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    • Outcomes of Laparoscopic Sleeve Gastrectomy and Mini-Gastric Bypass as a Revision Surgery after Failed Gastric Banding

    Mohammed Matar, Fady Makram, Gamal Fawzy
    Department of General Surgery, Ain Shams University, Cairo, Egypt.

    Background: Laparoscopic adjustable gastric banding (LAGB) is one of the frequently performed bariatric surgeries. Even with a high failure rate, revision procedures such as re-banding or laparoscopic Roux-en-Y gastric bypass (LRYGB) were commonly performed. Recently, conversions of LAGB to laparoscopic sleeve gastrectomy (LSG) or mini gastric bypass (MGB) were also reported. Objectives: To compare the intraand postoperative complications of LSG and MGB as revision surgeries after failed LAGB, and the effect of both procedures on body mass index and weight loss at one year postoperative. Patients and methods: This study included 34 patients in the period from January 2013 to January 2016 who underwent a revision surgery, either LSG or MGB, following LAGB due to failure to achieve target weight loss or due to associated complications with one year follow up. Demographics, pre- and post-operative complications, percentage of excess weight loss (%EWL) and body mass index (BMI), were evaluated pre- and postrevision surgery. Results: This prospective randomized study included 19 patients who underwent LSG revision and 15 patients underwent laparoscopic MGB revision after failed LAGB. The overall operative complications were 21% and 20% in the LSG and MGB groups respectively. There was no statistically significant difference among both study groups as regard peri- and post-operative complications. There was no postoperative mortality in both study groups. Mean operative time was statistically significantly longer in the MGB group (p<0.05); also mean length of hospital stay was significantly longer in the MGB group (p<0.05). The mean difference in %EWL and BMI were non-significant among both study groups at 3 and 6 months postoperative; however, there was a statistically significant increase in % EWL and decrease in BMI at 9 months in MGB group more than in LSG group (p<0.05). The %EWL was significantly higher (p<0.01) and BMI significantly lower (p<0.05) in MGB patients at 12 months postoperative. Conclusion: Both LSG and MGB conversion after LAGB yield a positive outcome on BMI and % EWL with low complication rates. Key words: Revision surgery, sleeve gastrectomy, mini gastric bypass, adjustable gastric banding, post conversion complications. 

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