursheed, Dr. Ibtisam Al-Bader I, Dr. Ali Mouzannar, Dr. Abdulla Al-Haddad, Dr. Ali Sayed, Dr. Ali Mohammad, and Dr. Abe Fingerhut have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Kuwait University, Safat, P.O. Box 24923, 13110, Jabriya, Kuwait

    Mousa Khoursheed & Ibtisam Al-Bader

  2. Department of Surgery, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait

    Ali Mouzannar, Abdulla Al-Haddad, Ali Sayed & Ali Mohammad

  3. First Department of Surgery, Hippocration Hospital, University of Athens Medical School, Athens, Greece

    Abe Fingerhut

Authors
  1. Mousa Khoursheed
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  2. Ibtisam Al-Bader
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  5. Ali Sayed
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  6. Ali Mohammad
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Correspondence to Mousa Khoursheed.

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Khoursheed, M., Al-Bader, I., Mouzannar, A. et al. Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Surg Endosc 27, 4277–4283 (2013). https://doi.org/10.1007/s00464-013-3038-9

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  • DOI: https://doi.org/10.1007/s00464-013-3038-9

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