Meta-Analysis of Gastric Band Revision to Sleeve Gastrectomy Versus to Roux-en-Y Gastric Bypass

To evaluate comparative outcomes of gastric band revision to sleeve gastrectomy (rSG) versus to Roux-en-Y gastric bypass (rRYGB).

A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted. All comparative studies reporting outcomes of gastric band revision to SG or RYGB were included, and their risk of bias were assessed. Percent excess body weight loss (%EWL) at 1-year and 2-years, resolution of co-morbidities, postoperative morbidities and mortality were the evaluated outcome parameters.

Nineteen comparative studies reporting a total of 19,532 patients who had gastric band revision to SG (n-=10,646) or RYGB (n = 8,886) were included. rRYGB was associated with significantly higher %EWL at 1-year (MD -7.69; 95% CI-12.02- -3.35, p = 0.0005), %EWL at 2-years (MD -11.18; 95% CI -21.41-0.95, p = 0.03), and resolution of co-morbidities (OR 0.48; 95% CI 0.27-0.86, p = 0.01) compared with revision to SG. However, rSG was associated with significantly lower risk of overall postoperative morbidities (OR 0.50; 95% CI 0.34-0.74, p = 0.0005), postoperative leak (OR 0.64; 95% CI 0.49-0.83, p = 0.0008), or postoperative haemorrhage (OR 0.50; 95% CI 0.26-0.98, p = 0.04). There was no significant difference in mortality (RD 0.00; 95% CI-0.00-0.00, p = 0.39) between two groups.

The meta-analysis of best available evidence demonstrated that gastric band revision to RYGB is associated with significantly higher %EWL and resolution of co-morbidities compared with its revision to SG. However, rRYGB is associated with higher risk of postoperative complications considering its complexity. Careful counselling of the patients is crucial to establish the best approach for individual patients.