The CONSO-L Score: Predicting (CON)version (S)leeve Gastrectomy (O)utcomes Following (L)aparoscopic Adjustable Gastric Banding
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Updated: Nov 5, 2026
Laparoscopic Radical Gastrectomy for Remnant Gastric Cancer
Published on: October 31, 2025
Aaditya Narendra1, Thomas Viet Tung Vu2, Anagi Wickremasinghe2
1Department of Oesophago-gastric and Bariatric Surgery, The Alfred Hospital, Melbourne, Australia. aaditya.narendra@sa.gov.au.
Introduction:
Conversion sleeve gastrectomy (CSG) following a sub-optimal response to laparoscopic adjustable gastric banding (LAGB) is regularly performed, yet reliable predictors of unfavourable outcomes remain undefined. An unfavourable overall outcome was defined using a composite of non-beneficial weight loss (< 5% total body weight loss [TBW]), serious morbidity or reoperation after CSG. Pre-operative predictors were identified and used to develop a predictive risk scoring tool.
Methods:
A retrospective analysis of prospectively collected data, cross-referenced with national registry records, was performed for all patients undergoing CSG following LAGB at a tertiary bariatric unit (2006-2023). Unfavourable overall outcome was defined as < 5% TBW, serious complications, or requirement for further conversion surgery. Predictive factors were identified using linear regression and chi-square analyses. The CONSO-L score incorporated significant predictors and was optimized through regression modelling and ROC analysis.
Results:
Among 608 patients (median age 45 years, 85.7% female, median BMI 42.5 kg/m²), 14.8% experienced unfavourable overall outcomes. Non-beneficial weight loss occurred in 7.0% of patients, while serious complications affected 8.8% (staple line leak 2.8%). 12% required additional conversion surgery. Significant predictors of unfavourable overall outcomes included pre-operative BMI ≤ 35 kg/m², prior LAGB complications, smoking, non-private insurance status, non-weight-related surgical indications, and CSG within 5 years of initial LAGB. The CONSO-L score demonstrated moderate discriminative ability (AUC 0.63) with optimal cutoff ≥ 6 points providing 60% sensitivity and 63% specificity.
Conclusion:
Approximately 15% of patients experience unfavourable overall outcomes after CSG following LAGB. The CONSO-L score provides modest predictive accuracy for unfavourable outcomes but should be considered an exploratory tool in need of refinement and external validation.
