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Simultaneous Gastric Band Removal and Sleeve Gastrectomy: a Comparison with Front-Line Sleeve Gastrectomy
Obesity Surgery, 07/17/2012
Clinical Article
Rebibo L et al. – Weight loss after RGB + LSG validates the concept of “restrictive surgery after restrictive surgery”. Authors did not find any independent risk factors that would have justified the avoidance of RGB + SG.
Methods- The purpose of this retrospective study was to evaluate and compare postoperative morbidity and outcome weight for simultaneous GB removal (RGB) and LSG (the RGB+LSG group) and front–line LSG only (the LSG group) after unsuccessful GB.
- From May 2005 to May 2009, 305 patients underwent first– or second–line LSG at Amiens University Hospital.
- The primary endpoint was the postoperative complication rate (according to the Clavien classification) in the RGB+LSG and LSG groups.
- The secondary endpoints were intra–operative data, postoperative data, and weight loss over a period of 2 years (body mass index, percentage of excess weight loss, and percentage of excess body mass index (BMI) loss).
- Univariate and multivariate propensity score analyses were used to search for independent risk factors for postoperative complications.
- The RGB + LSG group (n=46) had a mean age of 42 and a mean BMI of 44 kg/m2.
- The indication for surgery was renewed weight gain or insufficient weight loss in 68 % of these cases.
- The LSG group (n=259) had a mean age of 41 and a mean BMI of 49.2 kg/m2. All procedures were performed laparoscopically.
- The complication rate was 8.6 % in the RGB + LSG group and 8 % in the SG group (p=0.42).
- The fistula rates in the two groups were 4.3 and 3.4 %, respectively (p=0.56), and the mean BMI at 2 years was 33.4 kg/m2 (RGB + LSG group) and 34.4 kg/m2, respectively (p=0.83).
- The operating time for LSG (after subtracting the time associated with RGB for a combined procedure) averaged 107 min, whereas the operating time for front–line LSG was 89 min (p=0.011).
- The propensity score analysis failed to find independent risk factors for postoperative complications.
- The performance of RGB + LSG is feasible and does not increase the postoperative morbidity rate.
