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Gastric band conversion: Sleeve or bypass?

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As with any surgical weight loss procedure, gastric banding has a recognized failure rate.  About 15% of those who have a gastric band have an unsatisfactory outcome, either because they simply don’t lose weight (non-responders) or because they have complications such as band slippage.  Many of these patients opt to have the band removed and converted to a different procedure, either sleeve gastrectomy or a Roux-en-Y gastric bypass (RYGBP).  A key question is which of these procedures delivers the best outcomes and a recent study was designed to address exactly that question. 

In all, 59 patients (11 men and 48 women) were included in the study. The most frequent reason for conversion was insufficient weight loss or weight regain (the non-responders).  This was the case for 44 people out of the 59 in the study whilst the remaining 15 had band complications.  The operative complication rate in the non-responders group was 7% and in the complicated band group was 13%.

Importantly, percentage excess weight loss in the RYGBP group was 55% compared with 28% in those having a sleeve gastrectomy.

One should bear in mind that the numbers of people in the study were very small. However, these findings suggest that both sleeve gastrectomy and RYGBP are suitable revisional operations for patients who have not succeeded with the gastric band, but that weight loss is likely to be better with gastric bypass.
 

Dr David Ashton MD PhD
27th February 2014 

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