Systematic Review and Meta-Analysis of Outcomes After Revisional Bariatric Surgery Following a Failed Adjustable Gastric Band

Abstract

Introduction

Laparoscopic adjustable gastric band (LAGB)-related complications have been reported in significant numbers of patients often leading to band removal. Increasingly revisional bariatric surgery (RBS) is offered, most commonly either band to Roux-en-Y gastric bypass (B-RYGB) or band to sleeve gastrectomy (B-SG).

Objectives

We conducted a systematic review and meta-analysis of studies to evaluate the efficacy of RBS following failed LAGB.

Methods

Medline, Embase, The Cochrane Library and NHS Evidence were searched for English language studies assessing patients who had undergone LAGB and who subsequently underwent either B-RYGB or B-SG.

Results

Thirty-six studies met the inclusion criteria. There were 2617 patients. B-RYGB was performed in 60.5% (n = 1583). There was one death within 30 days (0.0004%). The overall pooled morbidity rate was 13.2%. There was no difference between the B-RYGB and B-SG groups in morbidity, leak rate or return to theatre. Percentage excess weight loss (%EWL) following the revisional procedure for all patients combined at 6, 12 and 24 months was 44.5, 55.7 and 59.7%, respectively. There was no statistical difference in %EWL between B-RYGB and B-SG at any time point. The rates of remission of diabetes, hypertension and obstructive sleep apnoea were 46.5, 35.9 and 80.8%, respectively.

Conclusions

Randomised controlled trials (RCTs) do not exist on this issue but the available observational evidence does suggest that RBS is associated with generally good outcomes similar to those experienced after primary surgery. Further, high-quality research, particularly RCTs, is required to assess long-term weight loss, comorbidity and quality of life outcomes.

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Acknowledgements

Dr. A A Tahrani is a clinician scientist supported by the National Institute for Health Research (NIHR) in the UK. The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the NIHR or the Department of Health.

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Correspondence to Alistair J. Sharples.

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AAT and RS contribute equally as joint senior authors.

Appendix 1: Electronic Search Strategy

Appendix 1: Electronic Search Strategy

A comprehensive literature search was run Medline, Embase, The Cochrane Library and NHS Evidence up to November 2015. The following search strategy was used:

‘Laparoscopic Adjustable Gastric Banding OR Laparoscopic Sleeve Gastrectomy OR Laparoscopic Roux-en-Y Gastric Bypass’, ‘Revision OR Revisional OR Reoperation OR Salvage OR Rescue OR Repeat’, ‘Weight loss OR Postoperative Complication OR Surgical Complication OR Morbidity OR Mortality OR Quality of Life OR Comorbidities’.

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Sharples, A.J., Charalampakis, V., Daskalakis, M. et al. Systematic Review and Meta-Analysis of Outcomes After Revisional Bariatric Surgery Following a Failed Adjustable Gastric Band. OBES SURG 27, 2522–2536 (2017). https://doi.org/10.1007/s11695-017-2677-7

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Keywords

  • Revisional bariatric surgery
  • Adjustable gastric band