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Original Investigation |

Similar Postoperative Safety Between Primary and Revisional Gastric Bypass for Failed Gastric Banding

Jérémie Thereaux, MD1; Nicolas Veyrie, MD1; Charles Barsamian, MD2; Nicola Corigliano, MD, PhD1; Alain Beauchet, MD3; Christine Poitou, MD, PhD4; Jean-Michel Oppert, MD, PhD4; Sebastien Czernichow, MD, PhD2,5; Jean-Luc Bouillot, MD1
[+] Author Affiliations
1Department of General, Digestive, and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique–Hôpitaux de Paris, Boulogne-Billancourt, France
2Department of Nutrition, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique–Hôpitaux de Paris, Boulogne-Billancourt, France
3Department of Epidemiology and Clinical Research, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique–Hôpitaux de Paris, Boulogne-Billancourt, France
4Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique–Hôpitaux de Paris, Pierre-et-Marie-Curie University (University of Paris VI), Human Nutrition Research Center Île-de-France, Paris, France
5Centre for Research in Epidemiology and Population Health, Institut National de la Santé et de la Récherche Médicale Unité 1018, Paul Brousse Hospital, Villejuif, France
JAMA Surg. 2014;149(8):780-786. doi:10.1001/jamasurg.2014.625.
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Importance  Adjustable gastric bands are widely used because of low postoperative morbidity, but their long-term results are poor, often leading to revisional surgery.

Objective  To assess the safety of revisional procedures by comparing the 30-day outcomes of primary gastric bypass vs revisions following failed adjustable gastric banding.

Design, Setting, and Participants  Retrospective review using logistic regression models to compute odds ratios (95% CIs) across preoperative body mass index (calculated as weight in kilograms divided by height in meters squared) quartiles to evaluate the risk for major adverse outcomes at 30 days (death, venous thromboembolism, reinterventions, and failure to be discharged). The prospective database of a single university surgical center in Paris, France, was queried for clinical and other relevant data among all patients undergoing primary or revisional laparoscopic gastric bypass between January 1, 2004, and June 30, 2013.

Main Outcomes and Measures  The primary outcome was a comparison between 30-day outcomes of primary gastric bypass and procedures following failed adjustable gastric banding.

Results  In total, 831 patients had a primary procedure (group 1), and 177 patients had a secondary procedure after failed adjustable gastric banding (group 2). Overall, 78.7% of patients were female, the mean (SD) patient age was 42.6 (11.6) years, the mean (SD) body mass index was 47.6 (7.6), and mortality at 30 days was 0.5%. The rates of major adverse outcomes were similar in group 1 (7.8%) and group 2 (8.5%) (P= .77). In multivariate analyses, odds ratios for major adverse outcomes across preoperative body mass index quartiles (<42, 42-46, >46 to 52, and >52) were 1.00, 0.39 (95% CI, 0.20-0.77; P = .006), 0.55 (95% CI, 0.30-1.02; P = .06), and 0.50 (95% CI, 0.27-0.94; P = .03), respectively.

Conclusions and Relevance  The 30-day major adverse outcome rates were similar for primary gastric bypass and for procedures following failed adjustable gastric banding. Long-term comparative studies are required to better understand the quadratic relationship between body mass index and early postoperative outcomes.

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