One or two steps for laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy: a nationwide French study on 3357 morbidly obese patients.

Background: Adjustable gastric banding (AGB) has been a very common bariatric procedure, but long-term AGB related complications have led to an increased number of second procedures. Sleeve gastrectomy (SG) is one option and can be done as a 1- or 2-step procedure.

Objectives: To compare the 1-step and 2-step approachs of conversion of AGB to SG with respect to postoperative mortality and morbidity.

Setting: Nationwide study, France.

Methods: All morbidly obese patients who underwent AGB followed by SG in France between 2007 and 2012 were included. Multivariate analyses were conducted using the French National Health Service Database data to ascertain predictive factors for 90-day postoperative mortality and morbidity.

Results: There were 2061 and 1296 patients in the 1-step and 2-step conversion groups, respectively. The readmission rate was 22.8% and 16.5% in the 1- and 2-step groups, respectively (P<.001). More patients required an intensive care unit stay in the 1-step group (11.7 % versus 6.7%; P<.001). The 90-day mortality was .1%, with no difference between the 2 groups (1% versus .08%). The complication rate was 14.7% (1-step 15.9% versus 2-step 12.7%; P = .009). The timing of AGB removal (P = .02), patient age 50-60 years (P = .004), hypertension (P = .01), surgical approach (P = .002), and hospital status (P = .015) were significantly associated with the complication rate.

Conclusion: This study indicates that the 2-step conversion of failed AGB to SG results in a significantly reduced rate of postoperative staple line leaks, gastric tube stricture, respiratory complication, and need for intensive care unit stay.