title: A one-step conversion from gastric banding to laparoscopic Roux-en-Y gastric bypass is as safe as a two-step conversion: A comparative analysis of 885 patients.
abstract: OBJECTIVE
  To achieve additional weight loss or to resolve band-related problems, a laparoscopic adjustable gastric banding (LAGB) can be converted to a laparoscopic Roux-en-Y gastric bypass (RYGB). There is limited data on the feasibility and safety of routinely performing a single-step conversion. We assessed the efficacy of this revisional approach in a large cohort of patients operated in a high-volume bariatric institution.
  
  
  METHODS
  Between October 2004 and December 2015, a total of 885 patients who underwent LAGB removal with RYGB were identified from a prospectively collected database. In all cases, a single-stage conversion procedure was planned. The feasibility of this approach and peri-operative outcomes of these patients were evaluated and analyzed.
  
  
  RESULTS
  A single-step approach was successfully achieved in 738 (83.4%) of the 885 patients. During the study period, there was a significant increase in performing the conversion from LAGB to RYGB single-staged. No mortality or anastomotic leakage was observed in both groups. Only 45 patients (5.1%) had a 30-d complication: most commonly hemorrhage (N = 20/45), with no significant difference between the groups.
  
  
  CONCLUSIONS
  Converting a LAGB to RYGB can be performed with a very low morbidity and zero-mortality in a high-volume revisional bariatric center. With increasing experience and full standardization of the conversion, the vast majority of operations can be performed as a single-stage procedure. Only a migrated band remains a formal contraindication for a one-step approach.
authors.affiliation: a Department of Surgery , AZ Sint-Jan Brugge ? Oostende AV, Campus Brugge , Brugge , Belgium.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Debergh
authors.affiliation: b Department of Surgery , AZ Maria Middelares , Gent , Belgium.
authors.forename: Barbara
authors.initials: B
authors.lastname: Defoort
authors.affiliation: c Department of Surgery , AZ Sint-Vincentiusziekenhuis , Deinze , Belgium.
authors.forename: Marieke
authors.initials: M
authors.lastname: De Visschere
authors.affiliation: a Department of Surgery , AZ Sint-Jan Brugge ? Oostende AV, Campus Brugge , Brugge , Belgium.
authors.forename: Silke
authors.initials: S
authors.lastname: Flahou
authors.affiliation: a Department of Surgery , AZ Sint-Jan Brugge ? Oostende AV, Campus Brugge , Brugge , Belgium.
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Van Cauwenberge
authors.affiliation: d Department of Anesthesia , AZ Sint-Jan Brugge ? Oostende AV, Campus Brugge , Brugge , Belgium.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Mulier
authors.affiliation: a Department of Surgery , AZ Sint-Jan Brugge ? Oostende AV, Campus Brugge , Brugge , Belgium.
authors.forename: Bruno
authors.initials: B
authors.lastname: Dillemans
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D061214:Patient Safety; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Revisional bariatric surgery; conversion; gastric banding; gastric bypass; high volume center; one-step; two-step