Comparison of safety between 1-stage and 2-stage surgery: from laparoscopic adjustable gastric banding to laparoscopic sleeve gastrectomy.

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is becoming increasingly popular. With significant failure rates for laparoscopic adjustable gastric banding (LAGB), conversion to LSG is an attractive consideration for maintenance of target percentage excess weight loss (%EWL). Conversions can be successfully achieved in either 1-stage (OS) or 2-stage (TS) surgery.

OBJECTIVES

We intend to examine safety between OS and TS surgery and determine features indicative for OS surgery.

SETTING

Records were audited from the database of a private surgical practice located in Perth, Western Australia.

METHODS

We analyzed 86 patients in a prospective observational study over a 3-year time frame (38 OS, 48 TS). The primary outcome was perioperative events, graded using the Clavien-Dindo classification system. Secondary outcomes included any preoperative, intraoperative, and postoperative events.

RESULTS

Surgical complications were similar between OS and TS groups. Grades of complications were not significantly different. No difference was found in procedural normality between cohorts (P = .95). More adhesions were present in the TS group compared with the OS group after accounting for adjustments (P = .05). Patient demographic characteristics were not different between groups, with the exception of body mass index (BMI). There were no staple line leaks within the OS group; 2 leaks occurred in the TS group.

CONCLUSION

OS surgery appears as safe as TS surgery provided surgeons carefully assess patient eligibility. We recommend the following features for ideal OS candidacy: no previous band complications, minimal peritoneal adhesions under laparoscopy, minimal co-morbidities, and a lower BMI at entry into conversion.