Revisional bariatric surgery after an index adjustable gastric band (AGB) may be indicated to remedy insufficient weight loss/comorbidity resolution or complications. We examined outcomes 5 years following revision from AGB to laparoscopic sleeve gastrectomy (AGB-LSG) or from adjustable gastric band to Roux-en-Y gastric bypass (AGB-RYGB).
All patients who underwent revisional bariatric surgery from 1/2012 to 11/2015 at two affiliated medical centers were identified. We compared AGB-LSG to AGB-RYGB on 5 year weight loss [WL] and overall comorbidity resolution. In the low BMI group, rate of amelioration of symptoms relating to complications with the index AGB were also recorded.
Five-year follow-up (5Y-FU) data were available for 104/142 cases; 15 were excluded for having undergone either a different revisional procedure or additional revisions during the 5-year follow-up period, leaving 49 AGB-LSG and 40 AGB-RYGB. Of these, baseline BMI was >35 in 73 patients (Group I), and <35 in 16 patients (Group II). In Group I at 5Y-FU, all weight loss measures and the decrease in comorbidities was greater in AGB-RYGB vs. AGB-SG (Table 1). In Group II, revisional surgery ameliorated symptoms of dysphagia/chronic ABG intolerance in 12/14 (86%) patients regardless of type of revision (Table 1).
For patients with insufficient WL following AGB, revisional surgery that includes a malabsorptive component (i.e., RYGB) induced greater weight loss compared to one without (LSG). For patients with BMI < 35 who experienced complications following AGB, revisional surgery ameliorated complications and augmented WL in more than 81% of cases.