The Efficacy and Medium-Term Patient-Reported Outcomes Following Conversion From Sleeve Gastrectomy and Gastric Band...

Metabolic bariatric surgery is increasing, with conversion to one-anastomosis gastric bypass (cOAGB) as an option to address suboptimal outcomes. This study reports medium-term and patient-reported outcomes for cOAGB after laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG).

This retrospective cohort study reviewed a prospective database of cOAGB cases (2016-2023) at a single-surgeon center. Perioperative morbidity, further interventions, and patient-reported outcomes were recorded.

Of 261 patients, 60.9% had prior LAGB and 39.1% had prior SG, with 98.9% of all patients discharging home the following day. Within 30 days we experienced three complications Clavien-Dindo grade 3 or higher and 13 complications Clavien-Dindo grade 2 or less. Beyond 30 days, interventions were performed for reflux (18 patients), three port-site hernias, two perforated ulcers, and one obstruction secondary to adhesions. Endoscopy was performed for 14 symptomatic gastroenteric anastomotic ulcers and one reflux esophagitis, all managed conservatively. There was no mortality. A total of 159 (60.9%) patients responded to the survey (mean 41.8 months after conversion), with 37.1% reporting significant heartburn and 23.9% reporting significant regurgitation. Nonetheless, 81.8% were happy with the procedure, and 78% would choose it again. Among those with post-cOAGB reflux, enteroenterostomy markedly improved symptoms. Median BMI at follow-up was 30.4 kg/m² (IQR 26.4-35.7 kg/m²), which was 9.9 kg/m² less than the median BMI recorded before conversion. The median percent excess weight loss was 61.1% (IQR 37.7-89.5) and mean percent total weight loss was 22.5% (SD 13.3). Patients with prior SG had higher rates of regurgitation (p = 0.017) and reflux medication use (p = 0.016), while those with prior LAGB reported greater satisfaction (p < 0.001).

cOAGB is a safe and effective conversion procedure for weight loss following suboptimal primary metabolic bariatric surgery. While it can improve reflux symptoms in some patients, it appears less effective for complete reflux resolution. Nevertheless, patient-reported satisfaction remains high, reflecting favorable overall outcomes.