• Annals of surgery · Mar 2021

    Conversion of Adjustable Gastric Banding to Stapling Bariatric Procedures: Single- or Two-stage Approach.

    • Konstantinos Spaniolas, Jie Yang, Chencan Zhu, Altieri Maria, Andrew T Bates, Salvatore Docimo, Mark Talamini, and Aurora D Pryor.
    • Department of Surgery, Stony Brook University, Stony Brook, NY.
    • Ann. Surg. 2021 Mar 1; 273 (3): 542547542-547.

    ObjectiveThe aim of this study was to compare the safety of single- versus two-stage conversion of adjustable gastric band (AGB) to gastric bypass (RYGB) or sleeve gastrectomy (SG).Summary Background DataAGB patients often present for conversion to RYGB or SG. The impact of single- or two-stage approach of such conversion remains unclear.MethodsA statewide database was used to identify all patients who underwent AGB removal and concurrent (single-stage) or interval (two-stage) RYGB or SG. Propensity score matching schemes were constructed to account for differences in baseline comorbidities and demographics, allowing for matched pairs available for comparisons.ResultsA total of 4330 patients underwent AGB conversion. Complications, readmissions, and ED visits were noted in 394 (9.1%), 278 (6.42%), and 589 (13.6%) patients, respectively. Three hundred sixty-seven matched pairs underwent RYGB; single-stage patients experienced shorter length of stay (LOS) (median difference -1 d, P < 0.0001), less complications [risk difference (RD): -8.4%, 95% confidence interval (CI), -13.4% to -3.5%], readmissions (RD: -5.2%, 95% CI, -9.6% to -0.8%), and ED visits (RD: -5.7%, 95% CI, -11.3% to -0.2%). Eight hundred seventy-five matched pairs underwent SG; single-stage patients experienced improved outcomes in all measures examined. For single-stage procedures (809 pairs), RYGB was associated with longer LOS, and more complications (RD: 3.3%, 95% CI, 0.9%-5.8%), with similar readmissions, and ED visits.ConclusionsAGB conversion procedures have low morbidity. Single-stage conversion is associated with lower morbidity compared with the two-stage approach. Conversion to SG seems to be safer than RYGB.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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