Systematic review and meta-analysis of outcomes after revisional bariatric surgery following a failed adjustable gastric band

Introduction: Laparoscopic adjustable gastric band (LAGB) related complications have been reported in significant numbers of patients often leading to band removal. Increasingly revisional bariatric surgery (RBS) is offered, most commonly either band to roux-en-y gastric bypass (B-RYGB) or band to sleeve gastrectomy (B-SG).
Objectives: We conducted a systematic review and meta-analysis of studies to evaluate the efficacy of RBS following failed LAGB. Methods Medline, Embase, The Cochrane Library and NHS Evidence were searched for English language studies assessing patients who had undergone LAGB and who subsequently underwent RBS (either B-RYGB or B-SG).
Results: Thirty-six studies met the inclusion criteria. In total there were 2617 patients. BRYGB was performed in 60.5% (n=1583). There was only one death within 30 days reported (0.0004%). The overall pooled morbidity rate was 13.2%. There was no difference between the B-RYGB and B-SG groups in overall morbidity, leak rate or return to theatre. Percentage excess weight loss (%EWL) following the revisional procedure for all patients combined at 6, 12 and 24 months was 44.5%, 55.7% and 59.7% respectively. There was no statistical difference in %EWL between B-RYGB and B-SG at any time point. The rates of remission of diabetes, hypertension and obstructive sleep apnoea were 46.5%, 35.9% and 80.8% respectively.
Conclusions: Randomised controlled trials (RCTs) do not exist on this issue but the available observational evidence does suggest that RBS is associated with generally good outcomes similar to those experienced after primary surgery. Further, high quality research, particularly RCTs, is required to assess long-term weight loss, comorbidity and quality of life outcomes.