Background

Revisional bariatric surgery after an index adjustable gastric band (AGB) may be indicated to remedy weight relapse or band-related complications. We examined outcomes five years following revision from AGB to laparoscopic sleeve gastrectomy (AGB-LSG) or to Roux-en-Y gastric bypass (AGB-RYGB).

Methods

We conducted a retrospective review to identify patients (men and women, age 18–80) who underwent one revisional bariatric procedure with AGB as the index procedure at two medical centers in our healthcare system between January 2012 and February 2017. We only included patients with a pre-revision BMI > 30 kg/m² for whom 5-year follow-up data were available. We compared 5-year weight loss and remission of comorbidities in patients undergoing AGB-LSG and AGB-RYGB conversion.

Results

A total of 114 patients met inclusion criteria (65 AGB-LSG, 49 AGB-RYGB). At 5-year post-revision, percent total weight loss (3.4% vs 19.9%; p < 0.001), percent excess weight loss (7.0% vs 50.8%; p < 0.001) and decrease in BMI (1.5 vs 8.8; p < 0.001) was greater in AGB-RYGB vs. AGB-LSG. No significant difference in remission or development of new comorbidities was observed.

Conclusion

Conversion of AGB to RYGB is associated with superior intermediate-term weight loss compared to conversion of AGB to LSG. Future multicenter studies with larger sample sizes are necessary to further describe the intermediate-term outcomes of revisional bariatric surgery.

中文翻译：

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修正减肥手术的五年结果：胃束带至袖状胃切除术或 Roux-en-Y 胃绕道术

背景

指数可调胃束带 (AGB) 后的修正性减肥手术可能有助于治疗体重复发或与束带相关的并发症。我们检查了从 AGB 修改为腹腔镜袖状胃切除术 (AGB-LSG) 或 Roux-en-Y 胃绕道术 (AGB-RYGB) 五年后的结果。

方法

我们进行了一项回顾性审查，以确定 2012 年 1 月至 2017 年 2 月期间在我们医疗保健系统的两个医疗中心接受过一次以 AGB 作为指标手术的修正减肥手术的患者（男性和女性，年龄 18-80 岁）。我们只纳入了以下患者：修订前 BMI > 30 kg/m ²且可获得 5 年随访数据。我们比较了接受 AGB-LSG 和 AGB-RYGB 转换的患者 5 年体重减轻和合并症缓解情况。

结果

共有 114 名患者符合纳入标准（65 名 AGB-LSG，49 名 AGB-RYGB）。修正后 5 年，总体重减轻百分比（3.4% vs 19.9%；p  < 0.001）、超重减轻百分比（7.0% vs 50.8%；p  < 0.001）以及 BMI 下降（1.5 vs 8.8；p  < 0.001） 0.001）在 AGB-RYGB 中比 AGB-LSG 更大。没有观察到新合并症的缓解或发展存在显着差异。

结论

与 AGB 转换为 LSG 相比，AGB 转换为 RYGB 与更佳的中期减肥效果相关。未来需要进行更大样本量的多中心研究，以进一步描述修正减肥手术的中期结果。