title: A retrospective comparison of early results of conversion of failed gastric banding to sleeve gastrectomy or gastric bypass.
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) is associated with high long-term failure rates requiring conversion to alternative procedures. Operative conversion to laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric (LRYGB) bypass is associated with higher complication rates than primary procedures.
  
  
  OBJECTIVE
  To compare results for converting failed LAGB to LSG versus LRYGB.
  
  
  METHODS
  University Hospital, United Kingdom, National Health Service.
  
  
  METHODS
  All patients undergoing conversion of LAGB to LRYGB and LSG from July 2006 to September 2012 were included. A retrospective analysis of our prospectively maintained database was performed to identify differences in death rates, complication rates, length of hospital stay, and weight loss. Within this study LRYGB was the preferred choice for conversion and LSG was only considered in the presence of significant intraabdominal adhesions, because of patient choice, or in patients with contraindications to LRYGB.
  
  
  RESULTS
  Eighty-nine patients with failed LAGB underwent conversional surgery within this period. Of these, 64 patients underwent conversion to LRYGB and 25 underwent conversion to LSG. There was no statistical difference in percentage of excess weight loss at 1 or 2 years after conversional surgery to LSG or LRYGB. Conversion to LRYGB was carried out as a single procedure in 51/64 (80%) compared with 10/25 (40%) for conversion to LSG (P = .003). One postoperative complication occurred requiring reoperation after conversion to LRYGB.
  
  
  CONCLUSIONS
  There was no difference in complication rates, hospital stay, and early weight loss when converting failed LAGB to LRYGB or LSG. Both procedures are appropriate for conversion from LAGB, although a staged approach is often needed, especially for LSG.
authors.affiliation: Bariatric Surgery Unit, Sunderland Royal Hospital, Sunderland, United Kingdom. Electronic address: wrjcarr@doctors.org.uk.
authors.forename: William R J
authors.initials: WR
authors.lastname: Carr
authors.affiliation: Bariatric Surgery Unit, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Jennings
authors.affiliation: Bariatric Surgery Unit, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: Maureen
authors.initials: M
authors.lastname: Boyle
authors.affiliation: Bariatric Surgery Unit, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: Kamal
authors.initials: K
authors.lastname: Mahawar
authors.affiliation: Bariatric Surgery Unit, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: Shlokarth
authors.initials: S
authors.lastname: Balupuri
authors.affiliation: Bariatric Surgery Unit, Sunderland Royal Hospital, Sunderland, United Kingdom.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Small
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy; D015390:Gastric Bypass; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Complications; Conversion; Failed gastric band; Gastric bypass; Revision; Sleeve gastrectomy