Outcomes After Laparoscopic Conversion of Failed Adjustable Gastric Banding (LAGB) to Laparoscopic Sleeve Gastrectomy (LSG) or Single Anastomosis Duodenal Switch (SADS)

Abstract

Background

Inadequate weight loss following LAGB (laparoscopic adjusted gastric banding) requiring band removal and conversion to another bariatric procedure is common. There is a paucity of objective data to guide procedure selection. Single anastomosis modifications (SIPS, SADI, SADS) of the duodenal switch biliopancreatic division (DS-BPD) are being investigated. Laparoscopic sleeve gastrectomy (LSG) has become the most prevalent primary bariatric procedure and has been used for revision following LAGB.

Purpose

The purpose is to investigate single-stage LAGB removal to LSG SADS (single anastomosis duodenal switch). A matched cohort analysis compared each revision to a similar patient having a primary procedure. This was performed to understand the impact of prior banding on outcomes with each procedure.

Materials and Methods

This is a retrospective study to investigate the outcomes of revision of LAGB for inadequate weight loss to LSG or SADS. To determine whether prior banding impairs results, a matched cohort was done comparing each revision to a patient that had a primary procedure.

Results

As expected, patients who had SADS had greater weight loss than LSG. There was no difference in peri-operative and early complications. Both procedures resulted in weight loss. Importantly, with matched cohort, prior LAGB decreased weight loss outcomes in LSG, but not SADS.

Conclusion

Conversion of LAGB to LSG or SADS results in weight loss. The presence of LAGB decreases weight loss in LSG, but not in SADS. This can have important implications for long-term outcomes.

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Change history

  • 07 March 2019

    In the original article the Conflict of Interest statement was incomplete. Dr. Roslin discloses that he is a teaching consultant for Ethicon and Medtronics. He also has received research funding from Medtronics.

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Correspondence to Ali Shayesteh.

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Institutional Review Board of the Northwell Health approval was obtained for this study.

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Pearlstein, S., Sabrudin, S.A., Shayesteh, A. et al. Outcomes After Laparoscopic Conversion of Failed Adjustable Gastric Banding (LAGB) to Laparoscopic Sleeve Gastrectomy (LSG) or Single Anastomosis Duodenal Switch (SADS). OBES SURG 29, 1726–1733 (2019). https://doi.org/10.1007/s11695-019-03729-3

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Keywords

  • Laparoscopic adjustable gastric banding (LAGB)
  • Failed/revision LAGB
  • Single anastomosis duodenal switch
  • Laparoscopic vertical sleeve gastrectomy
  • Nutrition
  • Outcome of revision LAGB