Abstract：
BACKGROUND: Revisional bariatric surgery is associated with higher perioperative complications over primary procedures. Adjustable gastric bands (AGB) continue to be the most frequently converted bariatric configuration. This study examines trends in current clinical indication and safety profile of the most frequently pursued AGB conversions.
METHODS: MBSAQIP data from 2020 to 2022 was retrospectively analyzed in a cohort study examining 30-day postoperative outcomes after AGB conversion to sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or single anastomosis duodenoileostomy (SADI). Descriptive statistics were used, including multivariable and 2:1 nearest neighbor matching analysis.
RESULTS: This study included 19,335 AGB conversions, of which most were to SG (n = 11,736) followed by RYGB (n = 7442) and SADI (n = 157). While a majority were completed for weight loss, there were differences in distribution of primary indication for each conversion cohort, such as higher proportion of RYGB conversion for gastroesophageal reflux disease (18.7%) compared to SG (7.92%) and SADI (5.10%). Multivariable analysis demonstrates conversion to RYGB has significantly higher odds of 30-day major complications (OR 1.75, p < 0.001), reoperation (OR 2.08; p = 0.001), readmission (OR 1.69; p = 0.001), and emergency department visits (OR 1.50; p = 0.001) over SG. These risks and odds of reintervention (OR 1.75; p < 0.001) remained significantly higher after conversion to RYGB versus SG on matched analysis. None of these risks is significantly different between conversions to SADI versus SG in either multivariable or matched analysis.
CONCLUSIONS: Compared to AGB conversion to SG, single-stage conversion to RYGB had increased odds of perioperative complications while risks of conversion to SADI were not significantly different.
METHODS: MBSAQIP data from 2020 to 2022 was retrospectively analyzed in a cohort study examining 30-day postoperative outcomes after AGB conversion to sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), or single anastomosis duodenoileostomy (SADI). Descriptive statistics were used, including multivariable and 2:1 nearest neighbor matching analysis.
RESULTS: This study included 19,335 AGB conversions, of which most were to SG (n = 11,736) followed by RYGB (n = 7442) and SADI (n = 157). While a majority were completed for weight loss, there were differences in distribution of primary indication for each conversion cohort, such as higher proportion of RYGB conversion for gastroesophageal reflux disease (18.7%) compared to SG (7.92%) and SADI (5.10%). Multivariable analysis demonstrates conversion to RYGB has significantly higher odds of 30-day major complications (OR 1.75, p < 0.001), reoperation (OR 2.08; p = 0.001), readmission (OR 1.69; p = 0.001), and emergency department visits (OR 1.50; p = 0.001) over SG. These risks and odds of reintervention (OR 1.75; p < 0.001) remained significantly higher after conversion to RYGB versus SG on matched analysis. None of these risks is significantly different between conversions to SADI versus SG in either multivariable or matched analysis.
CONCLUSIONS: Compared to AGB conversion to SG, single-stage conversion to RYGB had increased odds of perioperative complications while risks of conversion to SADI were not significantly different.
摘要：
背景：减重手术与主要手术相比，围手术期并发症较高。可调节胃束带（AGB）仍然是最常见的转换减肥配置。本研究调查了当前临床适应症的趋势和最常见的AGB转换的安全性。
方法：在一项队列研究中回顾性分析了2020年至2022年的MBSAQIP数据，该研究检查了AGB转换为袖状胃切除术（SG）后30天的术后结局，Roux-en-Y胃旁路术(RYGB),或单个吻合十二指肠吻合术（SADI）。使用描述性统计数据，包括多变量和2：1最近邻匹配分析。
结果：这项研究包括19,335个AGB转换，其中大多数是SG（n=11,736），其次是RYGB（n=7442）和SADI（n=157）。虽然大部分都是为了减肥而完成的，每个转换队列的主要适应症分布存在差异，例如，与SG（7.92％）和SADI（5.10％）相比，胃食管反流病的RYGB转换比例（18.7％）更高。多变量分析表明，转换为RYGB的30天主要并发症的几率显着增加（OR1.75，p<0.001），再次手术（OR2.08；p=0.001），再入院(OR1.69；p=0.001)，和急诊科就诊（OR1.50；p=0.001）超过SG。在匹配分析中，转换为RYGB后，再干预的风险和几率（OR1.75;p<0.001）仍然显着高于SG。在多变量或匹配分析中，这些风险在转换为SADI和SG之间没有显着差异。
结论：与AGB转换为SG相比，单阶段转换为RYGB的围手术期并发症发生率增加,而转换为SADI的风险无显著差异.
方法：在一项队列研究中回顾性分析了2020年至2022年的MBSAQIP数据，该研究检查了AGB转换为袖状胃切除术（SG）后30天的术后结局，Roux-en-Y胃旁路术(RYGB),或单个吻合十二指肠吻合术（SADI）。使用描述性统计数据，包括多变量和2：1最近邻匹配分析。
结果：这项研究包括19,335个AGB转换，其中大多数是SG（n=11,736），其次是RYGB（n=7442）和SADI（n=157）。虽然大部分都是为了减肥而完成的，每个转换队列的主要适应症分布存在差异，例如，与SG（7.92％）和SADI（5.10％）相比，胃食管反流病的RYGB转换比例（18.7％）更高。多变量分析表明，转换为RYGB的30天主要并发症的几率显着增加（OR1.75，p<0.001），再次手术（OR2.08；p=0.001），再入院(OR1.69；p=0.001)，和急诊科就诊（OR1.50；p=0.001）超过SG。在匹配分析中，转换为RYGB后，再干预的风险和几率（OR1.75;p<0.001）仍然显着高于SG。在多变量或匹配分析中，这些风险在转换为SADI和SG之间没有显着差异。
结论：与AGB转换为SG相比，单阶段转换为RYGB的围手术期并发症发生率增加,而转换为SADI的风险无显著差异.
