Conversion to Roux-en-Y gastric bypass versus one-anastomosis gastric bypass after a failed primary gastric band: a matched nationwide study |
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| Affiliation: | 1. Department of Surgery, Maastricht University Medical Centre, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands;2. Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands;3. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands;4. Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands;5. Dutch Obesity Clinic, The Hague and Gouda, The Netherlands;6. Department of Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands;7. Dutch Obesity Clinic South, Heerlen, The Netherlands;8. Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands;1. Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran;2. Nutrition and Metabolic Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran;3. Department of Exercise Physiology, University of Isfahan, Isfahan, Iran;4. Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran;5. Department of Health and Human Performance, Marymount University, Arlington, Virginia;6. Sepidan Bagherololoom Higher Education College, Shiraz University of Medical Sciences, Shiraz, Iran;7. Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran |
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| Abstract: | BackgroundPrimary laparoscopic adjustable gastric band (LAGB) has high rates of patients not achieving the desired weight loss, and it remains unclear which bariatric conversion procedure gives better results.ObjectiveTo compare weight loss among patients undergoing conversion one-anastomosis gastric bypass (cOAGB) and conversion Roux-en-Y gastric bypass (cRYGB) after a failed LAGB.SettingNationwide population-based study including all 18 hospitals providing metabolic and bariatric surgery.MethodsPatients with a failed primary LAGB who underwent a cRYGB or cOAGB between January 1, 2015, and December 31, 2019, were selected from the Dutch Audit for Treatment of Obesity. The primary outcome was not achieving ≥20% total weight loss (TWL) at 1-year and up to 5-year follow-up. Secondary outcomes included postoperative complications, defined as Clavien-Dindo ≥III within 30 days, and co-morbidity remission. A propensity score matched logistic and Poisson regression model was used to estimate the difference in patients not achieving ≥20% TWL between cRYGB and cOAGB.ResultsA total of 615 (78.7%) patients underwent cRYGB, and 166 (21.3%) patients underwent cOAGB, with 163 patients successfully matched. Both groups had similar rates of patients not achieving ≥20% TWL at 1 year (odds ratio [OR] = .64, 95% confidence interval [CI]: .38–1.05). However, a sensitivity analysis showed that patients undergoing cOAGB had lower rates of patients not achieving ≥20% TWL up to 5-year follow-up (rate ratio = .69, 95% CI: .51–.95, P < .05). Patients undergoing cOAGB were less likely to achieve hypertension remission (OR = .22, 95% CI: .07–.66). There were no significant differences between groups in postoperative complications (OR = .39, 95% CI: .07–2.06, P > .05).ConclusionThis matched nationwide study suggests that the cOAGB has similar short-term weight loss outcomes but potentially better long-term weight loss results than cRYGB. Therefore, cOAGB could provide a reliable alternative but needs to be substantiated in future long-term studies. |
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| Keywords: | Revision bariatric surgery Conversion Population-based DATO Roux-en-Y gastric bypass One-anastomosis gastric bypass Failed gastric banding Propensity score matching |
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