Conversion of Adjustable Gastric Banding to Stapling Bariatric Procedures: Single- or Two-stage Approach

OBJECTIVE:The aim of this study was to compare the safety of single- versus two-stage conversion of adjustable gastric band (AGB) to gastric bypass (RYGB) or sleeve gastrectomy (SG). SUMMARY BACKGROUND DATA:AGB patients often present for conversion to RYGB or SG. The impact of single- or two-stage approach of such conversion remains unclear. METHODS:A statewide database was used to identify all patients who underwent AGB removal and concurrent (single-stage) or interval (two-stage) RYGB or SG. Propensity score matching schemes were constructed to account for differences in baseline comorbidities and demographics, allowing for matched pairs available for comparisons. RESULTS:A total of 4330 patients underwent AGB conversion. Complications, readmissions, and ED visits were noted in 394 (9.1%), 278 (6.42%), and 589 (13.6%) patients, respectively. Three hundred sixty-seven matched pairs underwent RYGB; single-stage patients experienced shorter length of stay (LOS) (median difference −1 d, P < 0.0001), less complications [risk difference (RD)−8.4%, 95% confidence interval (CI), −13.4% to −3.5%], readmissions (RD−5.2%, 95% CI, −9.6% to −0.8%), and ED visits (RD−5.7%, 95% CI, −11.3% to −0.2%). Eight hundred seventy-five matched pairs underwent SG; single-stage patients experienced improved outcomes in all measures examined. For single-stage procedures (809 pairs), RYGB was associated with longer LOS, and more complications (RD3.3%, 95% CI, 0.9%–5.8%), with similar readmissions, and ED visits. CONCLUSIONS:AGB conversion procedures have low morbidity. Single-stage conversion is associated with lower morbidity compared with the two-stage approach. Conversion to SG seems to be safer than RYGB.