Single Stage Conversion from Laparoscopic Adjustable Gastric Band to Laparoscopic Sleeve Gastrectomy is Safer than Laparoscopic Adjustable Gastric Band to Roux-en-Y Gastric Bypass: Results of a 10-Year Analysis of Complications

Abstract

Background: Conversion from laparoscopic Adjustable Gastric Band (AGB) to Roux-en-y gastric bypass (RNY) or Sleeve Gastrectomy (SG) is now common. Complication rates up to 25% have been reported. We reviewed the experience at a Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Center of Excellence.Study Design: Our prospective database was retrospectively reviewed for single-stage conversions over a 10-year period ending in 2017 to assess outcomes compared to primary procedures. In revisions, we reinforce staple lines with buttress material, oversew staple lines in high-risk patients, and avoid stapling or anastomosing into scar capsule tissue. Statistical analysis was performed using t-test, chi-square, Fisher's Exact, McNemar's, and Wilcoxon signed rank tests.Results: † Fisher's Exact test for conversion RNY vs. conversion SG re-op p = 0.0039 Conclusions:The risk of leak appears to be higher with conversion to RNY vs. SG. This finding should be weighed heavily when selecting revision procedures for high-risk patients.