Original article| Volume 12, ISSUE 10, P1769-1776, December 2016

5-year outcomes of 1-stage gastric band removal and sleeve gastrectomy



      No verdict has been reached on single-stage removal of gastric banding with sleeve gastrectomy.


      To report 5-year outcomes of 1-stage gastric band removal and sleeve gastrectomy (Conversion-LSG) compared with primary laparoscopic sleeve gastrectomy (Prim-LSG).


      Large single-surgeon prospective database.


      Two patient groups were included: Conversion-LSG as the study group and Prim-LSG for comparison. Preconversion characteristics, conversion indication, weight loss, and complications were compared. The surgical protocol was reviewed, focusing on key technical recommendations.


      A total of 209 Conversion-LSG and 3268 Prim-LSG patients, aged 32.9±9.8 and 31.8±10.7 years respectively (P = .2), were studied. No significant differences in age, body mass index (BMI), or gender distribution existed. Conversion-LSG Baseline BMI was 47±12 kg/m2. Patients spent 6.2±2.6 years with the band before Conversion-LSG. BMI at 1, 2, 3, 4, and 5 years was 37±8, 31±9, 29±11, 30±9, and 30±11 kg/m2, respectively. No significant difference in BMI change between the 2 groups existed. In the Conversion-LSG group, 1 patient had a successfully stented leak but developed a gastrobronchial fistula 1 year later. In the Prim-LSG group, 3 leak cases were reported and managed successfully through endoscopic stenting, 1 patient had pulmonary embolism that responded to standard treatment, and 3 patients had postoperative bleeding. No other major complications occurred, and there was no mortality in either group. Additionally, no Conversion-LSG patients required further bariatric intervention.


      Employing the surgical technique described in this paper, conversion-LSG is as well tolerated and effective as primary sleeve gastrectomy.


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        • Elnahas A.
        • Graybiel K.
        • Farrokhyar F.
        • Gmora S.
        • Anvari M.
        • Hong D.
        Revisional surgery after failed laparoscopic adjustable gastric banding: a systematic review.
        Surg Endosc. 2013; 27: 740-745
        • Rosenthal R.
        Sleeve gastrectomy as a revisional procedure.
        in: Brethauer S.A. Schauer P.R. Schirmer B.D. Minimally Invasive Bariatric Surgery. Springer, New York2015: 173-177
        • Schneck A.-S.
        • Lazzati A.
        • Audureau E.
        • et al.
        One or two steps for laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy: a nationwide French study on 3,357 morbidly obese patients.
        Surg Obes Relat Dis. Epub. 2015 Oct 21;
        • Shen X.
        • Zhang X.
        • Bi J.
        • Yin K.
        Long-term complications requiring reoperations after laparoscopic adjustable gastric banding: a systematic review.
        Surg Obes Relat Dis. 2015; 11: 956-964
        • Zellmer J.D.
        • Mathiason M.A.
        • Kallies K.J.
        • Kothari S.N.
        Is laparoscopic sleeve gastrectomy a lower risk bariatric procedure compared with laparoscopic Roux-en-Y gastric bypass? A meta-analysis.
        Am J Surg. 2014; 208 (discussion 9–10): 903-910
        • Chang S.
        • Stoll C.T.
        • Song J.
        • Varela J.
        • Eagon C.J.
        • Colditz G.A.
        The effectiveness and risks of bariatric surgery: An updated systematic review and meta-analysis, 2003-2012.
        JAMA Surgery. 2014; 149: 275-287
        • Stroh C.
        • Birk D.
        • Flade-Kuthe R.
        • et al.
        A nationwide survey on bariatric surgery in Germany--results 2005-2007.
        Obes Surg. 2009; 19: 105-112
        • Gagner M.
        • Deitel M.
        • Erickson A.L.
        • Crosby R.D.
        Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy.
        Obes Surg. 2013; 23: 2013-2017
        • Birkmeyer N.J.
        • Dimick J.B.
        • Share D.
        • et al.
        Hospital complication rates with bariatric surgery in Michigan.
        JAMA. 2010; 304: 435-442
        • Cook J.A.
        • Ramsay C.R.
        • Fayers P.
        Statistical evaluation of learning curve effects in surgical trials.
        Clin Trials. 2004; 1: 421-427
        • Schauer P.
        • Ikramuddin S.
        • Hamad G.
        • Gourash W.
        The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases.
        Surg Endosc. 2003; 17: 212-215
        • Flum D.R.
        • Dellinger E.P.
        Impact of gastric bypass operation on survival: a population-based analysis.
        J Am Coll Surg. 2004; 199: 543-551
        • Zacharoulis D.
        • Sioka E.
        • Papamargaritis D.
        • et al.
        Influence of the learning curve on safety and efficiency of laparoscopic sleeve gastrectomy.
        Obes Surg. 2012; 22: 411-415
        • Stroh C.
        • Benedix D.
        • Weiner R.
        • et al.
        Is a one-step sleeve gastrectomy indicated as a revision procedure after gastric banding? Data analysis from a quality assurance study of the surgical treatment of obesity in Germany.
        Obes Surg. 2014; 24: 9-14
        • Stroh C.
        • Weiner R.
        • Wolff S.
        • Knoll C.
        • Manger T.
        Revisional surgery and reoperations in obesity and metabolic surgery: Data analysis of the German bariatric surgery registry 2005-2012 [in German].
        Chirurg. 2015; 86: 346-354
        • Torrente J.E.
        • Cooney R.N.
        • Rogers A.M.
        • Hollenbeak C.S.
        Importance of hospital versus surgeon volume in predicting outcomes for gastric bypass procedures.
        Surg Obes Relat Dis. 2013; 9: 247-252
        • Birkmeyer J.D.
        • Stukel T.A.
        • Siewers A.E.
        • Goodney P.P.
        • Wennberg D.E.
        • Lucas F.L.
        Surgeon volume and operative mortality in the United States.
        N Engl J Med. 2003; 349: 2117-2127
        • Urbach D.R.
        Pledging to eliminate low-volume surgery.
        N Engl J Med. 2015; 373: 1388-1390
        • Kelly J.V.
        • Hellinger F.J.
        Physician and hospital factors associated with mortality of surgical patients.
        Med Care. 1986; 24: 785-800
        • Luft H.S.
        • Bunker J.P.
        • Enthoven A.C.
        Should operations be regionalized? The empirical relation between surgical volume and mortality.
        N Engl J Med. 1979; 301: 1364-1369
        • Aminian A.
        • Shoar S.
        • Khorgami Z.
        • Augustin T.
        • Schauer P.R.
        • Brethauer S.A.
        Safety of one-step conversion of gastric band to sleeve: a comparative analysis of ACS-NSQIP data.
        Surg Obes Relat Dis. 2015; 11: 386-391
        • Gagner M.
        • Buchwald J.N.
        Comparison of laparoscopic sleeve gastrectomy leak rates in four staple-line reinforcement options: a systematic review.
        Surg Obes Relat Dis. 2014; 10: 713-723
        • Gonzalez-Heredia R.
        • Masrur M.
        • Patton K.
        • Bindal V.
        • Sarvepalli S.
        • Elli E.
        Revisions after failed gastric band: sleeve gastrectomy and Roux-en-Y gastric bypass.
        Surg Endosc. 2015; 29: 2533-2537
        • Angrisani L.
        • Santonicola A.
        • Formisano G.
        • Hasani A.
        • Lorenzo M.
        Revisional surgery after LAGB.
        in: Agrawal S. Obesity, Bariatric and Metabolic Surgery. Springer International Publishing, Cham2015: 403-411
        • ten Broek R.P.
        • Issa Y.
        • van Santbrink E.J.
        • et al.
        Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis.
        BMJ. 2013; 347: f5588
        • van Goor H.
        Consequences and complications of peritoneal adhesions.
        Colorectal Dis. 2007; 9: 25-34
        • Noel P.
        • Schneck A.S.
        • Nedelcu M.
        • et al.
        Laparoscopic sleeve gastrectomy as a revisional procedure for failed gastric banding: lessons from 300 consecutive cases.
        Surg Obes Relat Dis. 2014; 10: 1116-1122
        • Khoursheed M.
        • Al-Bader I.
        • Mouzannar A.
        • et al.
        Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes.
        Surg Endosc. 2013; 27: 4277-4283
        • Sabbagh C.
        • Verhaeghe P.
        • Dhahri A.
        • et al.
        Two-year results on morbidity, weight loss and quality of life of sleeve gastrectomy as first procedure, sleeve gastrectomy after failure of gastric banding and gastric banding.
        Obes Surg. 2010; 20: 679-684
        • Goitein D.
        • Feigin A.
        • Segal-Lieberman G.
        • Goitein O.
        • Papa M.Z.
        • Zippel D.
        Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure.
        Surg Endosc. 2011; 25: 2626-2630
        • Rebibo L.
        • Mensah E.
        • Verhaeghe P.
        • et al.
        Simultaneous gastric band removal and sleeve gastrectomy: a comparison with front-line sleeve gastrectomy.
        Obes Surg. 2012; 22: 1420-1426
        • Alqahtani A.R.
        • Elahmedi M.
        • Alamri H.
        • Mohammed R.
        • Darwish F.
        • Ahmed A.M.
        Laparoscopic removal of poor outcome gastric banding with concomitant sleeve gastrectomy.
        Obes Surg. 2013; 23: 782-787
        • Sieber P.
        • Gass M.
        • Kern B.
        • Peters T.
        • Slawik M.
        • Peterli R.
        Five-year results of laparoscopic sleeve gastrectomy.
        Surg Obes Relat Dis. 2014; 10: 243-249