Medium-term outcomes of converting laparoscopic adjustable gastric band to Roux-en-Y gastric bypass in patients with body mass index <35 kg/m2: a uniquely Australian perspective.

Abstract

BACKGROUND\nThe rates of primary laparoscopic adjustable gastric banding (LAGB) have declined in the last 5 years due to band removal secondary to complications and the subsequent weight regain that requires revisional procedures.\n\n\nOBJECTIVES\nThis study aimed to present medium-term weight loss results and the safety profile of converting LAGB to Roux-en-Y gastric bypass in patients with body mass index (BMI) <35.0 kg/m2 who presented with LAGB intolerance or complications. Many health services do not permit such procedures on low BMI patients.\n\n\nSETTINGS\nSingle-surgeon series, including public and private practice, Brisbane, Australia.\n\n\nMETHOD\nA prospectively maintained database was reviewed and retrospectively analyzed for LAGB patients with a BMI <35.0 kg/m2 who underwent conversion to Roux-en-Y gastric bypass by a single surgeon. Indications for conversion, weight loss data, and early (30 d postoperative) and late complications were recorded with follow-up out to 5 years.\n\n\nRESULTS\nOne hundred thirty-two adult patients with a BMI <35.0 kg/m2 underwent conversion from 2009 to 2016. The main indications for conversion were reflux and band complications. Median BMI at bypass was 32.8 kg/m2 (23.1-35.0). Median percentage excess weight loss was 77%, 90%, 73%, 47%, 49%, and 44% at 1, 2, 3, 4, and 5 years, respectively among patients who were eligible and present at follow-up. Median BMI was <30.0 kg/m2 (29.1-40.9) at 5 years with only 1 subject exceeding >35.0 kg/m2. Mortality was 0%. Early morbidity occurred in 31.8% of patients. The most common late complication was gastrojejunostomy stricture requiring endoscopic dilation.\n\n\nCONCLUSIONS\nIn combination with our 2014 study showing morbidity data in the short-term period being comparable to patients with BMI >35.0 kg/m2, our study demonstrates that converting LABG to Roux-en-Y gastric bypass in low BMI patients is a feasible and safe option that avoids weight regain and maintains adequate weight loss at 5 years, with acceptable morbidity and no mortality.