One-stage conversion of laparoscopic adjustable gastric banding to laparoscopic 1-anastomosis gastric bypass: a single-center experience on 1,000 patients at 5 years of follow-up |
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| Institution: | 1. Department of Digestive and Bariatric Surgery, Geoffroy Saint Hilaire Clinic, Ramsay Santé, Paris, France;2. ELSAN, Obesity Surgical Center, Saint Michel Clinic, Toulon, France;3. Department of Digestive and Bariatric Surgery, Madonna della Salute Clinic, Porto Viro, Italy;1. Department of Surgery, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas;2. Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas;1. Department of Surgery, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, Texas;2. Department of Surgery, William Beaumont Army Medical Center, El Paso, Texas;3. Department of Surgery, Mayo Clinic, Rochester, Minnesota;1. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan;2. Center for Obesity, Life Style, and Metabolic Surgery, National Taiwan University Hospital, Taipei, Taiwan;3. Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan;4. Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan;5. Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;6. Metabolic and Weight Management Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan;7. Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan;8. Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan;1. Department of Digestive and Endocrine Surgery, Magellan Center, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France;2. Endocrinology and Nutrition Department, INSERM Unit 1215, Bordeaux University Hospital, University of Bordeaux, Bordeaux, France;3. French National Health Fund, Paris, France;1. Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China;2. Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China;1. Université de Paris, Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies, Centre de Recherche sur l’Inflammation Paris Montmartre INSERM UMRS 1149, F-75890, Paris, France;2. Service de chirurgie générale et digestive, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France;3. Service d’hépato-gastro-entérologie, AP-HP, Hôpital Louis Mourier, DMU ESPRIT-GHU AP-HP, Nord-Université de Paris, Colombes, France |
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| Abstract: | BackgroundData regarding the use of 1-anastomosis gastric bypass (OAGB) as a conversion technique after laparoscopic adjustable gastric banding (LAGB) failure is scarce in the literature.ObjectivesThe aim of this study was to assess our experience with OAGB as a rescue procedure after failed LAGB.SettingThis study involved patients treated at a private hospital in France.MethodsThis single-center retrospective study included all consecutive patients receiving OAGB from January 2005 to January 2016. Of the 3,224 patients, 63.5% received primary OAGB (pOAGB) and 36.5% received OAGB as a conversion procedure after LAGB (cOAGB).ResultsDuring the period considered, 2,046 patients with obesity received pOAGB, whereas 1,000 patients underwent conversion of LAGB to OAGB in 1 step. The rate of patients lost to follow-up at 5 years was 31% in the pOAGB group and 32.5% in the cOAGB group (P = .4). Five years after the surgery, the mean body mass index was 30.8 ± 10.2 kg/m2, the mean percentage total weight loss was 34.6% ± 9.6%, and the mean percentage excess weight loss was 76.1% ± 24.6% in the pOAGB group, and the mean was 29.7 ± 10.4 kg/m2 (P = .58), the mean percentage total weight loss was 33.8% ± 10.2% (P = .82) and the mean percentage excess weight loss was 73.5% ± 22.2% (P = .78) in the cOAGB group. There was no difference in terms of early complications between the 2 groups (3.2% pOAGB versus 3.6% cOAGB, P = .59), while there was a statistically significant difference in terms of late complications (11% pOAGB versus 18% cOAGB, P < .00001). In particular, there was a significantly higher incidence of symptomatic postoperative biliary reflux in the cOAGB group (12% in cOAGB versus 5% in pOAGB, P < .00001).ConclusionIn this study, OAGB was effective and safe as a rescue technique after LAGB failure. Conversion in one step did not appear to increase the risk of early complications, whereas a history of gastric banding seems to increase the risk of bile reflux in the long term. |
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