title: Safety of one-step conversion of gastric band to sleeve: a comparative analysis of ACS-NSQIP data.
abstract: BACKGROUND
  The conversion rate of laparoscopic adjustable gastric banding (LAGB) to laparoscopic sleeve gastrectomy (LSG) has increased during recent years. The safety profile of one-step conversion of LAGB to LSG is not clear from the current literature.
  
  
  METHODS
  Using the database of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), morbidly obese patients undergoing primary LSG and conversion of LAGB to LSG in one-step between 2010 and 2012 were identified. Perioperative outcomes (including 30-day composite rate comprised of 18 postoperative adverse events) were compared between groups using a univariate cross-sectional analysis.
  
  
  RESULTS
  Data of 11,320 patients (10,997 primary LSG and 323 LAGB to LSG) were analyzed. The LAGB-to-LSG group had better preoperative health status, including significantly lower body mass index, American Society of Anesthesiologists scores, and prevalence of diabetes and hypertension. Operative time for the LAGB-to-LSG group (130.0±53.7 min) was significantly longer than primary LSG group (98.5±42.8 min, P<.001). The 30-day composite adverse event rate was 6.8% in the LAGB-to-LSG group and 5.4% in the primary LSG group (P = .29). The rate of minor complications, including urinary tract infection and wound infection were significantly higher in the revisional surgery group. Thirty-day rates of other postoperative complications, reoperation, readmission, mortality, and length of hospital stay were comparable between the 2 groups.
  
  
  CONCLUSIONS
  This national data suggests that conversion of LAGB to LSG in a single stage has comparable safety to primary LSG. In this study, improved preoperative health status of patients in the revisional group may serve as an equalizer with regards to postoperative outcomes of conversion to LSG.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Saeed
authors.initials: S
authors.lastname: Shoar
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Zhamak
authors.initials: Z
authors.lastname: Khorgami
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Toms
authors.initials: T
authors.lastname: Augustin
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH. Electronic address: brethas@ccf.org.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
mesh_terms: D000328:Adult; D015331:Cohort Studies; D066264:Datasets as Topic; D005260:Female; D005743:Gastrectomy; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D058996:Quality Improvement; D016896:Treatment Outcome; D014481:United States; D015431:Weight Loss
keywords: Bariatric surgery; Complication; Conversion; Gastric banding; Reoperation; Revision; Sleeve gastrectomy; Weight loss