Single stage conversion from adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass: an analysis of 4875 patients

Background The previous popularity of adjustable gastric banding (AGB), along with inconsistent long-term results, has resulted in the need for conversion to other procedures. The perioperative safety of laparoscopic sleeve gastrectomy (SG) and gastric bypass (RYGB) as single-stage conversion procedures is unclear. Objectives To compare the early safety of SG and RYGB when performed as single-stage conversion procedures at the time of AGB removal. Setting Nationwide analysis of accredited centers. Methods The Metabolic and Bariatric Surgery Accreditation Quality and Improvement Program public use file for 2015 was queried for all patients who underwent single-stage conversion to SG or RYGB. Multivariable logistic regression was performed to control for baseline differences, and odds ratios (ORs) with 95% confidence intervals are reported. Results There were 4865 patients who underwent a single-stage AGB conversion. SG was performed in 3364 (69.1%). The 30-day reoperation (1.6% versus 2.7%, P =.008), readmission (4% versus 5.7%, P =.006), reintervention (1.7% versus 2.7%, P =.024), and overall morbidity (2.9% versus 6.5%, P<.0001) were significantly less common in the SG group. After controlling for baseline characteristics, RYGB was independently associated with higher overall 30-day reoperation (OR 1.81, 1.19–2.75), readmission (OR 1.42, 1.07–1.88), reintervention (OR 1.59, 1.06–2.4), and overall morbidity (OR 2.17, 1.62–2.9). Conclusions AGB conversions are associated with low overall 30-day event rates. Patients undergoing RYGB as a single-stage conversion experience higher complication rates and the need for additional early procedures compared with SG.