Surgical Endoscopy

, Volume 30, Issue 12, pp 5453–5458 | Cite as

Safety and efficacy of single-stage conversion of failed adjustable gastric band to laparoscopic Roux-en-Y gastric bypass: a case–control study

  • Kamran SamakarEmail author
  • Travis J. McKenzie
  • James Kaberna
  • Ali Tavakkoli
  • Ashley H. Vernon
  • Arin L. Madenci
  • Scott A. Shikora
  • Malcolm K. Robinson



We conducted the following study to evaluate the safety and efficacy of single-stage conversion of failed laparoscopic adjustable gastric band (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) as compared to a cohort of primary LRYGB patients.


A single-institution, prospectively maintained bariatric database was used to retrospectively identify consecutive patients who underwent single-stage removal of LAGB with concomitant conversion to LRYGB between the years of 2007 and 2013. The study cohort was matched 1:1 for age, gender, body mass index (BMI), and approximate date of operation to patients who underwent primary LRYGB. Primary endpoints were operative time, complication rate, length of hospital stay (LOS), and percent excess BMI lost (%EBMIL) at 24-month follow-up.


Ninety-four conversion patients met inclusion criteria. There were no statistically significant differences in the mean LOS (3.1 vs. 3.0 days, p = 0.97) or the major complication rate (3.2 vs. 1.1 %, p = 0.62) at 30 days postoperatively. Likewise, 30-day minor complication rates, including readmission, were similar between groups (7.5 vs. 6.4 %, p = 0.77). The average operative time was significantly longer for conversion compared to primary LRYGB (193.5 vs. 132 min; p < 0.01). At most recent follow-up after conversion or primary LRYGB, median %EBMIL was 61.3 and 77.3 % (p < 0.01), percent total weight loss was 23.6 and 30.5 % (p < 0.01), and percent change in BMI was 23.4 and 30.5 % (p < 0.01), respectively. Median follow-up time was 17 and 18.6 months after conversion and primary LRYGB, respectively.


Single-stage conversion of LAGB to LRYGB is safe with an acceptable complication rate and similar LOS compared to primary LRYGB.


Gastric banding Revisional surgery Gastric bypass Obesity Outcomes 


Compliance with ethical standards


Drs. Samakar, McKenzie, Madenci, Tavakkoli, Vernon, Shikora, Robinson and Mr. Kaberna have no conflicts of interest or financial ties to disclose.

Ethical approval

For this type of study (retrospective) formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Buchwald H (2005) Consensus conference statement bariatric surgery for morbid obesity: health implications for patients, health professionals and third-party payers. Surg Obes Relat Dis 1:371–381CrossRefPubMedGoogle Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737CrossRefPubMedGoogle Scholar
  3. 3.
    Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122:248–256CrossRefPubMedGoogle Scholar
  4. 4.
    Colquitt JL, Picot J, Loveman E, Clegg AJ (2009) Surgery for obesity. Cochrane Database Syst Rev 2:CD003641Google Scholar
  5. 5.
    Cunneen SA, Phillips E, Fielding G, Banel D, Estok R, Fahrback K, Sledge I (2008) Studies of Swedish adjustable gastric band and Lap-Band: systematic review and meta-analysis. Surg Obes Relat Dis 4:174–185CrossRefPubMedGoogle Scholar
  6. 6.
    Lancaster RT, Hutter MM (2008) Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc 22:2554–2563CrossRefPubMedGoogle Scholar
  7. 7.
    O’Brien PE, Macdonald L, Anderson M, Brennan L, Brown WA (2013) Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg 257(1):87–94CrossRefPubMedGoogle Scholar
  8. 8.
    Favretti F, Segato G, Ashton D, Busetto L, De Luca M, Mazza M, Ceoloni A, Banzato O, Calo E, Enzi G (2007) Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results. Obes Surg 17(2):168–175CrossRefPubMedGoogle Scholar
  9. 9.
    Suter M, Calmes JM, Paroz A, Giusti V (2006) A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg 16(7):829–835CrossRefPubMedGoogle Scholar
  10. 10.
    DeMaria EJ, Sugerman HJ, Meador JG, Doty JM, Kellum JM, Wolfe L, Szucs RA, Turner MA (2001) High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg 233(6):809–818CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Kindel T, Martin E, Hungness E, Nagle A (2014) High failure rate of the laparoscopic-adjustable gastric band as a primary bariatric procedure. Surg Obes Relat Dis 10(6):1070–1075CrossRefPubMedGoogle Scholar
  12. 12.
    Aarts EO, Dogan K, Koehestanie P, Janssen IMC, Berends FJ (2014) What happens after gastric band removal without additional bariatric surgery? Surg Obes Relat Dis. doi: 10.1016/j.soard.2013.10.014 Google Scholar
  13. 13.
    Santos BF, Wallaert JB, Trus TI (2014) Band removal and conversion to sleeve or bypass: are they equally safe? Surg Endosc. doi: 10.1007/s00464-014-3584-9 Google Scholar
  14. 14.
    Martin MJ, Mullenix PS, Steele SR, See CS, Cuadrado DG, Carter PL (2004) A case-match analysis of failed prior bariatric procedures converted to resectional gastric bypass. Am J Surg 187:666–671CrossRefPubMedGoogle Scholar
  15. 15.
    Topart P, Becouarn G, Ritz P (2009) One-year weight loss after primary or revisional Roux-en-Y gastric bypass for failed adjustable gastric banding. Surg Obes Relat Dis 5:459–462CrossRefPubMedGoogle Scholar
  16. 16.
    Sanchez H, Cabrera A, Cabrera K, Zerrweck C, Mosti M, Sierra M, Dominguez G, Herrera MF (2008) Laparoscopic Roux-en-Y gastric bypass as a revision procedure after restrictive bariatric surgery. Obes Surg 18:1539–1543CrossRefPubMedGoogle Scholar
  17. 17.
    van Wageningen B, Berends FJ, Van Ramshorst B, Janssen IF (2006) Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg 16:137–141CrossRefPubMedGoogle Scholar
  18. 18.
    te Riele WW, Sze YK, Wiezer MJ, Van Ramshorst B (2008) Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis 4:735–739CrossRefGoogle Scholar
  19. 19.
    Brolin RE, Cody RP (2008) Weight loss outcome of revisional bariatric operations varies according to the primary procedure. Ann Surg 248:227–232CrossRefPubMedGoogle Scholar
  20. 20.
    Zingg U, McQuinn A, DiValentino D, Kinsey-Trotman S, Game P, Watson D (2010) Revisional vs. primary Roux-en-Y gastric bypass—a case-matched analysis: less weight loss in revisions. Obes Surg 20:1627–1632CrossRefPubMedGoogle Scholar
  21. 21.
    Radtka JF III, Puelo FJ, Wang L, Cooney RN (2010) Revisional bariatric surgery: who, what, where, and when? Surg Obes Relat Dis 6:635–642CrossRefPubMedGoogle Scholar
  22. 22.
    Mongol P, Chosidow D, Marmuse JP (2004) Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surgt 14:1349–1353CrossRefGoogle Scholar
  23. 23.
    Spivak H, Beltran OR, Slavchev P, Wilson EB (2007) Laparoscopic revision from LAP-BAND to gastric bypass. Surg Endosc 8:1388–1392CrossRefGoogle Scholar
  24. 24.
    Marin-Perez P, Betancourt A, Lamota M, Menzo EL, Szomsteins S, Rosenthal R (2014) Outcomes after laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass. BJS 101:254–260CrossRefGoogle Scholar
  25. 25.
    Weber M, Muller MK, Michel JM, Belal R, Horber F, Hauser R, Clavien PA (2003) Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg 238:827–833CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Mor A, Keenan E, Portenier D, Torquati A (2013) Case-matched analysis comparing outcomes of revisional versus primary laparoscopic Roux-en-Y gastric bypass. Surg Endos 27:548–552CrossRefGoogle Scholar
  27. 27.
    Buchwald H (2008) Introduction and current status of bariatric procedures. Surg Obes Relat Dis 4:21–26CrossRefGoogle Scholar
  28. 28.
    Victorzon M, Tolonen P (2013) Mean fourteen-year, 100% follow-up of laparoscopic adjustable gastric banding for morbid obesity. Surg Obes Relat Dis 5:753–757CrossRefGoogle Scholar
  29. 29.
    Elnahas A, Graybiel K, Farrokhyar F, Gmora S, Anvari M, Hong D (2013) Revisional surgery after failed laparoscopic adjustable gastric banding: a systematic review. Surg Endos 27:740–745CrossRefGoogle Scholar
  30. 30.
    Roller JE, Provost DA (2006) Revision of failed gastric restrictive operations to Roux-en-Y gastric bypass: impact of multiple prior bariatric operations on outcome. Obes Surg 16:865–869CrossRefPubMedGoogle Scholar
  31. 31.
    Ikramuddin S, Kellogg TA, Leslie DB (2007) Laparoscopic conversion of vertical banded gastroplasty to a Roux-en-Y gastric bypass. Surg Endosc 21:1927–1930CrossRefPubMedGoogle Scholar
  32. 32.
    Khaitan L, Van Sickle K, Gonzalez R, Lin E, Ramshaw B, Smith CD (2005) Laparoscopic revision of bariatric procedures: is it feasible? Am Surg 6:206–211Google Scholar
  33. 33.
    Deylgat B, D’Hondt M, Pottel H, Vansteenkiste F, Van Rooy F, Devriendt D (2012) Indications, safety, and feasibility of conversion of failed bariatric surgery to Roux-en-Y gastric bypass: a retrospective comparative study with primary laparoscopic Roux-en-Y gastric bypass. Surg Endosc 26:1997–2002CrossRefPubMedGoogle Scholar
  34. 34.
    Delko T, Kostler T, Peev M, Esterman A, Oertli D, Zingg U (2014) Revisional versus primary Roux-en-Y gastric bypass: a case-matched analysis. Surg Endosc 28:552–558CrossRefPubMedGoogle Scholar
  35. 35.
    Carr WRJ, Jennings NA, Boyle M, Mahawar K, Balupuri S, Small PK (2015) A retrospective comparison of early results of conversion of failed gastric banding to sleeve gastrectomy or gastric bypass. Surg Obes Relat Dis 2:379–384CrossRefGoogle Scholar
  36. 36.
    Aarts E, Koehestanie P, Dogan K, Berends F, Janssen I (2014) Revisional surgery after failed gastric banding: results of one-stage conversion to RYGB in 195 patients. Surg Obes Relat Dis 10:1077–1083CrossRefPubMedGoogle Scholar
  37. 37.
    Emous M, Apers J, Hoff C, van Beek AP, Totte E (2015) Conversion of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass is safe as a single-step procedure. Surg Endosc 29(8):2217–2223CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Kamran Samakar
    • 1
    Email author
  • Travis J. McKenzie
    • 2
  • James Kaberna
    • 3
  • Ali Tavakkoli
    • 3
  • Ashley H. Vernon
    • 3
  • Arin L. Madenci
    • 4
  • Scott A. Shikora
    • 3
  • Malcolm K. Robinson
    • 3
  1. 1.Department of General and GI SurgeryUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.Department of General SurgeryMayo ClinicRochesterUSA
  3. 3.Department of General and GI SurgeryBrigham and Women’s HospitalBostonUSA
  4. 4.Department of UrologyBrigham and Women’s HospitalBostonUSA

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