title: One or two steps for laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy: a nationwide French study on 3357 morbidly obese patients.
abstract: BACKGROUND
  Adjustable gastric banding (AGB) has been a very common bariatric procedure, but long-term AGB related complications have led to an increased number of second procedures. Sleeve gastrectomy (SG) is one option and can be done as a 1- or 2-step procedure.
  
  
  OBJECTIVE
  To compare the 1-step and 2-step approachs of conversion of AGB to SG with respect to postoperative mortality and morbidity.
  
  
  METHODS
  Nationwide study, France.
  
  
  METHODS
  All morbidly obese patients who underwent AGB followed by SG in France between 2007 and 2012 were included. Multivariate analyses were conducted using the French National Health Service Database data to ascertain predictive factors for 90-day postoperative mortality and morbidity.
  
  
  RESULTS
  There were 2061 and 1296 patients in the 1-step and 2-step conversion groups, respectively. The readmission rate was 22.8% and 16.5% in the 1- and 2-step groups, respectively (P<.001). More patients required an intensive care unit stay in the 1-step group (11.7 % versus 6.7%; P<.001). The 90-day mortality was .1%, with no difference between the 2 groups (1% versus .08%). The complication rate was 14.7% (1-step 15.9% versus 2-step 12.7%; P = .009). The timing of AGB removal (P = .02), patient age 50-60 years (P = .004), hypertension (P = .01), surgical approach (P = .002), and hospital status (P = .015) were significantly associated with the complication rate.
  
  
  CONCLUSIONS
  This study indicates that the 2-step conversion of failed AGB to SG results in a significantly reduced rate of postoperative staple line leaks, gastric tube stricture, respiratory complication, and need for intensive care unit stay.
authors.affiliation: Centre Hospitalier Universitaire de Nice, Digestive Center, Nice, France and University of Nice-Sophia-Antipolis, Faculty of Medecine, Nice, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Schneck
authors.affiliation: Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lazzati
authors.affiliation: Public Health Department, Hôpital Henri Mondor - AP-HP, Créteil, France and LIC EA4393, University Paris-Est Creteil, France; Medical Information Department, Hôpital Henri Mondor - AP-HP, Créteil, France and University Paris-Est, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Audureau
authors.affiliation: Public Health Department, Hôpital Henri Mondor - AP-HP, Créteil, France and LIC EA4393, University Paris-Est Creteil, France; Medical Information Department, Hôpital Henri Mondor - AP-HP, Créteil, France and University Paris-Est, France.
authors.forename: François
authors.initials: F
authors.lastname: Hemery
authors.affiliation: Centre Hospitalier Universitaire de Nice, Digestive Center, Nice, France and University of Nice-Sophia-Antipolis, Faculty of Medecine, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
authors.affiliation: Department of Digestive, HepatoPancreatoBiliary and Liver Transplantation Surgery; Hôpital Henri Mondor - AP-HP, Créteil, France and University Paris-Est, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.affiliation: Centre Hospitalier Universitaire de Nice, Digestive Center, Nice, France and University of Nice-Sophia-Antipolis, Faculty of Medecine, Nice, France. Electronic address: iannelli.a@chu-nice.fr.
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006276:Health Facility Size / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome
keywords: Adjustable gastric banding; Obesity; Revisional bariatric surgery; Sleeve gastrectomy