A. Wang1, S. Sprinkle1, M. Cox1, C. Park1, D. Portenier1, J. Yoo1, R. Sudan1, K. Seymour1 1Duke University Medical Center,Durham, NC, USA
Introduction:
The adjustable gastric banding (AGB) was popular as a primary weight loss procedure in the late 2000 but has decreased in popularity due to weight loss failure. With only approximately 50% of patients achieving adequate weight loss, patients may seek revision surgery to improve their outcome despite increased surgical risk. We thus aim to assess the safety and efficacy of revision roux-en-y gastric bypass (RGB) after AGB for weight loss failure.
Methods:
After IRB approval, retrospective review from September 2004 to October 2014 at a single institution was performed. Only those with at least 1 year follow up were included in the analysis (n=53). All surgeries were performed laparoscopically by 8 surgeons. Excess BMI loss was calculated as percent decrease in BMI compared to ideal BMI 25. Successful weight loss was defined as excess BMI loss greater than 50%. Continuous variables were compared with t-tests and categorical variables were compared with Wilcoxon rank-sum, Fisher’s exact test, or McNemar’s chi-squared test.
Results:
Average age was 46 +/- 10 years, 15% of patients were male and 64% were Caucasion race. Average length of time between AGB and RGB was 3.8 +/- 1.6 years. Average length of stay during the revision operation was 2.7 +/- 3.3 days. At 30 days, there were 5 readmissions (3 for poor oral intake, 1 for obstruction, and 1 for cellulitis) and 3 reoperations (2 for obstruction and 1 for bleeding). There were no 30-day mortality, pulmonary embolism, or leak. Patients did not experience a significant decrease in BMI between baseline BMI at primary AGB surgery and BMI at time of revision (45.3 vs 44.0, p=0.24, CI -0.9 – 3.7). Patients did experience a significant decrease in BMI after revision RGB (44.0 vs 38.12, p<0.0001, CI 3.4-8.4) and 30% (n=16) of patients experienced weight loss success at 1 year. There was no significant difference in medication controlled DMII at 1 year after revision (17% vs 9%, p=0.25, CI -5%-20%); however, the average number of HTN medications decreased at 1 year (0.83 vs. 0.62, p=0.033, 0.02-0.40).
Conclusion:
In this cohort of patients who underwent AGB to RGB for weight loss failure, patients experienced improved weight loss at 1 year compared to their original operation. Overall, patients required fewer HTN medications at 1 year but had similar rates of medication controlled DMII. Revisional RGB after AGB can be performed safely with improvement in co-morbidities at 1 year.