title: Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes.
abstract: BACKGROUND
  A considerable number of patients require revisional surgery after laparoscopic adjustable gastric banding (LAGB). Studies that compared the outcomes of revisional sleeve gastrectomy (r-SG) and revisional Roux-en-Y gastric bypass (r-RYGB) after failed LAGB are scarce in the literature. Our objective was to determine whether significant differences exist in outcomes between r-SG and r-RYGB after failed LAGB.
  
  
  METHODS
  From 2005 to 2012, patients who underwent laparoscopic r-SG and r-RYGB after failed LAGB were retrospectively compared and analyzed. Data included demographics, indication for revision, operative time, hospital stay, conversion rate, percentage excess weight loss (%EWL), and morbidity and mortality.
  
  
  RESULTS
  Out of 693 bariatric procedures, 42 r-SG and 53 r-RYGB were performed. The median preoperative weight (107.7 and 117.7 kg, respectively, p = 0.02) and body mass index (BMI) (38.5 vs. 43.2 kg/m(2), respectively, p = 0.01) were statistically significantly lower in r-SG than in r-RYGB. The mean operative time and median hospital stay were significantly shorter in r-SG than in r-RYGB (108.4 vs. 161.2 min, p < 0.01) (2 vs. 3 days, p = 0.02), respectively. One patient underwent conversion to open surgery after r-RYGB (p = 0.5). The reoperation rate was lower in r-SG than in r-RYGB (0.0 vs. 3.8 %, p = 0.5). There was one postoperative leak in the r-RYGB, and the overall complication rate was significantly lower in r-SG patients than in r-RYGB patients (7.1 vs. 20.8 %, p = 0.05). The mean follow-up was significantly shorter in the r-SG group (9.8 vs. 29.3 months, p < 0.01). However, the mean postoperative BMI was not different at 1 year (32.3 vs. 34.7, p = 0.29) as well as mean %EWL was (47.4 vs. 45.6 %, p = 0.77).
  
  
  CONCLUSIONS
  Both r-SG and r-RYGB are safe procedures with similar outcomes in terms of %EWL. As a result of the long-term potential nutritional complication of r-RYGB, r-SG may be a better option in this group of patients. Longer follow-up is needed.
authors.affiliation: Department of Surgery, Faculty of Medicine, Kuwait University, Safat, P.O. Box 24923, 13110, Jabriya, Kuwait, khoursheed@hsc.edu.kw.
authors.forename: Mousa
authors.initials: M
authors.lastname: Khoursheed
authors.forename: Ibtisam
authors.initials: I
authors.lastname: Al-Bader
authors.forename: Ali
authors.initials: A
authors.lastname: Mouzannar
authors.forename: Abdulla
authors.initials: A
authors.lastname: Al-Haddad
authors.forename: Ali
authors.initials: A
authors.lastname: Sayed
authors.forename: Ali
authors.initials: A
authors.lastname: Mohammad
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss