A comparison between one- and two-stage revisional gastric bypass

Background: The safety of performing a one-stage revision from laparoscopic adjustable gastric banding (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) has been questioned. The objective of this study was to compare safety and outcomes of one-stage versus two-stage revisional LRYGB performed after failed LAGB. Methods: A retrospective analysis of all patients undergoing revisional LRYGB after failed LAGB between January 2007 and March 2017 was performed. Patients undergoing one- and two-stage revisions were compared. The primary outcome assessed was the early complication rate, while secondary outcomes included late complications, weight loss, and improvement of comorbidities. Results: During the study period, 161 revisional LRYGB’s were performed, including 121 one-stage and 40 two-stage procedures. Baseline demographic data, BMI and presence of comorbidities were similar between the groups. In patients undergoing a two-stage procedure, band slippage, port infection, and erosion were more commonly cited as indications for revision. Similar early complication rates were demonstrated between the groups. However, late complications were more common in the two-stage group (20.0% vs. 7.4%, P = 0.03), including higher rates of gastro-gastric fistula (5.0% vs. 0%, P = 0.01) and anemia (10.0% vs. 1.1%, P = 0.02). Three-fourths of the cohort had a follow-up of more than 6 months, and the two groups demonstrated similar weight loss results and improvement/resolution of comorbidities. Conclusion: The performance of one-stage revisional LRYGB after failed LAGB seems to be a safe procedure, with noninferior outcomes when compared to a two-stage revisional procedure. It is a valid option, except in cases of mechanical and infectious band complications.