Conversion from Band to Bypass in Two Steps Reduces the Risk for Anastomotic Strictures

Nieuwenhove, Yves Van; Ceelen, Wim; Renterghem, Katrien Van; Putte, Dirk Van de; Henckens, Tom; Pattyn, Piet

doi:10.1007/s11695-010-0331-8

Cited by 47 publications

(18 citation statements)

References 32 publications

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“…Previous reports indicate that the incidence of GJ anastomotic stricture following secondary gastric bypass is increased compared to primary operations [6,17]. Surprisingly, no anastomotic stricture was found in this study.…”

Section: Discussioncontrasting

confidence: 67%

“…The question of performing a conversion from LAGB to LRYGB in one or two steps is controversial [6,17]. There were two postoperative complications (one pneumonia and one subphrenical abscess, Table 3) in the seven conversions in one step (2/7=28.6%) compared to the seven complications in the two-step conversions (7/21=33.3%, Table 3), but our numbers are too small for any conclusions on this matter.…”

Section: Discussionmentioning

confidence: 88%

“…Seven of the 28 conversions to RYGB following failed gastric bandings were done by laparoscopic removal of the band and conversion during the same operation. The rest of these operations were done in two steps, with removal of the band during the primary operation, followed by LRYGB 4-6 months later, which may be considered a safer way to accomplish conversion from gastric banding to LRYGB [17]. Either way, there were no major complications in these patients, except for a double-sided pulmonary embolism in the emergency patient described earlier.…”

Section: Discussionmentioning

confidence: 95%

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Revisional Bariatric Surgery by Conversion to Gastric Bypass or Sleeve—Good Short-Term Outcomes at Higher Risks

Victorzon

2011

OBES SURG

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This is a retrospective study of prospectively collected data from 34 patients who had revisional bariatric surgery at a single centre. The aim was to report the indications for revisional surgery, operative time, conversion to open surgery, mortality, hospital stay, early and late complications, reoperations and short-term efficacy. From 2006 to 2011, 31 patients who formerly had been operated for morbid obesity with restrictive operations and 3 patients who had been operated in the upper abdomen for other morbidities (fundoplications 2, Heller's myotomy 1) underwent a revisional Roux-en-Y gastric bypass operation (n = 30) or sleeve gastrectomy (n = 4). Demographic data, perioperative characteristics and follow-up data were entered prospectively in the hospital's database for bariatric patients. Twenty-five operations were done by laparoscopic and nine by open technique. The mean operative time was 113.17 (33.98, 54-184) min. The mean postoperative hospital stay was 3.25 (5.71, 1-32) days. Intra-operative complications occurred in six patients (17.65%), postoperative complications in nine (26.47%), and major complications in three patients (8.82%), including leakage in the gastrojejunal anastomosis in two (5.88%) patients. The conversion rate to open surgery was 2.94% (one emergency patient). There was no mortality. Excess weight loss (%, ± SD) at 3 months follow-up averaged 42.31%, ± 21.54. Revisional bariatric surgery can be performed with an increased but acceptable risk, with at least short-term weight loss comparable to primary operations.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 95%

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Revisional Bariatric Surgery by Conversion to Gastric Bypass or Sleeve—Good Short-Term Outcomes at Higher Risks

Victorzon

2011

OBES SURG

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“…The rest of these operations were performed in two steps; the band was removed during the primary operation, and a RYGB was performed 4-6 months later. This may be considered a safer way to accomplish conversion from gastric banding to LRYGB (21).…”

Section: Discussionmentioning

confidence: 99%

Perioperative Morbidity, Mortality and Early Outcome of the First 360 Gastric Bypass Operations Performed in a District Hospital

2012

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Background and Aims: We report the results for the first consecutive 360 roux-en-y gastric bypass (rygb) operations performed in a district hospital in finland.Material and Methods: demographic data, perioperative characteristics, and follow-up data were entered prospectively in the hospital's database for bariatric patients.Results: We performed 325 primary laparoscopic roux-en-y gastric bypass (lrygb) operations, one open rygb, and 34 revisions. mean bmi before the operations was 47.5 ± 7.8 kg/m 2 (31.5-91.0 kg/m 2 ). the percentage of patients with type 2 diabetes mellitus (t2dm) was high; 52.3% (170 patients). the mean operative time decreased from 110 minutes during the first 108 operations to 82 minutes for the second 108 operations, and to 74 minutes for the last 109 operations (P < 0.001). Postoperative hospital stay was significantly reduced (P < 0.001) for the last 109 patients compared to the first and second group of patients. overall morbidity averaged 19.1% (62/325). severe complications were detected in 15 patients (4.6%). there was a tendency to more serious complications in the first group of patients. there was one death (mortality 0.3%). With a follow-up rate of 97% at 3 months t2dm had resolved in 48.2%, and had resolved or improved in a minimum of 92.9% of the diabetic patients. Weight loss (Wl) and excess weight loss (eWl) averaged 20% and 46% respectively.Conclusions: operative time and postoperative hospital stay decrease significantly with increasing experience. the first one hundred patients may be at higher risk for complications. lrygb operations may have an important impact on the resolution of t2dm in the operated population.

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“…However, this strategy is not consensual. According to Van Nieuwenhove et al, 27 a time interval after a band removal, might allow inflammation reduction of the upper gastric portion. In their series, there were no differences between the two conversion strategies in terms of weight loss, whereas morbidity and rate of anastomotic strictures were reduced.…”

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confidence: 99%

Laparoscopic Adjustable Gastric Band: Complications, Removal and Revision in a Portuguese Highly Differentiated Obesity Treatment Center

et al. 2015

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2014 and were subsequently converted to gastric banding, gastric bypass or sleeve gastrectomy. Women who got pregnant during the initial gastric banding follow-up and patients that performed more than one conversion were excluded. Results: A total of 103 patients were included. Fifteen underwent revision to gastric banding, 71 to gastric bypass and 17 to sleeve gastrectomy. Respectively, percentage of excess weight loss at 1 month were 1.9 ± 12.2% in 6 patients, 36.9 ± 18.2% in 49 patients and 27.1% (13.3 -68.6) in 11 patients (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p < 0.001, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0.002 and laparoscopic Roux-en-Y gastric bypass--laparoscopic sleeve gastrectomy p = 0.474). At 3 months there were 12.8% (5.7 -84.8) in 6 patients, 44.8 ± 19.7% in 24 patients and 48 ± 20.1% in 8 patients (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p = 0.017, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0.039 and laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0.691). Discussion: At revision, ages and body mass indices are higher than other studies. Gastric bypass is the preferred revision surgery, because combines restriction and malabsorption, surgeons have more experience and long term outcomes are better described. Conclusions:The main indications for reoperation were inadequate weight loss (37.4%) and band slippage (30%). At short term, in our patients, gastric banding as a revision surgery was not effective, as opposed to gastric bypass and sleeve gastrectomy.

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Conversion from Band to Bypass in Two Steps Reduces the Risk for Anastomotic Strictures

Abstract: Operating time and hospital stay are increased when conversion is performed in two steps, but, in this small series, this strategy decreased morbidity and more specifically the rate of anastomotic strictures.

Cited by 47 publications

References 32 publications

Revisional Bariatric Surgery by Conversion to Gastric Bypass or Sleeve—Good Short-Term Outcomes at Higher Risks

Revisional Bariatric Surgery by Conversion to Gastric Bypass or Sleeve—Good Short-Term Outcomes at Higher Risks

Perioperative Morbidity, Mortality and Early Outcome of the First 360 Gastric Bypass Operations Performed in a District Hospital

Laparoscopic Adjustable Gastric Band: Complications, Removal and Revision in a Portuguese Highly Differentiated Obesity Treatment Center

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