Safety and Effectiveness of Conversion from Adjustable Gastric Band to Ring Augmented Roux-en-Y Gastric Bypass

Laparoscopic Adjustable Gastric Band (AGB) has shown suboptimal long-term results with a non-success rate of 20-56% with an accompanying removal rate of 10-50% due to suboptimal clinical response or complications. Conversion to RYGB is proven to be a safe and effective option. However, current literature contains no studies which use additional placement of a silicone ring (MiniMizer) around the pouch. Therefore, this study aims to evaluate the safety and effectiveness of conversion from AGB to ring augmented RYGB (raRYGB).

All consecutive laparoscopic AGB to raRYGB conversions performed between January 2016 and October 2023 were included. All procedures were performed by a one-stage approach. The primary outcome was percentage total weight loss (%TWL) after 1-year follow-up. Secondary outcomes consisted of %TWL after 2, 3, 4, and 5 years, cumulative %TWL, and early and late complications.

We included a total of 240 patients of whom 195 were female (81.3%). Mean pre-conversion BMI was 40.3 kg/m². The average %TWL 1- and 5-year after the conversion was 25.4% and 18.9%. Cumulative %TWL, calculated from before AGB, was 33.7% after 1 and 30.2% after 5 years. 8 complications occurred within 30 days, 3 of which were ≤ CD3a and 5 ≥ CD3b. A total of 8 MiniMizers were removed.

Conversion from laparoscopic AGB to raRYGB is a valid one-stage conversion method with significant weight loss after 1 and durable weight loss up to 5 years of follow-up. The short- and long-term complication rate is acceptable and ring-specific complications are rare.