Medium-Term Outcomes of Revisional Gastric Bypass after failed Gastric Banding vs. Primary Gastric Bypass A Matched Case-Control Study
André Costa Pinho, Hugo Santos Sousa, André Pereira, Eduardo Lima Costa, Silvestre Carneiro, José Barbosa, John Preto, J. Costa-Maia (corresponding author: André Costa Pinho e-mail:
[email protected]) Centro Hospitalar de São João Porto - Portugal
Introduction: Many patients require additional bariatric procedures after failed adjustable gastric band (AGB). In those patients Revisional Gastric Bypass (R-GB) is the most often indicated surgery but outcomes and complications may not be similar to Primary Gastric Bypass (P-GB). The objectives of this study were to compare weight loss outcomes, surgical complications and resolution of comorbidities 3 to 5 years after R-GB and P-GB.
Methods: Between 2010 and 2017, 334 (14.9% of 2247) patients were submitted to revisional procedures. The 50 first consecutive R-GB after failed AGB were selected and a group of 50 patients submitted to P-GB were matched regarding age, gender and BMI. The following variables were compared: demographics; pre-operative weight, height, BMI and obesity-related comorbidities; duration of surgery; early (50
R-GB
P-GB
Resolution of co-morbidities (%)
MEAN %TWL AT LAST FOLLOW UP
R-GB
75,0
11
55,6
8 50,0 44,0 6
37,5 31,8 28,6
2,9 2,4
0 DIABETES
DYSLIPIDEMIA
P-GB
R-GB
P-GB
R-GB
OSA
MEAN DURATION OF SURGERY (HOURS)
TOTAL COMPLICATIONS
P-GB
REOPERATIONS
0
R-GB
Late Complications (>90days)
Reoperations
Trocar hernia Intra-abdominal hemorrhage Respiratory complication
4 Trocar hernias Anastomotic stricture Small-bowel obstruction 2 Severe hypoglicemias Esophageal reflux Anastomotic stricture
5 Hernia corrections Control of mesentery hemorrhage
0
0
CONVERSION TO OPEN SURGERY
Early Complications (50 N (%) *
31 (67.4)
43 (91.5)
0.005
TWL at last follow up (kg) mean ± SD
29.7 ± 14.4
35.6 ± 10.2
0.024
%TWL at last follow up mean ± SD
24.7 ± 10.6
30.6 ± 6.9
0.002
Duration of surgery (min) mean ± SD
172.9 ± 47.2
142.4 ± 33.5
24months were included
Conclusion: Weight loss and safety outcomes of R-GB are inferior to those of P-GB. Nonetheless a mean %EWL of 58.4% in R-GB at medium term follow-up must be considered a fair result in this difficult set of patients. Furthermore, although reoperation rate is greater after R-GB the majority of cases are due to trocar hernias. No conversions to open surgery and no mortality were observed in both groups.