title: One versus two-step Roux-en-Y gastric bypass after gastric banding—data analysis of the German Bariatric Surgery Registry.
abstract: BACKGROUND
  Bariatric surgery outcomes have been examined in Germany since January 1, 2005. All data were registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg.
  
  
  METHODS
  The data were collected from an online data bank. Data collection began in 2005 for gastric banding (GB) and Roux-en-Y gastric bypass (RYGB) results. In addition to primary bariatric operations, data regarding the complications of revision procedures and redo operations were analyzed. Participation in the quality assurance study was required for all certified centers in Germany.
  
  
  RESULTS
  RYGBs are a popular redo operation after failed gastric banding. In the German Bariatric Surgery Registry (GBSR), we analyzed data from 263 RYGB operations that used a one-step approach after GB and 116 operations that used a two-step approach. The leakage rates for primary RYGB decreased to 1.8%. The incidence of leakage after a one-step RYGB after GB was lower (1.9%) than after the two-step procedure (2.6%).
  
  
  CONCLUSIONS
  RYGBs are popular procedures after failed GB in Germany. The multivariable analysis for overall intraoperative complications revealed a significant difference between the two-step and the one-step procedure. In an unadjusted and multivariate assessment, the one-step procedure had statistically lower general postoperative complications than the two-step approach. Therefore, we suggest performing band removal and RYGB as a one-step procedure. Further analysis is necessary to evaluate the risk factors for the one-step procedure. Follow-up investigations must be performed to determine whether RYGB is an effective and safe option after GB.
authors.affiliation: Department of General, Abdominal and Pediatric Surgery, SRH Municipal Hospital Gera, Straße des Friedens 122, 07548, Gera, Germany, christine.stroh@wkg.srh.de.
authors.forename: Christine
authors.initials: C
authors.lastname: Stroh
authors.forename: R
authors.initials: R
authors.lastname: Weiner
authors.forename: S
authors.initials: S
authors.lastname: Wolff
authors.forename: C
authors.initials: C
authors.lastname: Lerche
authors.forename: C
authors.initials: C
authors.lastname: Knoll
authors.forename: Th
authors.initials: T
authors.lastname: Keller
authors.forename: C
authors.initials: C
authors.lastname: Bruns
authors.forename: Th
authors.initials: T
authors.lastname: Manger
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000379:methods; D005858:Germany; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011785:Quality Assurance, Health Care; D012042:Registries; D012086:Reoperation; D016896:Treatment Outcome