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A comparison between one- and two-stage revisional gastric bypass

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Abstract

Background

The safety of performing a one-stage revision from laparoscopic adjustable gastric banding (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) has been questioned. The objective of this study was to compare safety and outcomes of one-stage versus two-stage revisional LRYGB performed after failed LAGB.

Methods

A retrospective analysis of all patients undergoing revisional LRYGB after failed LAGB between January 2007 and March 2017 was performed. Patients undergoing one- and two-stage revisions were compared. The primary outcome assessed was the early complication rate, while secondary outcomes included late complications, weight loss, and improvement of comorbidities.

Results

During the study period, 161 revisional LRYGB’s were performed, including 121 one-stage and 40 two-stage procedures. Baseline demographic data, BMI and presence of comorbidities were similar between the groups. In patients undergoing a two-stage procedure, band slippage, port infection, and erosion were more commonly cited as indications for revision. Similar early complication rates were demonstrated between the groups. However, late complications were more common in the two-stage group (20.0% vs. 7.4%, P = 0.03), including higher rates of gastro-gastric fistula (5.0% vs. 0%, P = 0.01) and anemia (10.0% vs. 1.1%, P = 0.02). Three-fourths of the cohort had a follow-up of more than 6 months, and the two groups demonstrated similar weight loss results and improvement/resolution of comorbidities.

Conclusion

The performance of one-stage revisional LRYGB after failed LAGB seems to be a safe procedure, with noninferior outcomes when compared to a two-stage revisional procedure. It is a valid option, except in cases of mechanical and infectious band complications.

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Authors and Affiliations

  1. Department of Surgery, Hadassah-Hebrew University Medical Center, Mount Scopus, 91240, Jerusalem, Israel

    Abbas Al-Kurd, Ronit Grinbaum, Ido Mizrahi, Ala’a Abubeih, Atara Indursky, Hani Abu Hamdan, Haggi Mazeh & Nahum Beglaibter

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  1. Abbas Al-Kurd
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  2. Ronit Grinbaum
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  3. Ido Mizrahi
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  4. Ala’a Abubeih
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  5. Atara Indursky
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  6. Hani Abu Hamdan
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  7. Haggi Mazeh
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  8. Nahum Beglaibter
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Correspondence to Abbas Al-Kurd.

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Disclosures

Drs. Abbas Al-Kurd, Ronit Grinbaum, Ido Mizrahi, Ala’a Abubeih, Atara Indursky, Hani Abu Hamdan, Haggi Mazeh, and Nahum Beglaibter have no conflicts of interest or financial ties to disclose.

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Al-Kurd, A., Grinbaum, R., Mizrahi, I. et al. A comparison between one- and two-stage revisional gastric bypass. Surg Endosc 33, 1459–1464 (2019). https://doi.org/10.1007/s00464-018-6427-2

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  • DOI: https://doi.org/10.1007/s00464-018-6427-2

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