Revisional single-anastomosis gastric bypass for a failed restrictive procedure: 5-year results

Background: Long-term outcomes of revisional laparoscopic single anastomosis-gastric bypass for a failed restrictive procedure (rSAGB) have not been analyzed. Objectives: To assess 5-year outcomes of rSAGB compared with 5-year outcomes of primary SAGB (pSAGB). Setting: University public hospital, France. Methods: One hundred twenty-six patients who underwent SAGB between October 2006 and October 2008 were included in this retrospective study. rSAGB was defined as SAGB performed after failure of a first restrictive procedure. Five-year outcomes of each procedure regarding mortality, morbidity (i.e., Clavien-Dindo score), weight loss (change in body mass index [BMI] and percentage of excess BMI loss [%EBMIL]), co-morbidities remission, and Gastrointestinal Quality of Life Index (GIQLI) score, were assessed. Results: Thirty patients (24%) who had prior restrictive bariatric surgery (including 22 laparoscopic adjustable gastric bandings, 4 vertical banded gastroplasties, and 4 sleeve gastrectomies) underwent conversion to rSAGB. Ninety-six patients (76%) underwent primary SAGB (pSAGB group). Both groups were comparable in age, gender, BMI, and preoperative co-morbidities. Preoperative mean BMI of the rSAGB group was 45.5 +/- 7 kg/m(2). There were no deaths and the major complications rate was 10%. No increase in morbidity was found between the 2 groups. Two patients required conversion to RYGB after rSAGB because of intractable biliary reflux. At 5 years, mean BMI was 32 kg/m(2) and mean %EBMIL was 66% after rSAGB; no significant differences were found compared with pSAGB (BMI = 31 kg/m(2), %EBMIL = 73%). Co-morbidities and remission rates were statically similar. Overall, GIQLI score was significantly lower in the rSAGB group (104.1 +/- 17.6 versus 112.5 +/- 16.8, P = .025). Significant differences were found in "upper gastrointestinal symptoms" and "psychological" scores. Conclusion: At 5 years, rSAGB for a failed restrictive procedure was safe and effective, but quality of life and upper gastrointestinal function were lower compared with pSAGB. (C) 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved.