Short-Term Outcomes of Conversion of Failed Gastric Banding to Laparoscopic Sleeve Gastrectomy or Roux-En-Y Gastric Bypass: a Meta-Analysis
Laparoscopic adjustable gastric banding (LAGB) is associated with high long-term failure rates, often requiring conversion to an alternative bariatric procedure. The most efficacious procedure after failed LAGB is subject to debate. Our objective was to compare 12-month weight loss following laparoscopic sleeve gastrectomy (LSG) vs. laparoscopic Roux-en-Y gastric bypass (LRYGB) performed for insufficient weight loss or weight regain after LAGB.
A systematic search was conducted in PubMed and Medline for English language studies comparing weight loss after a conversion surgery for failed gastric banding. We examined studies with patients who had at least 1-year follow-up and included conversions to both LSG and LRYGB. A fixed effects model was created, and variance measures were calculated to measure heterogeneity. Both were analyzed for significance. All statistical analyses were conducted with the “meta” package in R 3.3.2.
The initial search produced 17 studies. Six studies, consisting of 205 LSG and 232 LRYGB patients, met our inclusion criteria and were included in the review. Heterogeneity among studies was high (Q = 23.1; p < 0.001). There was no statistically significant difference in weight loss after 12 months between the groups (p = 0.14).
It remains unknown which conversion procedure is more appropriate to perform after a failed gastric band in order to achieve the highest weight loss potential. In our meta-analysis, there was no difference in weight loss after 12 months in patients who were converted to LSG or LRYGB. Further studies and longer follow-up comparisons are required before firm conclusions can be drawn.
KeywordsConversion bariatric surgery Laparoscopic sleeve gastrectomy vs. Roux-en-Y bypass after failed band Revisional bariatric surgery
Compliance with Ethical Standards
Informed consent was not a necessary component of this study.
This article does not contain any studies with human participants or animals performed by any of the author.
Conflict of Interest
The authors declare that they have no conflict of interest.
- 7.Aarts E, Koehestanie P, Dogan K, et al. Revisional surgery after failed gastric banding: results of one-stage conversion to RYGB in 195 patients. Surg Obes Relat Dis. 2014;10(6):1077–83. https://doi.org/10.1016/j.soard.2014.07.006. http://www.ncbi.nlm.nih.gov/pubmed/25443075 CrossRefPubMedGoogle Scholar
- 8.Holst JJ, Madsbad S, Bojsen-Møller KN, et al. Mechanisms in bariatric surgery: gut hormones, diabetes resolution, and weight loss. Surg Obes Relat Dis. 2018;14(5):708–14. https://doi.org/10.1016/j.soard.2018.03.003. https://www.sciencedirect.com/science/article/pii/S1550728918301242 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Carr WRJ, Jennings NA, Boyle M, et al. A retrospective comparison of early results of conversion of failed gastric banding to sleeve gastrectomy or gastric bypass. Surg Obes Relat Dis. 2015;11(2):379–84. https://doi.org/10.1016/j.soard.2014.07.021. http://www.ncbi.nlm.nih.gov/pubmed/25443072.CrossRefPubMedGoogle Scholar
- 10.Dimitriadis E, Daskalakis M, Kampa M, et al. Alterations in gut hormones after laparoscopic sleeve gastrectomy: a prospective clinical and laboratory investigational study. Ann Surg. 2013;257(4):647–54. https://doi.org/10.1097/SLA.0b013e31826e1846. https://www.ncbi.nlm.nih.gov/pubmed/23108120 CrossRefPubMedGoogle Scholar
- 12.Acholonu E, McBean E, Court I, et al. Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity. Obes Surg. 2009;19(12):1612–6. https://doi.org/10.1007/s11695-009-9941-4. http://www.ncbi.nlm.nih.gov/pubmed/19711138 CrossRefPubMedGoogle Scholar
- 15.Marin-Perez P, Betancourt A, Lamota M, et al. Outcomes after laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy or roux-en-Y gastric bypass. Br J Surg. 2014;101(3):254–60. https://doi.org/10.1002/bjs.9344. http://onlinelibrary.wiley.com/doi/10.1002/bjs.9344/abstract CrossRefPubMedGoogle Scholar
- 16.Khoursheed M, Al-Bader I, Mouzannar A, et al. Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Surg Endosc. 2013;27(11):4277–83. https://doi.org/10.1007/s00464-013-3038-9. http://www.ncbi.nlm.nih.gov/pubmed/23756590 CrossRefPubMedGoogle Scholar
- 18.Al Sharqawi N, Al Sabah S, Al Mulla A, et al. Conversional surgery: single-step conversion of laparoscopic adjustable gastric band to laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(10):1808–11. https://doi.org/10.1007/s11695-014-1358-z. http://www.ncbi.nlm.nih.gov/pubmed/25005810 CrossRefPubMedGoogle Scholar
- 19.Palikhe G, Gupta R, Behera B, et al. Efficacy of laparoscopic sleeve gastrectomy and intensive medical management in obese patients with type 2 diabetes mellitus. Obes Surg. 2014;24(4):529–35. https://doi.org/10.1007/s11695-013-1114-9. http://www.ncbi.nlm.nih.gov/pubmed/24272885 CrossRefPubMedGoogle Scholar