Propensity score matching analysis comparing outcomes between primary and revision Roux-en-Y gastric bypass after adjustable gastric banding: a retrospective record-based cohort study

Abstract

Background One-stage revision Roux-en-Y gastric bypass (RRYGB) after Laparoscopic adjustable gastric banding (LAGB) is widely adopted, but its safety is still debated. Objective This study aimed to compare outcomes between primary Roux-en-Y gastric bypass (PRYGB and RRYGB after LAGB. Method A retrospective record-based cohort study of patients who underwent PRYGB and RRYGB for failed LAGB and completed at least 2 years of follow-up from 2008 to 2019. Propensity score matching (PSM) analysis was conducted to obtain a balanced sample of patients with RRYGB and PRYGB interventions by adjusting for baseline covariates including age and sex. Results Patients with PRYGB (n = 558) and RRYGB (n = 156) were included. PSM identified 98 patients for RRYGB and 98 patients for PRYGB. Both cohorts exhibited significant reductions in BMI compared to baseline values (p < 0.001), but reductions were significantly higher in PRYGB compared to those in RRGYB at 6 months (− 10.55 ± 8.54 vs. − 8.38 ± 5.07; p = 0.032), 1-year (− 21.50 ± 8.19 vs. 16.14 ± 6.93; p < 0.001), and 2 years (− 24.02 ± 7.85 vs. − 18.93 ± 6.80; p < 0.001), respectively. A significant improvement in food tolerance from the 1st to the 2nd year was seen after RYGB (p < 0.001). The rates of early and late complications were similar in both cohorts (p = 0.537, p = 1.00). Overall re-intervention rates were 5.1 and 3.1% for RRYGB and PRYGB p = 0.721). Both cohorts exhibited significant improvement in comorbidities after 2 years (p < 0.001). Conclusions One-stage RRYGB for failed LAGB is safe and effective with comparable rates of complications, re-interventions, and resolution of associated comorbid conditions compared to PRYGB.

Outcomes of primary versus conversional Roux-En-Y gastric bypass after laparoscopic sleeve gastrectomy: a retrospective propensity score–matched cohort study

“…Moreover, studies comparing PRYGB cohorts to similar cohorts of CRYGB following one primary procedure, for example, adjustable gastric banding or vertical banded gastroplasty, also showed less weight loss with CRYGB [ 18 , 19 ].…”

“…Consequently, it was difficult to determine which procedure yielded the most favorable outcomes. In the literature, few studies have compared the outcomes of PRYGB to conversional RYGB following a single procedure, such as adjustable gastric band [ 18 ] or vertical banded gastroplasty [ 19 ]. To the best of our knowledge, there is a dearth of studies comparing the outcomes of primary Roux-en-Y gastric bypass (PRYGB) and conversional Roux-en-Y gastric bypass (CRYGB) exclusively following LSG.…”