Conversion of Laparoscopic Adjustable Gastric Banding to Gastric
Bypass: a Comparison to Primary Gastric Bypass
Published online: 4 December 2017
Springer Science+Business Media, LLC, part of Springer Nature 2017
Introduction Laparoscopic adjustable gastric banding (LAGB) has a considerable failure rate. Laparoscopic Roux-en-Y gastric
bypass (LRYGB) is one of the rescue options. This study aims to compare the complication rates and outcomes between LAGB
converted to LRYGB and primary LRYGB.
Materials and Methods A retrospective analysis was performed in all patients converted from LAGB to LRYGB between
January 2007 and March 2017. This group was compared to a matched cohort of primary LRYGB patients operated during
the same period. Early and late complications, weight loss, and improvement of comorbidities were analyzed.
Results One hundred sixty-one revisional LRYGB patients were compared to a similar number of primary LRYGB patients.
Preoperative age, gender distribution, weight, and BMI were comparable. Mean operative time was longer in the revisional group
(137.7 vs. 112.7 min, respectively, P < 0.001). The overall early complication rates were comparable between the groups (7.5 vs.
11.8%, P = 0.16), including postoperative leak rate (0.62%). Follow-up of at least 6 months was attained in 78% of the patients.
Revisional cases demonstrated less weight loss (61.5 vs. 73.5%EWL, respectively, P = 0.004) and slightly less improvement of
comorbidities (75.0 vs. 85.7%, respectively, P = 0.09). The late complication rate was comparable (8.1 vs. 8.1%, P =1.0).
Conclusion Albeit longer operating time, revision of LAGB to LRYGB is a safe procedure, with similar complication rates when
compared to primary LRYGB. Although revisional LRYGB does result in less weight loss than primary LRYGB, the procedure’s
safety makes it a very plausible option as a rescue operation for failed LAGB.
Keywords Failed LAGB
Morbid obesity is a disease of increasing prevalence world-
wide, and surgery is its only proven long-term treatment [1, 2].
One of the once most commonly practiced bariatric proce-
dures was laparoscopic adjustable gastric banding (LAGB);
however, high long-term failure rates have been associated
with this operation, reported to be as high as 40–50% [1, 2].
As a consequence, the incidence of revisional surgery after
LAGB reaches 20–40% [2–5].
Several factors may contribute to the failure of LAGB,
including pouch dilation, food intolerance, gastroesophageal
reflux disease (GERD), band slippage, esophageal dilatation,
band erosion, band leak, infection, pseudoachalasia, failure of
weight loss, or weight regain [1, 2]. Several revisional options
have been proposed; however, there is no consensus regarding
the procedure of choice. The most common revisional proce-
dures include laparoscopic sleeve gastrectomy (LSG) and lap-
aroscopic Roux-en-Y gastric bypass (LRYGB).
At our institution, the revisional procedure of choice after
failed LAGB has evolved to LRYGB for several reasons.
Unlike LAGB and LSG, in addition to being restrictive in
nature, this procedure has some hormonal and malabsorptive
elements. In comparison to LSG, it is an excellent solution for
GERD—a burden to a large proportion of these patients [6–8].
Finally, the performance of gastric bypass after failed banding
avoids the need to create a staple line through the area adjacent
* Abbas Al-Kurd
Department of Surgery, Hadassah-Hebrew University Medical
Center, Jerusalem, Israel
Obesity Surgery (2018) 28:1519–1525