title: Concomitant Removal of Gastric Band and Gastric Bypass: Analysis of Outcomes and Complications from the ACS-NSQIP Database.
abstract: Conversion of laparoscopic adjustable gastric banding (LGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) is an established procedure. However, multiple reports have indicated higher morbidity and mortality rates associated with this operation, especially when performed as a single-staged procedure.
  
  
  
  We sought to compare mortality and morbidity of LRYGB vs. LRYGB with concomitant gastric band removal (LRYGB/LGBR).
  
  
  
  Data from the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database was obtained for the time period of 2008 to 2014 using CPT codes for LRYGB and LGBR. Sepsis was the primary outcome measure with overall morbidity as a secondary outcome. Bivariate and multivariate analyses were carried out using SAS (Statistical Analysis System).
  
  
  
  During the study period, 64,866 patients had primary LRYGB and 1212 had LRYGB/LGBR. On bivariate analyses, mean operative time was lower for patients undergoing LRYGB rather than LRYGB/LGBR (132.88 ± 56.29 vs. 177.72 ± 70.21 min, p < 0.001). There was no statistically significant difference in the rate of postoperative mortality (0.16 vs. 0.08 %, p > 0.999), sepsis (0.78 vs. 0.74 %, p = 0.87), or other postoperative outcomes such as return to the operating room, wound infection, and venous thromboembolism. The odds ratio (OR) for sepsis remained not significant (OR = 0.74; 95 % confidence interval (CI) = (0.38-1.45)) after multivariate analysis.
  
  
  
  LRYGBP/LGBR is not associated with a higher morbidity and mortality compared to LRYGB alone. The data implies that a one-step revisional procedure is appropriate when converting a failed gastric band to LRYGB.
authors: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon. elie.ramly@gmail.com.
authors: Elie P
authors: EP
authors: Ramly
authors: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors: Bassem Y
authors: BY
authors: Safadi
authors: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors: Hanaa Dakour
authors: HD
authors: Aridi
authors: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors: Rami
authors: R
authors: Kantar
authors: Clinical Research Institute, Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon.
authors: Aurelie
authors: A
authors: Mailhac
authors: Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
authors: Ramzi S
authors: RS
authors: Alami
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D016896:Treatment Outcome
keywords: ACS-NSQIP; Gastric banding; Laparoscopic; Laparoscopic band removal; Revision; Roux-en-Y gastric bypass