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Revisional versus primary Roux-en-Y gastric bypass: a case-matched analysis

Delko, Tarik ; Köstler, Thomas ; Peev, Miroslav ; Esterman, Adrian ; Oertli, Daniel ; Zingg, Urs

In: Surgical Endoscopy, 2014, vol. 28, no. 2, p. 552-558

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    Titre
    • Revisional versus primary Roux-en-Y gastric bypass: a case-matched analysis
    Auteur
    • Delko, Tarik. Department of Surgery, Limmattal Hospital Zurich-Schlieren, Zurich, Switzerland
    • Köstler, Thomas. Department of Surgery, Limmattal Hospital Zurich-Schlieren, Zurich, Switzerland
    • Peev, Miroslav. Department of Surgery, Limmattal Hospital Zurich-Schlieren, Zurich, Switzerland
    • Esterman, Adrian. Sansom Institute of Health Service Research and School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia
    • Oertli, Daniel. Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
    • Zingg, Urs. Department of Surgery, Limmattal Hospital Zurich-Schlieren, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Surgical Endoscopy, 2014, vol. 28, no. 2, p. 552-558. Springer US; http://www.springer-ny.com
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:325785
    Summary
    Background: Laparoscopic adjustable gastric banding (LAGB) has been a widely performed bariatric procedure. Unfortunately, revisional surgery is required in 20-30% of cases. Data comparing revisional and primary gastric bypass procedures are scarce. This study compared revisional malabsorptive laparoscopic very very long limb (VVLL) Roux-en-Y gastric bypass (RYGB) with primary VVLL RYGB and tested the hypothesis that one-stage revisional laparoscopic VVLL RYGB is an effective procedure after failed LAGB. Methods: In this study, 48 revisional VVLL RYGBs were matched one-to-one with 48 primary VVLL RYGBs. The outcome measures were operating time, conversion to open surgery, excess weight loss (EWL), and early and late morbidity. Results: Surgical and medical morbidities did not differ significantly. No conversions occurred. The revisional group showed an EWL of 41.8% after 12months of follow-up evaluation and 45.1% after 24months based on the pre-revisional weight. The total EWL based on the weight before the LAGB was calculated to be 54.3% after 12months and 57.2% after 24months. The EWL in the primary RYGB group was significantly higher for both types of calculation: 41.8%/54.3% versus 64.1% (p<0.001 and <0.01) after 12months and 45.1%/57.2% versus 70.4% (p<0.001 and <0.002) after 24months. Conclusions: Revisional laproscopic VVLL RYGB can be performed as a one-stage procedure by experienced bariatric surgeons but shows less effective EWL than primary RYGB procedures.