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Invited Commentary |

Conversion of Adjustable Gastric Banding to Roux-en-Y Gastric Bypass Not as Optimal as Primary Gastric Bypass?

Michel Gagner, MD, FRCSC1,2
[+] Author Affiliations
1Herbert Wertheim College of Medicine, Florida International University, Miami
2Hôpital du Sacre Coeur, Montreal, Quebec, Canada
JAMA Surg. 2014;149(8):786-787. doi:10.1001/jamasurg.2014.634.
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Once popular, adjustable gastric band operation rates are plummeting to new record lows worldwide because of poor weight loss, weight regain, and frequent reoperation due to slippage, erosions, hiatal hernias or reflux, and mechanical device failures. During the Longitudinal Assessment of Bariatric Surgery study,1 laparoscopic adjustable gastric banding (LAGB) at 3 years had only a median of 15.9% of baseline weight loss compared with 31.5% for Roux-en-Y gastric bypass (RYGB). Also, there were 77 subsequent procedures following 610 LAGBs during 3 years vs 4 subsequent procedures in more than 1691 RYGBs. Hence, conversion of adjustable gastric banding to another intervention (sleeve gastrectomy, gastric bypass, or duodenal switch) is on the rise. In this issue of JAMA Surgery, Thereaux et al2 have retrospectively reviewed their prospective database of a single-university surgical center and compared primary gastric bypass with revision gastric bypass, mainly bands revised to gastric bypass.

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