What to Propose After Failed Adjustable Gastric Banding: One- or Two-step Procedure?

Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) can be proposed in case of failed laparoscopic adjustable gastric band (LAGB). The main question is whether the revisional procedure is carried out in one or two stages.

Postoperative outcomes between the one-step approach and the two-step approach of conversion of failed LAGB to RYGB or SG were, respectively, compared.

A systematic review of the literature published until June 2019 was conducted. All studies comparing one-step and two-step approaches after failed LAGB were included. Primary outcomes include both mortality and morbidity at 30 days postoperatively according to Dindo-Clavien classification. Among the studies included, a random effect model was used with Review Manager 5.3 (Cochrane Collaboration, Oxford, UK).

A total of 3895 patients had conversion of failed LAGB to RYGB (n = 3214) or SG (n = 681), respectively. The conversion was carried out in one-step (n = 2767) or two-step (n = 1128) approaches. Meta-analysis did not show statistical difference for overall morbidity rate (OR = 1.01, 95%CI = 0.78-1.30, p = 0.96) whether it is for SG (OR = 1.25, 95%CI = 0.73-2.14, p = 0.42) or RYGB (OR = 0.94, 95%CI = 0.71-1.26, p = 0.69) and for major postoperative morbidity (OR = 0.96, 95%CI = 0.59-1.56, p = 0.87) whether it is for SG (OR = 0.66, 95%CI = 0.22-1.97, p = 0.46) or RYGB (OR = 1.05, 95%CI = 0.61-1.81, p = 0.86). Moreover, there was no statistical difference for specific morbidity rate including reoperation, leak, abscess, postoperative bleeding, and late postoperative complications.

Given the retrospective nature of the studies, these results should be interpreted with caution.

This updated meta-analysis suggests that conversion of failed LAGB to RYGB or SG can be safely performed in one-step or two-step approaches.