Conversion to laparoscopic sleeve gastrectomy after failure of laparoscopic gastric band: A systematic review of the literature and cost considerations.

No universal consensus has been achieved as to whether the laparoscopic adjustable gastric band to laparoscopic sleeve gastrectomy conversion should be performed in one or two steps. To determine the differences in operative outcomes and cost, a systematic, comprehensive review of the literature was conducted using the PubMed database from the National Institutes of Health. Nine studies were included with 809 patients. Weighted averages were calculated to compare operative outcomes, and cost analyses were conducted with these averages. Results indicate a longer operative time for the one-step approach than the two-step approach, but studies included in the meta-analysis found no statistical difference between the two. The two-step approach was found to have a longer length of hospital stay, but this finding refuted included studies that indicate no significant difference. Complication rates were higher for the one-step approach than the two-step approach, and costs associated with complications average $806 more for one-step patients than two-step patients. This suggests that the two-step approach could prove better for patient safety and cost outcomes, but both approaches are comparable in operating time and length of stay.