Panagiotis Drakos1, Panagiotis Volteas1, Alisa Khomutova2, Jie Yang3, Lizhou Nie4, Aurora D Pryor5, Salvatore Docimo5, Kinga A Powers5, Konstantinos Spaniolas5. 1. Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, T19-053, Stony Brook, NY, 11794-8191, USA. 2. Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, T19-053, Stony Brook, NY, 11794-8191, USA. Alisa.khomutova@stonybrookmedicine.edu. 3. Division of Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA. 4. Department of Biostatistics, Renaissance School of Medicine, Stony Brook, NY, USA. 5. Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA.
Abstract
BACKGROUND: Patients with adjustable gastric banding (AGB) often require revision to one-stage or two-stage sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). OBJECTIVE: To compare the long-term durability of revisional SG and RYGB, in terms of subsequent revision or conversion (RC). METHODS: The New York Statewide Planning and Research Cooperative Systems dataset was queried from 2006 to 2013 for patients who underwent primary SG and RYGB, one-stage, and two-stage conversion from AGB to SG and RYGB. Patients who required RC were identified. A multivariable Cox proportional hazard model was used to compare the RC risk among these groups. RESULTS: 13,749 had primary SG, 621 one-stage, and 321 two-stage AGB to SG. 31,814 had primary RYGB, 555 one-stage, and 248 two-stage AGB to RYGB. The estimated 5-year cumulative RC incidence rate was significantly lower after primary surgery than after prior AGB (one-stage AGB to SG 14.4%, two-stage AGB to SG 11.6%, primary SG 5.2%, one-stage AGB to RYBG 3.4%, two-stage AGB to RYGB 2.9%, and primary RYGB 1.1%, p-value < 0.0001). RYGB and SG did not differ significantly in terms of the elevation effect of one- and two-stage AGB conversion over primary surgeries (RYGB vs SG: one stage vs primary ratio of HR = 0.97, 95% CI = [0.58, 1.63], p-value = 0.9153; two stage vs primary ratio of HR = 1. 02, 95% CI = [0.50, 2.07], p-value = 0.9596). CONCLUSION: RC after AGB to SG or RYGB is more frequent compared to primary surgeries with procedures following AGB to SG being more common than AGB to RYGB. However, that difference was proportionally similar to the RC rate ratio differences noted for primary SG and RYGB.
BACKGROUND: Patients with adjustable gastric banding (AGB) often require revision to one-stage or two-stage sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB). OBJECTIVE: To compare the long-term durability of revisional SG and RYGB, in terms of subsequent revision or conversion (RC). METHODS: The New York Statewide Planning and Research Cooperative Systems dataset was queried from 2006 to 2013 for patients who underwent primary SG and RYGB, one-stage, and two-stage conversion from AGB to SG and RYGB. Patients who required RC were identified. A multivariable Cox proportional hazard model was used to compare the RC risk among these groups. RESULTS: 13,749 had primary SG, 621 one-stage, and 321 two-stage AGB to SG. 31,814 had primary RYGB, 555 one-stage, and 248 two-stage AGB to RYGB. The estimated 5-year cumulative RC incidence rate was significantly lower after primary surgery than after prior AGB (one-stage AGB to SG 14.4%, two-stage AGB to SG 11.6%, primary SG 5.2%, one-stage AGB to RYBG 3.4%, two-stage AGB to RYGB 2.9%, and primary RYGB 1.1%, p-value < 0.0001). RYGB and SG did not differ significantly in terms of the elevation effect of one- and two-stage AGB conversion over primary surgeries (RYGB vs SG: one stage vs primary ratio of HR = 0.97, 95% CI = [0.58, 1.63], p-value = 0.9153; two stage vs primary ratio of HR = 1. 02, 95% CI = [0.50, 2.07], p-value = 0.9596). CONCLUSION: RC after AGB to SG or RYGB is more frequent compared to primary surgeries with procedures following AGB to SG being more common than AGB to RYGB. However, that difference was proportionally similar to the RC rate ratio differences noted for primary SG and RYGB.
Authors: Selim G Gebran; Brooks Knighton; Ledibabari M Ngaage; John A Rose; Michael P Grant; Fan Liang; Arthur J Nam; Stephen M Kavic; Mark D Kligman; Yvonne M Rasko Journal: Obes Surg Date: 2020-02 Impact factor: 4.129