Conversion to Roux-en-Y gastric bypass versus one-anastomosis gastric bypass after a failed primary gastric band

a matched nationwide study

Journal article (2022)

Authors

Erman O. Akpinar Universiteit Maastricht
Simon W. Nienhuijs Catharina Hospital
Ronald S.L. Liem Dutch Obesity Clinic, Groene Hart Hospital
Jan Willem M. Greve Dutch Obesity Clinic South, Universiteit Maastricht, Zuyderland Medical Centre
P.J. Marang-van de Mheen Leiden University Medical Center
Affiliation
External organisation
Conversion Population-based Propensity score matching Roux-en-Y gastric bypass DATO Failed gastric banding One-anastomosis gastric bypass Revision bariatric surgery
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Published Date

2022

Language

English

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Abstract

Background: Primary laparoscopic adjustable gastric band (LAGB) has high rates of patients not achieving the desired weight loss, and it remains unclear which bariatric conversion procedure gives better results. Objective: To compare weight loss among patients undergoing conversion one-anastomosis gastric bypass (cOAGB) and conversion Roux-en-Y gastric bypass (cRYGB) after a failed LAGB. Setting: Nationwide population-based study including all 18 hospitals providing metabolic and bariatric surgery. Methods: Patients with a failed primary LAGB who underwent a cRYGB or cOAGB between January 1, 2015, and December 31, 2019, were selected from the Dutch Audit for Treatment of Obesity. The primary outcome was not achieving ≥20% total weight loss (TWL) at 1-year and up to 5-year follow-up. Secondary outcomes included postoperative complications, defined as Clavien-Dindo ≥III within 30 days, and co-morbidity remission. A propensity score matched logistic and Poisson regression model was used to estimate the difference in patients not achieving ≥20% TWL between cRYGB and cOAGB. Results: A total of 615 (78.7%) patients underwent cRYGB, and 166 (21.3%) patients underwent cOAGB, with 163 patients successfully matched. Both groups had similar rates of patients not achieving ≥20% TWL at 1 year (odds ratio [OR] = .64, 95% confidence interval [CI]: .38–1.05). However, a sensitivity analysis showed that patients undergoing cOAGB had lower rates of patients not achieving ≥20% TWL up to 5-year follow-up (rate ratio = .69, 95% CI: .51–.95, P < .05). Patients undergoing cOAGB were less likely to achieve hypertension remission (OR = .22, 95% CI: .07–.66). There were no significant differences between groups in postoperative complications (OR = .39, 95% CI: .07–2.06, P > .05). Conclusion: This matched nationwide study suggests that the cOAGB has similar short-term weight loss outcomes but potentially better long-term weight loss results than cRYGB. Therefore, cOAGB could provide a reliable alternative but needs to be substantiated in future long-term studies.