Sleeve Gastrectomy As a Rescue of Failed Gastric Banding: Comparison of 1- and 2-Step Approaches Publisher Pubmed



Demouron M¹ ; Rebibo L^{2, 3, 4} ; Davarpanah Jazi AH⁵ ; Arapis K² ; Hansel B⁶ ; Dhahri A^{1, 4} ; Regimbeau JM^{1, 4} ; Msika S^{2, 3}
Source: Surgery for Obesity and Related Diseases Published:2020

Abstract

Background: Series comparing gastric banding (GB) removal and sleeve gastrectomy (SG) when procedures are performed as a 1- or a 2-step approach are contradictory in their outcomes. No series comparing these approaches with midterm weight loss is available. Objectives: Compare the outcomes and weight loss of SG performed as 1- and 2-step approaches as a revisional procedure for GB failure. Setting: University Hospital, France, public practice. Methods: Between February 2006 and January 2017, all patients undergoing SG with a previous history of implementation of GB (n = 358) were included in this 2-center, retrospective, observational study. Revisional surgery was proposed in patients with insufficient excess weight loss (excess weight loss ≤50%) or weight regain after GB. A 1-step (1-step group, n = 270) or 2-step (2-step group, n = 88) approach was decided depending on patient's choice and/or surgeon's preference. The primary efficacy endpoint was the comparison of weight loss in the 1- and 2-step groups at the 2-year follow-up. The secondary efficacy endpoints were short-term outcomes (overall mortality and morbidity at postoperative day 30, specific morbidity, reoperation, length of hospital stay, and readmission). Results: In the 1-step group, the mean preoperative body mass index before SG was 40.5 kg/m2 (27.0–69.0), while in the 2-step group, the mean preoperative body mass index was 43.5 kg/m2 (31.5–61.7). Mean operating time was 109 minutes (50–240) in the 1-step group and 78.7 minutes (40–175) in the 2-step group (P =. 22). In the 1-step group, 6 conversions to laparotomy occurred, while in the 2-step group, 2 conversions to laparotomy occurred (P =. 75). One death (.2%, in the 2-step group) and 39 complications (30 in the 1-step group [11.1%] and 9 in the 2-step group [10.2%]) also occurred. The mean length of hospital stay was 6.2 days in the 1-step group and 4.1 days in the 2-step group. At 2-year follow-up, mean body mass index was 32.4 kg/m2 in the 1-step group and 33.2 kg/m2 in the 2-step group (P =. 15), representing excess weight losses of 61.9 and 50.1 (P = .05), respectively. The rates of revisional surgery were. 7% and 2.2%, respectively. Conclusions: SG after previous GB is efficient with similar outcomes depending on the 1- or 2-step approach. The 1-step approach seems to have increased weight loss compared with the 2-step approach. © 2020 American Society for Bariatric Surgery