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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

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One-stage vs Two-stage Revisional Laparoscopic Gastric Bypass in 124 Patients after failed Adjustable Gastric Banding

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  • Julian Umlauft - Medical University Innsbruck, Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck, Österreich
  • Tomasz Dziodzio - Charité, Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
  • Robert Sucher - Charité, Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
  • Christian Denecke - Charité, Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
  • Sascha Weiss - Medical University Innsbruck, Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck, Österreich
  • Alexander Perathoner - Medical University Innsbruck, Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck, Österreich
  • Andreas Brandl - Medical University Innsbruck, Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck, Österreich
  • Katrin Kienzl - Medical University Innsbruck, Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck, Österreich
  • Heinz Wykypiel - Medical University Innsbruck, Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck, Österreich
  • Johann Pratschke - Charité, Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland
  • Matthias Biebl - Charité, Department of General, Visceral and Transplantation Surgery, Berlin, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch005

doi: 10.3205/15dgch005, urn:nbn:de:0183-15dgch0054

Published: April 24, 2015

© 2015 Umlauft et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Introduction: It has been advocated, that revisional laparoscopic Roux-en-Y gastric bypass (LRYGB) is the preferred procedure in patients after failed adjustable gastric banding. Yet there is little known whether a one-stage procedure (band removal and simultaneous LRYGB) or a LRYGB after former band removal (two stage procedure) is superior. Aim of this study is to compare early- and long-term results of both methods at our institute.

Material and methods: Retrospective analysis of 124 (f=105) consecutive patients (69 one-stage procedures, 55 two-stage procedures) undergoing revisional bypass. Follow-up time was 47.4 ± 34.0 months. Indications for one-stage vs two-stage procedures, operation time, postoperative complications, morbidity, and mortality were analyzed. Data are reported as total numbers (%) and mean±standard deviation.

Results: Mean age at bypass was 43.1 ± 10.7 vs 44.9 ± 10.9 years with a mean BMI of 36.9 ± 7.1 vs 39.9 ± 7.3 (one-stage vs two-stage). In the one-stage group the most common indications for surgery were weight regain (n=29, 39.1%), followed by GERD (n=21, 30.4%) and esophageal dilatation (n=21, 30.4%), whereas weight regain (n=52, 94.5%) and motility disorders (n=6, 10.9%) were the most common indications for a LRYGB in the two-stage group (multiple enumerations possible). Operative time differed only marginally: 194.2±54.2 vs 199.1±68.0 minutes, as well as the length of in-hospital stay: 8.2±2.8 vs 9.5±6.2 days. One-year mortality in both groups was 0%, 30-day complication rate was 10.0% vs 12.7%.

Conclusion: Postoperative complications, morbidity, and mortality are comparable after LRYGB in the one-stage vs. the two-stage setting. Nonetheless the LRYGB in the one-stage approach shows shorter operation time and a shorter in-hospital stay. Therefore, the one-stage approach should be preferred.