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Re-do operations

More adverse events for bypass patients after band failure

Complication rates, costs are higher for rescue procedures
Paper calls for re-evaluation of banding in the US

The first population-based study examining adverse outcomes after primary gastric bypass or a gastric bypass after failed gastric banding, has concluded that patients who have a bypass after a failed gastric band have more adverse outcomes. Published in the Annals of Surgery, the authors from the Duke University Medical Center also highlighted that the number of patients undergoing a reoperation after gastric banding increased “drastically” from 2005 to 2008, and concluded that the broad indication for gastric banding should be reassessed for the US population.

The study compared the short-term outcomes for patients undergoing primary gastric bypass surgery with those who had gastric bypass procedures performed as a rescue procedure after failed gastric banding, and examined trends in the frequency of reoperations between 2005 and 2008for patients who had prior gastric banding.

The researchers used the Nationwide Inpatient Sample for their data analysis. A total of 66,303 patients (53,594 women, mean age 43.5 years) were included in the analyses. Only patients undergoing a one-step conversion from gastric banding to gastric bypass were included the study.

A total of 63,171 patients (95.3%) underwent a primary gastric bypass procedure and 3,132 patients (4.7%) underwent a gastric band-related reoperation. Three hundred and one patients underwent a reoperation for gastric band with a concomitant gastric bypass procedure.

Results

A total of 17 patients (5.6%) experienced an intra-operative complication for following a secondary gastric bypass procedure, compared with 63 patients (2.4%) undergoing a primary gastric bypass procedure (p<0.001). Patients undergoing a secondary gastric bypass procedure had higher rate of  overall postoperative complications (30.2%), compared with patients undergoing a primary gastric bypass procedure (4.9%, p< 0.001).

The rate of re-interventions/re-operations was higher in patients undergoing secondary gastric bypass operation (3.7%, n=11/301) than in patients undergoing primary gastric bypass (0.6%, 353/63,171; p<0.001). Patients undergoing a secondary gastric bypass procedure also had a significantly longer median hospital stay (3.16 days) than those undergoing a primary gastric bypass procedure (2.31 days, p<0.001).

There was also a significant difference in costs with the median unadjusted total hospital charges higher in patients undergoing secondary gastric bypass ($49,377) than in those undergoing a primary gastric bypass ($35,189; p<0.001).

Between 2005 and 2008, the number of band-related reoperations increased 196% from 579 in 2005 to 1,132 in 2008. Band-related reoperations concomitant with a gastric bypass procedure (secondary gastric bypass) increased from 63 to 101 operations (160%), rebandings from 31 to 82 operations (265%), and other concomitant reoperations from 10 to 47 (470%), annually. In total, any band-related reoperation concomitant with a rescue bariatric procedure increased from 104 to 230 operations (221%) per year.

Conclusion

The researchers highlighted that laparoscopic gastric band procedures increased more than 300% from 2004 to 2007 in the US, and expect that reoperations will continue to increase.

The authors concluded that “patients undergoing gastric bypass surgery after earlier gastric band operation with patients undergoing primary gastric bypass clearly favour primary gastric bypass procedures.”

They claim that the results of the study show that gastric bypass after failed gastric banding is associated with significantly more intra- and postoperative morbidity, higher rate of re-operations, a significantly longer hospital stay and higher hospital charges.

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