Weight Loss and Late Complications after Silastic Ring Vertical Gastroplasty. A 10 Year Follow-up.

BACKGROUND AND AIM: Severe obesity is a public health care system challenge that requires bariatric surgery. Among the plethora of bariatric surgery techniques silastic ring vertical gastroplasty (SRVG) is a safe and efficient restrictive method that has been successfully used previously. However, it's performance by open approach has been abandoned and replaced by other methods using the laparoscopic method. The aim of the present study was to investigate patients with severe obesity submitted to open SRVG and to report our results over a period of 10 years in terms of weight loss, late complications and surgical re-interventions. MATERIAL AND METHODS: 112 severely obese patients submitted to open SRVG between years 2008- 2009 were investigated retrospectively for body mass index (BMI), percent excess BMI loss (%EBMIL), late surgical complications and reoperations. 41.96% of the patients were followed up 10 years after SRVG. Results: The initial mean BMI was 47.38 +- 7.59 kg/m2 and dropped statistically significant (p 0.001) to 31.05 +- 6.54 kg/m2 by the first year after SRVG. The mean BMI was rather stable along the first 5 years after SRVG when it started to increase gradually, reaching 35.93 +- 7.20 kg/m2 by the 10th year of follow-up when it remained still significantly lower (p 0.001) as compared to the mean baseline value. The %EBMIL was 79% at one year after surgery and reached 51% by the 10th year of follow-up. The most frequent late complications after SRVG were stoma stenosis (8.92%), enlargement of the stoma (8.03%) and incisional hernia (3.36%). As a consequence of stoma stenosis the ring has been removed in all cases. In 2 cases, after the ring removal, the patients underwent gastric bypass. CONCLUSION: SRVG is a safe and efficient restrictive technique of bariatric surgery open to many options to be revised, leading to a successful sustained long term weight loss and maintenance. Stoma stenosis, enlargement of the stoma and incisional hernia are the most frequent late complications after SRVG requesting reoperations.

Endoscopic gastric reduction with an endoluminal suturing device: a multicenter prospective trial with 1-year follow-up.

BACKGROUND: Obesity is the pandemic disease of this century. Surgery is the only effective treatment but cannot be offered to every patient. Endoscopic sutured gastroplasty is a minimally invasive technique that may potentially fill the gap between surgery and behavioral therapy. In this study, we prospectively investigated the efficacy and safety of a novel suturing device. METHODS: After a pre-bariatric multidisciplinary work-up, class 1 and 2 obese patients were included. Using a simple triangulation platform, transmural sutures with serosa-to-serosa apposition were performed in the gastric cavity. Patients were followed according to the same routines as those performed for bariatric procedures. RESULTS: Between November 2015 and December 2016, 51 patients were included across three European Centers. Mean body mass index at baseline was 35.1 kg/m2 (SD 3.0). Excess weight loss and total body weight loss at 1 year were 29 % (SD 28) and 7.4 % (SD 7), respectively, for the whole cohort (45 patients). At follow-up gastroscopy, 88 % of sutures were still in place (30 patients). No severe adverse events were observed. CONCLUSIONS: Endoscopic sutured gastroplasty using this novel device is safe and achieved weight loss results in line with criteria expected for these endoluminal techniques. Further prospective studies vs. placebo or nutritional support are needed.

Retained gastric band port and tube 5 years after gastric band removal and laparoscopic Roux-en-Y gastric bypass: a case report.

BACKGROUND: While LAGB has become uncommon in the bariatric surgery practice, band removal with or without revision surgery is still common. Retained postoperative foreign body, of which surgical sponges are the most common, is a rare condition. We report a rare case of retained gastric band port and the attached tube. CASE PRESENTATION: A 31-year-old Caucasian female presented to the outpatient clinic, 5 years after her last surgery, complaining of a left upper quadrant abdominal mass over the last 2 years. She had a history of 2 weight loss operations. She had no significant family history nor smoking. CT of the abdomen and pelvis revealed a retained foreign body. On exploration, the port with 10 cm of the connected tube was found and removed through a small incision without laparotomy. The patient made an uneventful recovery. CONCLUSION: A bariatric surgeon should be involved in the evaluation of any patient who complains of abdominal pain and/or palpable mass if she/he has a previous weight loss procedure because the bariatric surgeon is fully aware of the possible complications of the bariatric surgeries.

Safety and feasibility of an endoluminal-suturing device for endoscopic gastric reduction (with video).

BACKGROUND AND AIMS: Obesity is a major pandemic disease. Surgical therapy is highly effective, but its availability will likely be overwhelmed by the burden of the disease. Endoscopic technologies that could reproduce some of the clinical effects of surgery may become part of the treatment armamentarium. A simple transoral restrictive procedure could play a role in first-line surgical management. METHODS: We evaluated the safety and feasibility of transmural suturing using a simple triangulation platform for gastric volume reduction through the creation of multiple double plicatures. RESULTS: Between May and July 2015, 11 obese (body mass index 34.6 ± 2.1 kg/m2) patients (mean age, 36 ± 10 years) underwent gastroplasty through transmural endoscopic sutures (performed using a triangulation platform and an endoscopic stitcher). The median duration of the procedure was 2.00 hours (range, 1.15-3.15 hours) and dramatically decreased after the first 5 cases. No severe adverse events were observed. Mean (standard deviation) weight loss and percentage of excess weight loss were 5.8 kg (2.7%) and 21% (9%) at 1 month (n = 11), 8.8 kg (4.9%) and 33% (22%) at 3 months (n = 10), and 10.9 kg (7.3%) and 41% (33%) at 6 months (n = 10). CONCLUSIONS: Transoral endoscopic gastroplasty performed using a simple triangulation platform and a dedicated suturing device appears to be safe and effective at mid-term follow-up in creating gastric restriction and inducing weight loss in this first-in-humans experience. (Clinical trials registration number: NCT02534662.).

Laparoscopic Adjustable Gastric Banding: Predictive Factors for Weight Loss and Band Removal After More than 10 Years' Follow-Up in a Single University Unit.

BACKGROUND: Weight loss and overall outcomes following laparoscopic adjustable gastric banding (LAGB) are more variable than with other bariatric procedures. Our aim was to investigate the predictive value of certain parameters in a cohort of 794 patients with 10 years' minimum follow-up after LAGB. METHODS: We retrospectively reviewed the records of 794 patients undergoing LAGB performed by the authors between April 1996 and December 2004. We collected patients' data on weight loss and band-related complications and performed logistic regression modelling and calculated Kaplan-Meier curves for band preservation. RESULTS: The follow-up rate at 10 years was 90.4%. The mean follow-up duration was 15.1 years (range, 120-228 months). Overall band removal with or without conversion or replacement was required in 304 (38.2%) patients. The mean survival time of the band was 148.4 months (95% confidence interval: 138.3-167.4), and there was no difference in the rate of removal by operative technique (p = 0.7). The highest rate of band removal occurred in female patients (p = 0.05), those with BMI > 50 kg/m2 (p = 0.005) and in those <40 years of age (p = 0.04). For patients with the band in situ, the success rate was significantly lower in patients with initial BMI > 50 kg/m2. Conversely, differences in success rate were not statistically significant for age (using 50 years as the cut-off), technique or sex. CONCLUSIONS: Higher rates of removal occurred in women, younger patients and those with BMI > 50 kg/m2. Regardless of these criteria, the rate of band removal for complications rose over time. Patients should be informed of the high risk of the need for band removal long-term.

Laparoscopic adjustable gastric banding migration: an early approach for a late complication.

AIM: Laparoscopic adjustable gastric banding (LAGB) migration is an uncommon late complication after bariatric surgery. It usually presents with an unexplained weight increase or without any symptom. Current guidelines do not establish the timing of a clear endoscopic follow-up to prevent and/or to treat this kind of complication. PATIENTS AND METHODS: Long-term follow-up was performed in 217 patients with LAGB (37 underwent surgery in other bariatric centers). At the endoscopic check, 3 patients presented banding erosion respectively 7, 9 and 11 years after surgery. In all three cases the patients, lost at the follow-up in their bariatric centers, had weight gain. During the endoscopy was treated just one patient because of the advanced migration. For the other patients, with a minimal migration, the choice was to perform an endoscopic surveillance every 4 months. DISCUSSION: Removal of eroded gastric banding with common endoscopic devices is feasible, safe, and effective. CONCLUSION: With our experience we suggest to perform planned endoscopy at least within 2 years in order to guarantee the early diagnosis and managing of gastric banding erosion.

Closed-loop gastric electrical stimulation versus laparoscopic adjustable gastric band for the treatment of obesity: a randomized 12-month multicenter study.

OBJECTIVE: To compare the weight loss, change in quality of life (QOL) and safety of closed-loop gastric electrical stimulation (CLGES) versus adjustable gastric band (LAGB) in the treatment of obesity. METHODS: This multicenter, randomized, non-inferiority trial randomly assigned the patients in a 2:1 ratio to laparoscopic CLGES versus LAGB and followed them for 1 year. We enrolled 210 patients, of whom 50 were withdrawn preoperatively. Among 160 remaining patients (mean age=39±11 years; 75% women; mean body mass index=43±6 kg m-2) 106 received CLGES and 54 received LAGB. The first primary end point was non-inferiority of CLGES versus LAGB, ascertained by the proportion of patients who, at 1 year, fulfilled: (a) a ⩾20% excess weight loss (EWL); (b) no major device- or procedure-related adverse event (AE); and (c) no major, adverse change in QOL. Furthermore, ⩾50% of patients had to reach ⩾25% EWL. The incidence and seriousness of all AE were analyzed and compared using Mann-Whitney's U-test. RESULTS: At 1 year, the proportions of patients who reached all components of the primary study end point were 66.7 and 73.0% for the LAGB and CLGES group, respectively, with a difference of -6.3% and an upper 95% CI of 7.2%, less than the predetermined 10% margin for confirming the non-inferiority of CLGES. The second primary end point was also met, as 61.3% of patients in the CLGES group reached ⩾25% EWL (lower 95% CI=52.0%; P<0.01). QOL improved significantly and similarly in both groups. AE were significantly fewer and less severe in the CLGES than in the LAGB group (P<0.001). CONCLUSIONS AND RELEVANCE: This randomized study confirmed the non-inferiority of CLGES compared with LAGB based on the predetermined composite end point. CLGES was associated with significantly fewer major AE.

The use of adjustable gastric bands for management of severe and complex obesity.

BACKGROUND: Obesity levels in the UK have reached a sustained high and ∼4% of the population would be candidates for bariatric surgery based upon current UK NICE guidelines, which has important implications for Clinical Commissioning Groups. SOURCES OF DATA: Summary data from Cochrane systematic reviews, randomized controlled trials (RCTs) and cohort studies. AREAS OF AGREEMENT: Currently, the only treatment that offers significant and durable weight loss for those with severe and complex obesity is surgery. Three operations account for 95% of all bariatric surgery in the UK, but the NHS offers surgery to only a small fraction of those who could benefit. Laparoscopic adjustable gastric banding (gastric banding) has potentially the lowest risk and up-front costs of the three procedures. AREAS OF CONTROVERSY: Reliable Level 1 evidence of the relative effectiveness of the operations is lacking. GROWING POINTS: As a point intervention, weight loss surgery together with the chronic disease management strategy for obesity can prevent significant future disease and mortality, and the NHS should embrace both. AREAS TIMELY FOR DEVELOPING RESEARCH: Better RCT evidence is needed including clinical effectiveness and economic analysis to answer the important question 'which is the best of the three operations most frequently performed?' This review considers the current evidence for gastric banding for the treatment of severe and complex obesity.

Endoscopic treatment of food intolerance after a banded gastric bypass: inducing band erosion for removal using a plastic stent.

BACKGROUND AND STUDY AIMS: Ring complications after a banded Roux-en-Y gastric bypass (RYGB) are usually managed surgically. The aim of this study was to analyze the safety and effectiveness of endoscopic removal of noneroded rings after banded-RYGB, by inducing intragastric erosion of the ring using a self-expandable plastic stent (SEPS). PATIENTS AND METHODS: A total of 41 patients with banded RYGB who had noneroded rings and food intolerance were prospectively enrolled. Patients were treated with endoscopic SEPS placement and ring removal. Data from time of stenting, resolution of symptoms, need for endoscopic dilation, and complications were recorded. RESULTS: Successful ring removal was possible in all patients. In 21 cases, the SEPS induced complete erosion, and in 17 cases the ring was removed a month later because of incomplete erosion at the time of SEPS removal. Nine patients (22.0 %) needed endoscopic dilation after stent removal in order to treat fibrotic strictures. Food tolerance was observed in 32 patients (78.0 %) after the procedure. No patient needed surgery and there were no deaths. CONCLUSIONS: Endoscopic removal of the ring using SEPS appeared to be safe and effective after a banded RYGB.

Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York.

INTRODUCTION: We sought to determine the rate of revision and explant of the laparoscopic adjustable gastric banding (LAGB) over a ten-year period in the state of New York. METHODS: Following IRB approval, the SPARCS administrative database was used to identify LAGB placement from 2004 to 2010. We tracked patients who underwent band placement with subsequent removal/revision, followed by conversion to either Roux-en-Y gastric bypass (RYBG) or sleeve gastrectomy (SG) between 2004 and 2013. McNemar test and Chi-square test were used to compare complications between primary procedure and subsequent revision and to compare complication rates and mortality rates, respectively. Log-rank test was used to assess patient characteristics and comorbidities. p < 0.05 was considered significant. RESULTS: During a 7-year period, there were 19,221 records of LAGB placements and 6567 records of revisions or removal. We were able to follow up 3158 (16.43 %) who subsequently underwent a band removal or revision over the course of this period. An additional 3606 patients had no records in the state of New York following the procedure, thus making the rate of revision 20.22 %. Initial revision procedures were coded as band removal in 32.77 % (n = 1035), band revision in 30.53 % (n = 964), band removal and replacement in 19.09 % (n = 603), removal and conversion to SG in 5.64 % (n = 178), or removal and conversion to RYGB in 11.97 % (n = 378). From the 3158 patients, 2515 (79.64 %) required only one revision. Six hundred and forty-three patients underwent two or more revisions. Thirty-one out of 3158 (0.0098 %) patients had complications at their initial operation, but 919 (29.1 %) had complications during revision (p < 0.0001). CONCLUSIONS: Over a 7-year period, at least 20.22 % of LAGB required removal or revision. Based on all case numbers, total revision rate may be as high as 34.2 %. Although the band is believed to be a reversible procedure, revisional procedures are significantly more morbid than the initial procedure.

Safety and efficacy of single-stage conversion of failed adjustable gastric band to laparoscopic Roux-en-Y gastric bypass: a case-control study.

BACKGROUND: We conducted the following study to evaluate the safety and efficacy of single-stage conversion of failed laparoscopic adjustable gastric band (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) as compared to a cohort of primary LRYGB patients. METHODS: A single-institution, prospectively maintained bariatric database was used to retrospectively identify consecutive patients who underwent single-stage removal of LAGB with concomitant conversion to LRYGB between the years of 2007 and 2013. The study cohort was matched 1:1 for age, gender, body mass index (BMI), and approximate date of operation to patients who underwent primary LRYGB. Primary endpoints were operative time, complication rate, length of hospital stay (LOS), and percent excess BMI lost (%EBMIL) at 24-month follow-up. RESULTS: Ninety-four conversion patients met inclusion criteria. There were no statistically significant differences in the mean LOS (3.1 vs. 3.0 days, p = 0.97) or the major complication rate (3.2 vs. 1.1 %, p = 0.62) at 30 days postoperatively. Likewise, 30-day minor complication rates, including readmission, were similar between groups (7.5 vs. 6.4 %, p = 0.77). The average operative time was significantly longer for conversion compared to primary LRYGB (193.5 vs. 132 min; p < 0.01). At most recent follow-up after conversion or primary LRYGB, median %EBMIL was 61.3 and 77.3 % (p < 0.01), percent total weight loss was 23.6 and 30.5 % (p < 0.01), and percent change in BMI was 23.4 and 30.5 % (p < 0.01), respectively. Median follow-up time was 17 and 18.6 months after conversion and primary LRYGB, respectively. CONCLUSION: Single-stage conversion of LAGB to LRYGB is safe with an acceptable complication rate and similar LOS compared to primary LRYGB.

[Robotic-Assisted Oesophageal Surgery]. / Roboterchirurgie am Ösophagus.

BACKGROUND: Abdominothoracic oesophageal resections, also known as Ivor Lewis procedures, are complex visceral surgery procedures. In recent years, substeps have increasingly been performed using minimally invasive techniques. However, intrathoracic anastomosis is still a challenge given the instrumental and technological possibilities available to date. This article provides a detailed description of the use of the Da Vinci robotic system and our techniques in oesophageal surgery. METHODS: In a prospective data collection, we analysed the robotic-assisted oesophageal surgeries performed at the University Hospital of Schleswig-Holstein, Campus Kiel, between November 2013 and November 2015. RESULTS: A total of 56 patients underwent robotic-assisted oesophageal surgery, with 43 patients undergoing the Ivor Lewis technique, 10 patients undergoing the McKeown procedure and 3 patients undergoing enucleation of a leiomyoma. A complete tumour resection (R0 margin) was achieved in 53 patients (93.4%); the mean number of resected lymph nodes was 23 (14-75). Forty-five (80.5%) patients received an induction therapy. Mean operative time was 412 min (120-610); mean hospital stay was 19 days (4-145). A conversion to open surgery was necessary in 19 (34.1%) cases, most notably in the thoracic part of the surgical procedure (17 patients). Forty-three patients received intrathoracic oesophagogastrostomy; 4 out of 5 patients with an initial side-to-side anastomosis developed a leakage, whereupon the technique was switched to a hand-sewn procedure (leakage in 3 out of 20 patients). Other major morbidities included leakage of the gastric conduit in 2 patients (3.6%), airway fistula in 2 patients (3.6%), mesenteric ischaemia in one patient (1.8%), and peritonitis due to a dislocated feeding tube in one other patient. Pulmonary complications occurred in 19 patients (34%). Four patients (7.1%) died of pulmonary embolism, heart attack, and septic organ failure. CONCLUSION: Robotic-assisted, minimally invasive oesophagectomy is a feasible and useful approach for oncological surgery. This technique should be implemented in a structured program with an extensive and critical evaluation of the users' own results and an exchange with other experienced work teams. This helps to avoid pitfalls and to speed up the learning curve. Further technological developments and increasing experience might lead to a more widespread use of this technique.

Endoscopic gastric volume reduction with a novel articulating plication device is safe and effective in the treatment of obesity (with video).

BACKGROUND: Endoscopic volume reduction of the stomach may provide a minimally invasive alternative for surgical procedures in the treatment of obesity. OBJECTIVE: To assess safety and preliminary effectiveness in the first human application of a novel endoscopic stapling technique. DESIGN: Prospective, observational, phase 1 study. SETTING: Two university hospitals in The Netherlands. PATIENTS: Patients with a body mass index (BMI) of 40 to 45 kg/m(2) or 30 to 39.9 kg/m(2) with obesity-related comorbidity. INTERVENTIONS: Gastric volume reduction with an endoscopic stapler. MAIN OUTCOME MEASUREMENTS: Primary outcome measure was the prevalence of serious or mild adverse events. Reduction of excess body weight after 12 months was assessed as a secondary outcome measure for effectiveness of the procedure. RESULTS: Seventeen patients with a median BMI of 40.2 kg/m(2) (interquartile range [IQR] 37.6-42.8) underwent an endoscopic stapling procedure. Median procedure time was 123 minutes (IQR 95-129). No serious adverse events occurred. Adverse events were gastric pain (n = 7, range 1-3 days), sore throat (n = 4, 2-3 days), diarrhea (n = 4, 2-15 days), nausea (n = 3, 2-4 days), constipation (n = 4, 3-14 days), and vomiting (n = 3, 1-4 days). All adverse events were mild and resolved with conservative treatment within 15 days after surgery. The median percentage excess weight loss in the first year was 34.9% (IQR 17.8-46.6). LIMITATIONS: Limited number of patients. CONCLUSION: This first human application of this endoscopic stapler demonstrates that the procedure is technically feasible and safe. One hundred sixty plications were created in 17 patients without significant problems. Weight loss after 1 year is promising, but long-term follow-up and randomized, controlled studies should evaluate whether this procedure is an effective and durable minimally invasive endoscopic treatment for obesity. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01429194.).

Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population.

BACKGROUND AND AIMS: Novel endoscopic techniques have been developed as effective treatments for obesity. Recently, reduction of gastric volume via endoscopic placement of full-thickness sutures, termed endoscopic sleeve gastroplasty (ESG), has been described. Our aim was to evaluate the safety, technical feasibility, and clinical outcomes for ESG. PATIENT AND METHODS: Between August 2013 and May 2014, ESG was performed on 10 patients using an endoscopic suturing device. Their weight loss, waist circumference, and clinical outcomes were assessed. RESULTS: Mean patient age was 43.7 years and mean body mass index (BMI) was 45.2 kg/m(2). There were no significant adverse events noted. After 1 month, 3 months, and 6 months, excess weight loss of 18 %, 26 %, and 30 %, and mean weight loss of 11.5 kg, 19.4 kg, and 33.0 kg, respectively, were observed. The differences observed in mean BMI and waist circumference were 4.9 kg/m(2) (P = 0.0004) and 21.7 cm (P = 0.003), respectively. CONCLUSIONS: ESG is effective in achieving weight loss with minimal adverse events. This approach may provide a cost-effective outpatient procedure to add to the steadily growing armamentarium available for treatment of this significant epidemic.

[RANDOMIZED CONTROLLED COMPARATIVE INVESTIGATION OF EFFICACY OF LAPAROSCOPIC PLICATION OF BIG GASTRIC CURVATURE AND LAPAROSCOPIC SLEEVE GASTRECTOMY].

Laparoscopic plication (LP) of gastric big curvature (GBC) constitutes a new bariatric restrictive procedure, which has mechanism quite similar to that of a laparoscopic sleeve gastrectomy (LSG), but without danger for the sutures insufficiency development. The efficacy and safety of LSG and LP GBC were compared. Analysis of complications, the body mass (BM) index loss, an extra BM loss, an appetite loss, severity of the concomitant diseases course was conducted in accordance to results of the repeat examination. In 2 yrs the loss of extra BM have constituted the loss of an extra BM, accordingly, (42.4 ± 18) and (78.9 ± 20)%; in 3 yrs - (28.5 ± 23) and (72.8 ± 22)%. Thus, LP GBC is less effective, then LSG, in the treatment of morbid obesity.

Gastric band slippage: a case-controlled study comparing new and old radiographic signs of this important surgical complication.

OBJECTIVE: The purpose of this study was to compare the diagnostic performance of four radiographic signs of gastric band slippage: abnormal phi angle, the "O sign," inferior displacement of the superolateral gastric band margin, and presence of an air-fluid level above the gastric band. MATERIALS AND METHODS: A search of the electronic medical record identified 21 patients with a surgically proven slipped gastric band and 63 randomly-selected asymptomatic gastric band patients who had undergone barium swallow studies. These studies were evaluated for the four signs of band slippage by two independent radiologists who were blinded to clinical data. Sensitivity, specificity, and positive and negative predictive values were calculated for each radiographic sign of band slippage. Interobserver agreement between radiologists was assessed using the Fleiss kappa statistic. RESULTS: In evaluating for gastric band slippage, an abnormal phi angle greater than 58° was 91-95% sensitive and 52-62% specific (κ = 0.78), the O sign was 33-48% sensitive but 97% specific (κ = 0.84), inferior displacement of the superolateral band margin by more than 2.4 cm from the diaphragm was 95% sensitive and 97-98% specific (κ = 0.97), and the presence of an air-fluid level was 95% sensitive and 100% specific (κ = 1.00). CONCLUSION: We report two previously undescribed radiographic signs of gastric band slippage that are both sensitive and specific for this important surgical complication and recommend that these signs should be incorporated into the imaging evaluation of gastric band patients.

Single-stage versus 2-stage sleeve gastrectomy as a conversion after failed adjustable gastric banding: 30-day outcomes.

BACKGROUND: Sleeve gastrectomy (SG) is being performed as a conversion after adjustable gastric banding (AGB), often in a single stage. However, some argue that it should be performed in 2 stages to improve safety. Few studies compare complications between 1-stage and 2-stage procedures. Our aim is to compare the 30-day complication rates among these two groups. METHODS: We retrospectively reviewed patients converted from AGB to SG between 8/2008 and 10/2013 and compared patients undergoing 1-stage and 2-stage techniques. Primary outcome was overall 30-day adverse event rate (postoperative complication, readmission, or reoperation). Secondary outcomes included operating room (OR) time, length of stay (LOS), leak, infection, and bleeding rates, as well as mortality. RESULTS: A total of 83 patients underwent SG after band removal; three were excluded due to short follow-up, leaving 60 1-stage and 20 2-stage. Mean time from band removal to SG for 2-stage was 438 days. Demographics, intraoperative technique (bougie size, staple reinforcement, oversewing staple line, and leak test), and mean follow-up were not statistically different. Mean OR time (132.1 min 1-stage vs. 127.8 min 2-stage, p = 0.702) and LOS (3.1 vs. 2.4 days, p = 0.676) were similar. Overall 30-day adverse event rate was 12 % for 1-stage versus 15 % for 2-stage procedures (p = 0.705). Differences in 30-day readmission (8 vs. 5 %) and reoperation (5 vs. 0 %) were not statistically significant (p = 0.999 and 0.569, respectively). Leak (3 vs. 0 %, p = 0.999), abscess (2 vs. 5 %, p = 0.440), and bleeding rates (2 vs. 0 %, p = 0.999) were not different. There were no deaths. CONCLUSIONS: SG performed as a conversion after AGB is safe and feasible. Our findings indicate no statistical difference in 30-day outcomes when performed in 1 or 2 stages. Future studies with larger sample sizes are necessary to further investigate these differences.