Laparoscopic Roux-en-Y Gastric Bypass for Failed Gastric Banding: One-Step or Two-Step Revisional Surgery?

Background: Surgical revision rates are high, reaching 41% at 10 years after Laparoscopic gastric band (LAGB). Surgical revision may include re-banding, laparoscopic sleeve gastrectomy (LSG), duodenal switch (DS), or laparoscopic Roux-en-Y gastric bypass (LRYGB). LRYGBP has been proposed as the procedure of choice after failure of restrictive procedures with better results than any other procedure. LRYGB as a revisional bariatric surgery is hazardous compared with primary LRYGB. However, controversy as to whether revisional bariatric surgery should be performed as a one-step revision or as a two-step revision.

Objective: We aim to compare the mortality and morbidity between one-step versus two-step revisional surgery from LAGB to LRYGB.

Materials And Methods: Retrospective cohort study of our revisional surgery from LAGB to LRYGB between November 2007 and December 2016. Revisional surgery was indicated in cases of inadequate weight loss or weight regain and after band-related complications. Gastric band removal and conversion to LRYGB was either in a one-step or a two-step procedure, according to the indication of this revisional surgery and based on the intra-operative decision.

Results: One-step group included 107 patients, two-step group had 76 patients.

Minor Complications: Dindo-Clavien I-II: 5 complication in the one-step group, whereas 4 complication were seen in the two-step group (P = 1.000).

Major Complications: Dindo-Clavien ≥ IIIa complications: 10 complication in the one-step group, whereas 2 complications in the two-step group (P = 0.127).

Conclusion: One-step revision is safe and feasible, without significant increased morbidity when performed in a specialized institution. However, proper patient selection is of the utmost importance.