Safety and effectiveness of conversion from adjustable gastric band to ring augmented Roux-en-Y Gastric Bypass

Safety and effectiveness of conversion from adjustable gastric band to ring augmented Roux-en-Y Gastric Bypass | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Safety and effectiveness of conversion from adjustable gastric band to ring augmented Roux-en-Y Gastric Bypass Kayleigh Ann Martina van Dam, Geert Henricus Jozef Martinus Verkoulen, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7119358/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Jan, 2026 Read the published version in Obesity Surgery → Version 1 posted 9 You are reading this latest preprint version Abstract Background: Laparoscopic Adjustable Gastric Band (AGB) has shown suboptimal long-term results with a non-success rate of 20–56% with an accompanying removal rate of 10–50% due to suboptimal clinical response or complications. Conversion to RYGB is proven to be a safe and effective option. However, current literature contains no studies which use additional placement of a silicone ring (MiniMizer) around the pouch. Therefore, this study aims to evaluate the safety and effectiveness of conversion from AGB to ring augmented RYGB (raRYGB). Methods: All consecutive laparoscopic AGB to raRYGB conversions performed between January 2016 and October 2023 were included. All procedures were performed by a one-stage approach. The primary outcome was percentage total weight loss (%TWL) after 1-year follow-up. Secondary outcomes consisted of %TWL after 2, 3, 4, and 5 years, cumulative %TWL, and early and late complications. Results We included a total of 240 patients of whom 195 were female (81.3%). Mean pre-conversion BMI was 40.3 kg/m 2 . The average %TWL 1- and 5-year after the conversion was 25.4% and 18.9%. Cumulative %TWL, calculated from before AGB, was 33.7% after 1 and 30.2% after 5 years. 8 complications occurred within 30 days, 3 of which were ≤ CD3a and 5 ≥ CD3b. A total of 8 MiniMizers were removed. Conclusion Conversion from laparoscopic AGB to raRYGB is a valid one-stage conversion method with significant weight loss after 1 and durable weight loss up to 5 years of follow-up. The short- and long-term complication rate is low and ring-specific complications are rare. Adjustable Gastric Band Ring augmented Roux-en-Y Gastric Bypass MiniMizer Conversional surgery Figures Figure 1 Figure 2 Introduction The prevalence of overweight and obesity is rising worldwide causing major health issues [1, 2]. Metabolic Bariatric Surgery (MBS) is the most effective treatment in patients with obesity as it results in sustainable weight loss and resolution of medical-associated problems [3]. Nowadays, the most common procedures are the Roux-en-Y Gastric Bypass (RYGB) or the Sleeve Gastrectomy (SG). Adjustable Gastric Banding (AGB) is another procedure that was frequently performed in the past, however due to suboptimal long-term results the procedure has become mostly outdated [4]. Long-term follow-up results show a high non-succes rate ranging from 20 – 56% and a removal rate of 10 – 50% due to suboptimal clinical response or complications [4 - 6]. Common causes of non-success are pouch dilatation or slippage of the band [5]. In patients requiring surgery, conversion to another bariatric procedure is a common approach. The most frequently performed options include conversions to RYGB, SG, or biliopancreatic diversion with duodenal switch [5, 7]. Among these, the conversion to RYGB is widely accepted as the preferred procedure and has been proven safe and effective [4, 5, 7]. However, most studies on conversional surgery have focused on the conversion to RYGB without a (adjustable) band or ring. One study by Lecot et al evaluated whether the adjustable band from the AGB should be left in place [4]. Due to the high number of additional procedures required to remove the band after conversion it was concluded that leaving the band in place should not be advised. To date, no studies investigating the conversion from AGB to RYGB have evaluated the use of a non-adjustable silicone ring (e.g. MiniMizer). Ring augmented RYGB (raRYGB), involving the placement of a silicone ring (e.g. MiniMizer) around the gastric pouch, has been shown to be more effective than standard RYGB in primary procedures [8, 9]. RaRYGB not only leads to increased weight loss but also to reduced recurrent weight gain [8 - 10]. Additionally, raRYGB is also proven to be safe and effective in other secondary settings, such as conversion after SG [11]. Cumulative %TWL, so calculated from the initial procedure, after these conversions is comparable to %TWL achieved after a primary raRYGB procedure [11, 12]. Therefore, the aim of the present study was to evaluate the safety and effectiveness of conversion from AGB to raRYGB regarding weight loss and complications. Methods Patient selection All consecutive patients who underwent conversion from AGB to raRYGB between January 1 st 2016 and October 31 st 2023 in Hospital X were included in this retrospective study. Indications for conversion included recurrent weight gain, band-related problems such as slippage or pouch dilatation and functional problems such as GERD. Band-related and functional problems were categorized as band/functional problems. To allow for accurate subgroup analysis, patients were categorized into three groups: (1) recurrent weight gain, (2) band/functional problems, and (3) recurrent weight gain and band/functional problems. All patients were preoperatively screened and approved by a multidisciplinary team. For this retrospective data study, approval was given by the local ethics committee in accordance with the ethical standards as stated in the 2013 Declaration of Helsinki. Surgical procedure All procedures were performed laparoscopically using five trocars. Adhesiolysis was performed as necessary. The gastric band was dissected using diathermy and subsequently completely removed including its capsule of fibrous tissue. First an 8 – 10 cm long pouch was created and calibrated over a 40 French orogastric tube. If a hiatal hernia was present, correction by cruroplasty was performed. The jejenum was identified at the ligament of Treitz and the biliopancreatic limb was measured at 60 cm in all patients. The limb was brought antecolically and antegastrically to the gastric pouch and a linear stapled 30 – 40 mm end-to-side gastrojejunal anastomosis was created. The stapling defect was closed using a barbed wire (VLoc, Medtronic, USA). The biliopancreatic limb was transected and a linear stapled 40 – 60 mm side-to-side jejunojejunal anastomosis was created with an alimentary limb of 120 cm. The mesenteric defects were closed using endoclips (EHMS from Johnson & Johnson, USA or EndoHernia Stapler Universal from Medtronic, USA). A silicone ring, the MiniMizer (Bariatric Solutions International, Switzerland), was placed around the pouch. The MiniMizer was placed at least 2 cm above the gastrojejunal anastomosis and at least 2 cm below the gastroesophageal junction. The closing position was typically around 7.5 cm, but varied between 7 and 8 cm. The MiniMizer was fixated on the vertical staple line of the pouch with a non-absorbable suture (Prolene, Ethicon, USA). Data collection All data was retrospectively collected from electronic patient files. Baseline data included age, gender, height, weight, BMI, time interval between procedures and the indication for conversion. In addition, the weight and BMI at the moment of screening for the initial AGB were collected. Peri-operative data of the conversional procedure included surgery duration in min. The primary outcome measure of %TWL after 1 year follow-up was calculated using the weight after 1 year of follow-up compared to the weight prior to the conversional procedure. The secondary outcomes consisted of %TWL at 2-, 3-, 4- and 5-years follow-up, cumulative %TWL, early ( 30 days) complications. These complications included both general and ring related complications. The cumulative %TWL was calculated using the initial weight during screening for the AGB procedure. Classification of the complications was performed according to the Clavien-Dindo classification [13]. Statistical analysis Statistical analysis was performed using IBM SPSS Statistics for Windows, version 29. Categorical variables were presented as frequencies with percentages. Continuous variables were presented as mean + standard deviation (SD) in case of normal distributed variables and as median and inter-quartile-range (IQR) in case of skewed distributed variables. Differences between subgroups were tested using a One-way ANOVAfor three groups or more. A p-value of <0.05 was considered statistically significant. Missing data were reported as such. Results A total of 240 patients were analyzed of whom 195 were female (81.3%). The baseline characteristics are summarized in table 1. The group had a mean age of 49 + 9.7 years and mean preoperative BMI was 40.3 kg/m 2 ( + 5.8) at moment of screening for conversion. The primary indications for conversion were recurrent weight gain (76.6%), band or functional problems (11.7%) and a combination of band or functional problems and recurrent weight gain (11.7%). On average, 11 years (8 – 15) had elapsed between initial AGB and the conversion procedure as shown in table 2. The conversion to RYGB had a median operating time of 93 minutes (77 – 115). In terms of surgical technique, 86.7% of patients received a MiniMizer with a closing position of 7.5 cm, while the remaining patients received a MiniMizer with either 7 or 8 cm closing position. Weight loss outcomes Mean BMI at screening for AGB was 45 kg/m 2 ( + 5.5) while the mean BMI at screening for conversion was 40.3 kg/m 2 ( + 5.8). The 1-year follow-up point was reached by all patients while data was available for 228/240 (95%) of patients. Not all time points were reached by the patients and follow-up data was available in 87.4%, 58.2%, 65.7% and 55% after 2-, 3-, 4-, and 5-years respectively, as shown in table 3. Of the 240 patients, 212 underwent conversion due to recurrent weight gain, either with or without band-related issues. Among these patients, the lowest weight achieved after AGB was available for 146 patients. In this subgroup, the median %TWL from AGB to lowest recorded weight was 30.1% (21.2 – 37.5). However, prior to conversion these patients had regained a substantial portion of their lost weight, with a median weight regain of 25.5% (15 – 40.1) from their lowest weight. Following conversion, the 1-year %TWL, calculated from conversion and for all indications, was 25.4% + 10.2 as shown in table 3. During long-term follow-up %TWL was 25.3 + 11.7, 23.3 + 11.4, 21.2 + 12.1, and 18.9 + 10.6 at respectively 2-, 3-, 4-, and 5-year follow-up. In addition, table 3 also presents the cumulative %TWL using the start weight from the initial AGB procedure. At the moment of screening for conversion, patients had a mean %TWL of 10.6% ( + 11.6). After 1-year follow-up the cumulative %TWL was 33.7 + 10.3. and after 5 years 30.2 + 10.4. The maximum follow-up duration considered was up to 5 years, according to the Dutch Obesity Clinic protocol. The mean maximum follow-up time was 4.6 years with a cumulative %TWL at the latest follow-up of 32.3 + 10.9. Weight loss outcomes were also compared across the three indication subgroups (figures 1 and 2). Up to 2-year follow-up, a statistically significant difference in %TWL was observed between the groups (ANOVA, p<0.05 ). Post-hoc analysis revealed that patients converted for recurrent weight gain achieved significantly greater %TWL compared to those converted for band/functional problems at 1 year (26.3 + 9.3 vs 20.1 + 13.7, p=0.010 ). No statistically significant differences were found with the combined band/functional and recurrent weight gain group at any timepoint. From two years and onward no statistical differences in %TWL were found between any of the three groups ( all post-hoc p > 0.05 ). At 5-year follow-up, the recurrent weight gain group had a mean %TWL of 19.9 + 10.3, the band/functional group of 14.5 + 12.9 and the combined group of 20.6 + 4.1 ( p = 0.325) . Complications A total of 41 short- and long-term complications were observed in 40 patients, representing an overall complication rate of 16.7% (table 4 and 5). Of these complications, eight (3.3%) occurred within the first 30 days postoperatively. According to the Clavien-Dindo classification, these included three classified as CD3b. The short-term complications consisted of anastomotic leakages ( n=4 ) which were all treated laparoscopically. There was one case of a major bleeding which required laparotomy. Additionally, a gastro-gastric fistula and a case of food impaction were treated endoscopically, while one minor bleeding was treated conservatively with tranexamic acid. In all complications either prolonged admission or readmission was required. Long-term complications, defined as those occurring after more than 30 days postoperatively, were observed in 32 patients. The most frequent complication was internal herniation ( n=13 ) which were all treated laparoscopically. Other complications included diagnostic laparoscopies for unexplained abdominal pain ( n=3 ), pouch-related revisions with repositioning of the MiniMizer ( n=5 ) and stenosis of the gastrojejunostomy requiring revision surgery ( n=1 ). Marginal ulcers were observed in 5 patients, some of whom treated conservatively with proton pump inhibitors ( n=2) and some who presented with perforations and were managed laparoscopically ( n=2). In addition, one patient with a marginal ulcer required surgical revision of the gastro-enterostomy. Additional long-term complications included food impaction ( n=1) treated gastroscopically, and hematoma ( n=1 ) and a gastro-gastric fistula ( n=1), both managed laparoscopically. The MiniMizer was removed in two cases, one due to erosion and one due to dysphagia. Additionally, adhesiolysis was performed during diagnostics laparoscopy in one patient, and in another the entero-enterostomy was revised by resection and re-anastomosis due to an impending blow-out of the excluded stomach. Regarding the MiniMizer, the ring was removed in eight patients (3.3%). Two patients (0.8%) experienced MiniMizer-related complications after the initial 30-day postoperative period. One had dysphagia without visible abnormalities such as slippage or erosion. The other was due to erosion of the MiniMizer which was treated by endoscopic removal. In addition, six MiniMizers (2.5%) were removed not because of ring-related issues, but as part of surgical treatment for other complications. These complications included anastomotic leakage( n=2) , perforation of the gastrojejunostomy due to marginal ulcer ( n=2) , gastro-gastric fistula ( n=1), and stenosis of the gastrojejunostomy ( n=1) . Discussion This study evaluated the outcomes of a large series of conversion from AGB to raRYGB. The mean %TWL at 1-year follow-up was 25.4%, with a cumulative %TWL of 33.7%. The cumulative %TWL after 1-year is comparable to the 35.6% TWL after a primary raRYGB as shown by Jense et al. [ 8 ]. The weight loss results remain stable during five years of follow-up and are comparable with the 30–35% TWL after primary raRYGB [ 8 ]. In addition, the cumulative outcomes after conversion from AGB to raRYGB are superior to weight loss results after standard RYGB [ 8 , 14 ]. When comparing the current results to studies evaluating conversion from AGB to RYGB, the standard 25.4% TWL is comparable to the range of 24.8–33.5% reported in the literature [ 4 , 15 , 16 ]. However, these studies calculated %TWL using initial weight prior to AGB. This corresponds to the cumulative %TWL in the present study. When comparing cumulative outcomes, the 33.7% TWL is higher than those reported by Pujol-Rafols et al. (30.4%) and Creange et al. (24.8%) [ 15 , 16 ]. The study by Lecot et al. reported a comparable cumulative %TWL of 33.5%, although in this cohort the adjustable band was left in place around the pouch [ 4 ]. Subgroup analysis based on indication for conversion revealed significant differences in weight loss up to two years. Patients who underwent conversion due to recurrent weight gain achieved significantly greater %TWL in the first postoperative year compared to the band/functional indication group (26.3 vs. 20.1). However, after two years this difference was no longer significant. Although patients in the combined group might be expected to have less %TWL due to the presence of multiple indications, there were no significant differences between recurrent weight gain and the combined group. The relatively small sample size of the combined group (11.7%) compared to the recurrent weight gain group (76.6%) may have limited the ability to detect minor differences between groups. This study showed that short-term complications occurred in 3.3% of the patients. The long-term complications occurred in an additional 13.8% of the patients. MiniMizer related complications were rare as only two patients (0.8%) required removal due to ring-specific issues, i.e. dysphagia and erosion. An additional six rings were removed during surgical management of unrelated complications such as leakage or fistula. These findings highlight that ring removal is rarely due to device failure or intolerance. In the current study, the overall short-term complication rate is lower than the rates reported specific for the conversion from AGB to RYGB. Literature shows a complication rate between 4 and 10% for either one- or two-stage AGB to RYGB conversion [ 4 , 17 , 18 ]. This rate is comparable to the complication rate of 2.6% following secondary procedures reported by the Dutch Audit for Treatment of Obesity (DATO) [ 19 ]. In addition to the low short-term complication rate, this study provides insights into long-term safety outcomes. A total of 33 patients (13.8%) had a complication after the 30-day period. After primary RYGB with a long-term follow-up of more than ten years a range from 19.5–23% complication rate was found [ 20 , 21 ]. The weighted late complication rate in the meta-analysis by Buchwald et al. was 20% [ 22 ]. Among these studies the majority was due to internal herniation, as is the case in our study. A three-year follow-up after either primary RYGB or SG showed a slightly lower complication rate of 11% [ 23 ]. Our rate of 13.8% is comparable to these primary MBS long-term results. The rate is also comparable to published long-term complication rate after conversional MBS as a 15% long-term complication rate was found after conversion from AGB to SG or RYGB [ 24 ]. A notable feature of our surgical strategy was the single-stage approach, where band removal and conversion to raRYGB are performed during the same procedure. In our study all patients were operated following a single-stage approach. Some centers prefer a two-stage approach to reduce perioperative risks, especially in cases with severe adhesions. Our findings demonstrate that a single-stage approach can be performed safely. The early complication rate of 3.3% is lower than those reported in previous studies [ 4 , 17 , 18 ]. In recent literature, there is more evidence that shows no difference in complications between one- or two-stage conversions [ 15 , 25 , 26 ]. Limitations This study has a number of limitations. First, the retrospective aspect should be taken into account when interpreting the results. Second, although short-term follow-up rates were high with 95% at 1-year, the follow-up decreased over time. After 5 years of follow-up almost 50% was loss to follow-up. However, this loss to follow-up is consistent with trends observed in other bariatric surgery literature where long-term follow-up has drastically decreased even to 10% − 29% [ 27 – 30 ]. Conclusion This study demonstrates that conversion from AGB to raRYGB using a single-stage surgical approach is safe and effective. The cumulative weight loss outcomes are comparable to those of primary raRYGB and superior to standard RYGB. The low short-term complication rate of 3.3% and the long-term rate of 13.8% are both favorable compared to the literature. Additionally, the very low rate of ring-specific adverse events (0.8%) supports the safety of the MiniMizer ring in this type of surgical conversion. Declarations Conflict of interest The authors declare no competing interests Author Contribution The authors confirm contribution to the paper as follows: Study conception and design: EJB, JWG and KVD Data collection: KVDAnalysis and interpretation of results: KVD and EJB Draft manuscript preparation: KVDSubstantial revision manuscript: KVD, EJB, JWG All authors reviewed the manuscript critically. All authors have read and agreed to the published version of the manuscript. Ethics approval For this study type formal consent is not required References Ortega FB, Lavie CJ, Blair SN. Obesity and Cardiovascular Disease. Circ Res. 2016 May 27;118(11):1752-70. World Health Organization. Obesity and overweight. 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Higa KD, Himpens J. The reality of long-term follow-up of bariatric/metabolic surgery patients—A conundrum. JAMA Surg . 2018;153(5):435. Thereaux J, Lesuffleur T, Païta M, et al. Long-term follow-up after bariatric surgery in a national cohort. Br J Surg. 2017;104(10):1362–71. Clapp B, Wynn M, Martyn C, et al. Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis. Surg Obes Relat Dis . 2018;14(6):741–7. Tables Table 1. baseline characteristics Variables N = 240 Age (years) 49 + 9.7 Gender Male Female 45 (18.8) 195 (81.3) Height (cm) 168.6 + 0.9 Weight at initial procedure (kg) 128.7 + 19.8 BMI at initial procedure (kg/m 2 ) 45 + 5.5 Weight at screening for conversion (kg) 114.2 + 19.5 BMI at screening for conversion (kg/m 2 ) 40.3 + 5.8 Data are presented as mean + standard deviation or N (%) Table 2. Surgery details Variables N = 240 Time between AGB and conversion (years) 11 (8 – 15) Indication for conversion Recurrent weight gain Band/functional problems Band/functional problems and recurrent weight gain 184 (76.6) 28 (11.7) 28 (11.7) Surgery duration (min) 93 (77 – 115) Closing position MiniMizer 7 cm 7.5 cm 8 cm 23 (9.6) 208 (86.7) 4 (1.7) Data are presented as median (IQR) or N (%) Table 3. %TWL and cumulative %TWL during 5-year follow-up after conversion Follow-up %TWL cumulative %TWL (from primary procedure) Pre-conversion 10.6 + 11.6 3-month follow-up 237/240 (98.8) 15.3 + 6.1 24.4 + 9.8 6-month follow-up 234/240 (97.5) 21.2 + 7.8 30 + 9.4 1-year follow-up 228/240 (95) 25.4 + 10.2 33.7 + 10.3 2-year follow-up 188/215 (87.4) 25.3 + 11.7 33.8 + 11.3 3-year follow-up 124/213 (58.2) 23.3 + 11.4 31.6 + 10.8 4-year follow-up 90/137 (65.7) 21.2 + 12.1 30.6 + 10.1 5-year follow-up 55/100 (55) 18.9 + 10.6 30.2 + 10.4 Follow-up based on number of patients who reached the specific time-point. %TWL is calculated based on weight at screening for conversion (n = 240), cumulative %TWL is calculated based on weight for initial AGB (n = 201). Table 4. Short- and long-term complications Variables N = 240 MiniMizer in situ at last FU 232 (96.7) MiniMizer related complications Ring slippage Ring erosion Dysphagia 0 1 (0.4) 1 (0.4) Patients with complications 40 (16.7) Short-term complications Patients with short-term complications 8 (3.3) Short-term ( 30 days) complications according to Clavien-Dindo 2 3a 3b 2 (0.8) 4 (1.7) 26 (10.8) Table 5. Types of complications N = 240 Short-term Anastomotic leakage Bleeding Gastro-gastric fistula Food impaction 4 (1.7) 2 (0.8 1 (0.4) 1 (0.4) Long-term Internal herniation Pouch-related problems Marginal ulcers Diagnostic laparoscopies Impending blow-out of excluded stomach Food impaction Gastro-gastric fistula Hematoma Stenosis MiniMizer related Dysphagia Erosion 13 (5.4) 5 (2.1) 5 (2.1) 3 (1.3) 1 (0.4) 1 (0.4) 1 (0.4) 1 (0.4) 1 (0.4) 1 (0.4) 1 (0.4) Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Jan, 2026 Read the published version in Obesity Surgery → Version 1 posted Editorial decision: Revision requested 24 Aug, 2025 Reviews received at journal 19 Aug, 2025 Reviews received at journal 14 Aug, 2025 Reviewers agreed at journal 06 Aug, 2025 Reviewers agreed at journal 31 Jul, 2025 Reviewers invited by journal 29 Jul, 2025 Editor assigned by journal 26 Jul, 2025 Submission checks completed at journal 25 Jul, 2025 First submitted to journal 14 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7119358","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":493937747,"identity":"47ff60ca-a289-4a6b-9db4-d27a8868ef01","order_by":0,"name":"Kayleigh Ann Martina van Dam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYBACCTDJxsDAD6J5GBhkgJQBA0MBEVokGyBaeCBaDIjQYnCAWC2SDTyGnwvK7KKNz58xk3hTcY+Hf3bzBuYCPFqkGXiMpWecS87dduCMmeScM8U8EneOFTDPwKNFjoEtQZq3jTl328EeMyAjgYfhRo4BMw9+Lcm/edvqczc38wC1/EvgkSekRZqB+RjQ8MO5G9hAWhoSeAwIaZFsZj5mzXPueO6MM2zFlnOOJfAY3kgrOIxPi8TxxubbPGXVuf39hzfeeFOTICd3I3njY54K3FoYmBFMFgkY6wAeDai6PxCrchSMglEwCkYWAACuaEZW8zzH5QAAAABJRU5ErkJggg==","orcid":"","institution":"Zuyderland Medisch Centrum","correspondingAuthor":true,"prefix":"","firstName":"Kayleigh","middleName":"Ann Martina van","lastName":"Dam","suffix":""},{"id":493937749,"identity":"d020c9b6-0f60-4b74-ad04-ac7ed748307d","order_by":1,"name":"Geert Henricus Jozef Martinus Verkoulen","email":"","orcid":"","institution":"Zuyderland Medisch Centrum","correspondingAuthor":false,"prefix":"","firstName":"Geert","middleName":"Henricus Jozef Martinus","lastName":"Verkoulen","suffix":""},{"id":493937750,"identity":"8557a4da-6a1d-47ff-b0bd-088c0ea7eddd","order_by":2,"name":"Evelien de Witte","email":"","orcid":"","institution":"Zuyderland Medisch Centrum","correspondingAuthor":false,"prefix":"","firstName":"Evelien","middleName":"","lastName":"de Witte","suffix":""},{"id":493937752,"identity":"c7e2bc02-585a-41c8-a059-1899b8b8b055","order_by":3,"name":"Pieter Petrus Henricus Luciën Broos","email":"","orcid":"","institution":"Zuyderland Medisch Centrum","correspondingAuthor":false,"prefix":"","firstName":"Pieter","middleName":"Petrus Henricus Luciën","lastName":"Broos","suffix":""},{"id":493937755,"identity":"77450dff-3c10-4d93-8d50-57a7455cc619","order_by":4,"name":"Jan Willem M Greve","email":"","orcid":"","institution":"Maastricht University","correspondingAuthor":false,"prefix":"","firstName":"Jan","middleName":"Willem M","lastName":"Greve","suffix":""},{"id":493937757,"identity":"c9e4ea16-8934-42c3-afad-4cfbd5cd666d","order_by":5,"name":"Evert-Jan Gijsbert Boerma","email":"","orcid":"","institution":"Zuyderland Medisch Centrum","correspondingAuthor":false,"prefix":"","firstName":"Evert-Jan","middleName":"Gijsbert","lastName":"Boerma","suffix":""}],"badges":[],"createdAt":"2025-07-14 09:23:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7119358/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7119358/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11695-025-08463-7","type":"published","date":"2026-01-14T16:29:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88240743,"identity":"04ea408f-36e2-4ee8-b6db-539a6ddd29ab","added_by":"auto","created_at":"2025-08-04 11:11:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52749,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e%TWL over 5-year follow-up\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7119358/v1/1403e3c38a6c0a3f73a575c0.png"},{"id":88240746,"identity":"eb4a0296-09ce-4ed7-9127-5bf940e4281d","added_by":"auto","created_at":"2025-08-04 11:11:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":52067,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ecumulative %TWL over 5-year follow-up\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7119358/v1/d2f4b4295ecdc797617f1719.png"},{"id":100614572,"identity":"9c0dc116-c06c-444a-82c0-02be32d0d57f","added_by":"auto","created_at":"2026-01-19 17:22:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":889295,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7119358/v1/5ff502f2-6aeb-455f-b977-a1ffd04c4912.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Safety and effectiveness of conversion from adjustable gastric band to ring augmented Roux-en-Y Gastric Bypass ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe prevalence of overweight and obesity is rising worldwide causing major health issues [1, 2]. Metabolic Bariatric Surgery (MBS) is the most effective treatment in patients with obesity as it results in sustainable weight loss and resolution of medical-associated problems [3]. Nowadays, the most common procedures are the Roux-en-Y Gastric Bypass (RYGB) or the Sleeve Gastrectomy (SG). Adjustable Gastric Banding (AGB) is another procedure that was frequently performed in the past, however due to suboptimal long-term results the procedure has become mostly outdated [4]. Long-term follow-up results show a high non-succes rate ranging from 20 \u0026ndash; 56% and a removal rate of 10 \u0026ndash; 50% due to suboptimal clinical response or complications [4 - 6]. Common causes of non-success are pouch dilatation or slippage of the band [5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn patients requiring surgery, conversion to another bariatric procedure is a common approach. The most frequently performed options include conversions to RYGB, SG, or biliopancreatic diversion with duodenal switch [5, 7]. Among these, the conversion to RYGB is widely accepted as the preferred procedure and has been proven safe and effective [4, 5, 7]. However, most studies on conversional surgery have focused on the conversion to RYGB without a (adjustable) band or ring. One study by Lecot et al evaluated whether the adjustable band from the AGB should be left in place [4]. Due to the high number of additional procedures required to remove the band after conversion it was concluded that leaving the band in place should not be advised. To date, no studies investigating the conversion from AGB to RYGB have evaluated the use of a non-adjustable silicone ring (e.g. MiniMizer).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRing augmented RYGB (raRYGB), involving the placement of a silicone ring (e.g. MiniMizer) around the gastric pouch, has been shown to be more effective than standard RYGB in primary procedures [8, 9]. RaRYGB not only leads to increased weight loss but also to reduced recurrent weight gain [8 - 10]. Additionally, raRYGB is also proven to be safe and effective in other secondary settings, such as conversion after SG [11]. Cumulative %TWL, so calculated from the initial procedure, after these conversions is comparable to %TWL achieved after a primary raRYGB procedure [11, 12].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTherefore, the aim of the present study was to evaluate the safety and effectiveness of conversion from AGB to raRYGB regarding weight loss and complications.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods ","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePatient selection\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll consecutive patients who underwent conversion from AGB to raRYGB between January 1\u003csup\u003est\u003c/sup\u003e 2016 and October 31\u003csup\u003est\u003c/sup\u003e 2023 in Hospital X were included in this retrospective study. Indications for conversion included recurrent weight gain, band-related problems such as slippage or pouch dilatation and functional problems such as GERD. Band-related and functional problems were categorized as band/functional problems. To allow for accurate subgroup analysis, patients were categorized into three groups: (1) recurrent weight gain, (2) band/functional problems, and (3) recurrent weight gain and band/functional problems. All patients were preoperatively screened and approved by a multidisciplinary team. For this retrospective data study, approval was given by the local ethics committee in accordance with the ethical standards as stated in the 2013 Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSurgical procedure \u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were performed laparoscopically using five trocars. Adhesiolysis was performed as necessary. The gastric band was dissected using diathermy and subsequently completely removed including its capsule of fibrous tissue. First an 8 – 10 cm long pouch was created and calibrated over a 40 French orogastric tube. If a hiatal hernia was present, correction by cruroplasty was performed. The jejenum was identified at the ligament of Treitz and the biliopancreatic limb was measured at 60 cm in all patients. The limb was brought antecolically and antegastrically to the gastric pouch and a linear stapled 30 – 40 mm end-to-side gastrojejunal anastomosis was created. The stapling defect was closed using a barbed wire (VLoc, Medtronic, USA). The biliopancreatic limb was transected and a linear stapled 40 – 60 mm side-to-side jejunojejunal anastomosis was created with an alimentary limb of 120 cm. The mesenteric defects were closed using endoclips (EHMS from Johnson \u0026amp; Johnson, USA or EndoHernia Stapler Universal from Medtronic, USA). A silicone ring, the MiniMizer (Bariatric Solutions International, Switzerland), was placed around the pouch. The MiniMizer was placed at least 2 cm above the gastrojejunal anastomosis and at least 2 cm below the gastroesophageal junction. The closing position was typically around 7.5 cm, but varied between 7 and 8 cm. The MiniMizer was fixated on the vertical staple line of the pouch with a non-absorbable suture (Prolene, Ethicon, USA).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData collection \u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data was retrospectively collected from electronic patient files. Baseline data included age, gender, height, weight, BMI, time interval between procedures and the indication for conversion. In addition, the weight and BMI at the moment of screening for the initial AGB were collected. Peri-operative data of the conversional procedure included surgery duration in min. The primary outcome measure of %TWL after 1 year follow-up was calculated using the weight after 1 year of follow-up compared to the weight prior to the conversional procedure. The secondary outcomes consisted of %TWL at 2-, 3-, 4- and 5-years follow-up, cumulative %TWL, early (\u0026lt;30 days) and late \u003cu\u003e(\u0026gt;\u003c/u\u003e30 days) complications. These complications included both general and ring related complications. The cumulative %TWL was calculated using the initial weight during screening for the AGB procedure. Classification of the complications was performed according to the Clavien-Dindo classification [13].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analysis\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using IBM SPSS Statistics for Windows, version 29. Categorical variables were presented as frequencies with percentages. Continuous variables were presented as mean \u003cu\u003e+\u003c/u\u003e standard deviation (SD) in case of normal distributed variables and as median and inter-quartile-range (IQR) in case of skewed distributed variables. Differences between subgroups were tested using a One-way ANOVAfor three groups or more. A p-value of \u0026lt;0.05 was considered statistically significant. Missing data were reported as such.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 240 patients were analyzed of whom 195 were female (81.3%). The baseline characteristics are summarized in table 1. The group had a mean age of 49 \u003cu\u003e+\u003c/u\u003e 9.7 years and mean preoperative BMI was 40.3 kg/m\u003csup\u003e2\u003c/sup\u003e (\u003cu\u003e+\u003c/u\u003e 5.8) at moment of screening for conversion. \u003c/p\u003e\n\u003cp\u003eThe primary indications for conversion were recurrent weight gain (76.6%), band or functional problems (11.7%) and a combination of band or functional problems and recurrent weight gain (11.7%). On average, 11 years (8 – 15) had elapsed between initial AGB and the conversion procedure as shown in table 2. The conversion to RYGB had a median operating time of 93 minutes (77 – 115). In terms of surgical technique, 86.7% of patients received a MiniMizer with a closing position of 7.5 cm, while the remaining patients received a MiniMizer with either 7 or 8 cm closing position. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWeight loss outcomes\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMean BMI at screening for AGB was 45 kg/m\u003csup\u003e2\u003c/sup\u003e (\u003cu\u003e+\u003c/u\u003e 5.5) while the mean BMI at screening for conversion was 40.3 kg/m\u003csup\u003e2\u003c/sup\u003e (\u003cu\u003e+\u003c/u\u003e 5.8). The 1-year follow-up point was reached by all patients while data was available for 228/240 (95%) of patients. Not all time points were reached by the patients and follow-up data was available in 87.4%, 58.2%, 65.7% and 55% after 2-, 3-, 4-, and 5-years respectively, as shown in table 3. \u003c/p\u003e\n\u003cp\u003eOf the 240 patients, 212 underwent conversion due to recurrent weight gain, either with or without band-related issues. Among these patients, the lowest weight achieved after AGB was available for 146 patients. In this subgroup, the median %TWL from AGB to lowest recorded weight was 30.1% (21.2 – 37.5). However, prior to conversion these patients had regained a substantial portion of their lost weight, with a median weight regain of 25.5% (15 – 40.1) from their lowest weight. \u003c/p\u003e\n\u003cp\u003eFollowing conversion, the 1-year %TWL, calculated from conversion and for all indications, was 25.4% \u003cu\u003e+\u003c/u\u003e 10.2 as shown in table 3. During long-term follow-up %TWL was 25.3 \u003cu\u003e+\u003c/u\u003e 11.7, 23.3 \u003cu\u003e+\u003c/u\u003e 11.4, 21.2 \u003cu\u003e+\u003c/u\u003e 12.1, and 18.9 \u003cu\u003e+\u003c/u\u003e 10.6 at respectively 2-, 3-, 4-, and 5-year follow-up. In addition, table 3 also presents the cumulative %TWL using the start weight from the initial AGB procedure. At the moment of screening for conversion, patients had a mean %TWL of 10.6% (\u003cu\u003e+\u003c/u\u003e11.6). After 1-year follow-up the cumulative %TWL was 33.7 \u003cu\u003e+\u003c/u\u003e 10.3. and after 5 years 30.2 \u003cu\u003e+\u003c/u\u003e 10.4. The maximum follow-up duration considered was up to 5 years, according to the Dutch Obesity Clinic protocol. The mean maximum follow-up time was 4.6 years with a cumulative %TWL at the latest follow-up of 32.3 \u003cu\u003e+\u003c/u\u003e 10.9. \u003c/p\u003e\n\u003cp\u003eWeight loss outcomes were also compared across the three indication subgroups (figures 1 and 2). Up to 2-year follow-up, a statistically significant difference in %TWL was observed between the groups (ANOVA, \u003cem\u003ep\u0026lt;0.05\u003c/em\u003e). Post-hoc analysis revealed that patients converted for recurrent weight gain achieved significantly greater %TWL compared to those converted for band/functional problems at 1 year (26.3 \u003cu\u003e+\u003c/u\u003e 9.3 vs 20.1 \u003cu\u003e+\u003c/u\u003e 13.7, \u003cem\u003ep=0.010\u003c/em\u003e). No statistically significant differences were found with the combined band/functional and recurrent weight gain group at any timepoint. From two years and onward no statistical differences in %TWL were found between any of the three groups (\u003cem\u003eall post-hoc p \u0026gt; 0.05\u003c/em\u003e). At 5-year follow-up, the recurrent weight gain group had a mean %TWL of 19.9 \u003cu\u003e+\u003c/u\u003e 10.3, the band/functional group of 14.5 \u003cu\u003e+\u003c/u\u003e 12.9 and the combined group of 20.6 \u003cu\u003e+ \u003c/u\u003e4.1 (\u003cem\u003ep = 0.325)\u003c/em\u003e. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eComplications \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 41 short- and long-term complications were observed in 40 patients, representing an overall complication rate of 16.7% (table 4 and 5). Of these complications, eight (3.3%) occurred within the first 30 days postoperatively. According to the Clavien-Dindo classification, these included three classified as \u0026lt;CD3a and five as \u003cu\u003e\u0026gt;\u003c/u\u003eCD3b. The short-term complications consisted of anastomotic leakages (\u003cem\u003en=4\u003c/em\u003e) which were all treated laparoscopically. There was one case of a major bleeding which required laparotomy. Additionally, a gastro-gastric fistula and a case of food impaction were treated endoscopically, while one minor bleeding was treated conservatively with tranexamic acid. In all complications either prolonged admission or readmission was required. \u003c/p\u003e\n\u003cp\u003eLong-term complications, defined as those occurring after more than 30 days postoperatively, were observed in 32 patients. The most frequent complication was internal herniation (\u003cem\u003en=13\u003c/em\u003e) which were all treated laparoscopically. Other complications included diagnostic laparoscopies for unexplained abdominal pain (\u003cem\u003en=3\u003c/em\u003e), pouch-related revisions with repositioning of the MiniMizer (\u003cem\u003en=5\u003c/em\u003e) and stenosis of the gastrojejunostomy requiring revision surgery (\u003cem\u003en=1\u003c/em\u003e). Marginal ulcers were observed in 5 patients, some of whom treated conservatively with proton pump inhibitors (\u003cem\u003en=2)\u003c/em\u003e and some who presented with perforations and were managed laparoscopically (\u003cem\u003en=2). \u003c/em\u003eIn addition, one patient with a marginal ulcer required surgical revision of the gastro-enterostomy. Additional long-term complications included food impaction (\u003cem\u003en=1) \u003c/em\u003etreated gastroscopically, and hematoma (\u003cem\u003en=1\u003c/em\u003e) and a gastro-gastric fistula (\u003cem\u003en=1),\u003c/em\u003e both managed laparoscopically. The MiniMizer was removed in two cases, one due to erosion and one due to dysphagia. Additionally, adhesiolysis was performed during diagnostics laparoscopy in one patient, and in another the entero-enterostomy was revised by resection and re-anastomosis due to an impending blow-out of the excluded stomach. \u003c/p\u003e\n\u003cp\u003eRegarding the MiniMizer, the ring was removed in eight patients (3.3%). Two patients (0.8%) experienced MiniMizer-related complications after the initial 30-day postoperative period. One had dysphagia without visible abnormalities such as slippage or erosion. The other was due to erosion of the MiniMizer which was treated by endoscopic removal. In addition, six MiniMizers (2.5%) were removed not because of ring-related issues, but as part of surgical treatment for other complications. These complications included anastomotic leakage(\u003cem\u003en=2)\u003c/em\u003e, perforation of the gastrojejunostomy due to marginal ulcer (\u003cem\u003en=2)\u003c/em\u003e, gastro-gastric fistula (\u003cem\u003en=1), \u003c/em\u003eand stenosis of the gastrojejunostomy (\u003cem\u003en=1)\u003c/em\u003e. \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the outcomes of a large series of conversion from AGB to raRYGB. The mean %TWL at 1-year follow-up was 25.4%, with a cumulative %TWL of 33.7%. The cumulative %TWL after 1-year is comparable to the 35.6% TWL after a primary raRYGB as shown by Jense et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The weight loss results remain stable during five years of follow-up and are comparable with the 30\u0026ndash;35% TWL after primary raRYGB [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In addition, the cumulative outcomes after conversion from AGB to raRYGB are superior to weight loss results after standard RYGB [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhen comparing the current results to studies evaluating conversion from AGB to RYGB, the standard 25.4% TWL is comparable to the range of 24.8\u0026ndash;33.5% reported in the literature [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, these studies calculated %TWL using initial weight prior to AGB. This corresponds to the cumulative %TWL in the present study. When comparing cumulative outcomes, the 33.7% TWL is higher than those reported by Pujol-Rafols et al. (30.4%) and Creange et al. (24.8%) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The study by Lecot et al. reported a comparable cumulative %TWL of 33.5%, although in this cohort the adjustable band was left in place around the pouch [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSubgroup analysis based on indication for conversion revealed significant differences in weight loss up to two years. Patients who underwent conversion due to recurrent weight gain achieved significantly greater %TWL in the first postoperative year compared to the band/functional indication group (26.3 vs. 20.1). However, after two years this difference was no longer significant. Although patients in the combined group might be expected to have less %TWL due to the presence of multiple indications, there were no significant differences between recurrent weight gain and the combined group. The relatively small sample size of the combined group (11.7%) compared to the recurrent weight gain group (76.6%) may have limited the ability to detect minor differences between groups.\u003c/p\u003e\u003cp\u003eThis study showed that short-term complications occurred in 3.3% of the patients. The long-term complications occurred in an additional 13.8% of the patients. MiniMizer related complications were rare as only two patients (0.8%) required removal due to ring-specific issues, i.e. dysphagia and erosion. An additional six rings were removed during surgical management of unrelated complications such as leakage or fistula. These findings highlight that ring removal is rarely due to device failure or intolerance.\u003c/p\u003e\u003cp\u003eIn the current study, the overall short-term complication rate is lower than the rates reported specific for the conversion from AGB to RYGB. Literature shows a complication rate between 4 and 10% for either one- or two-stage AGB to RYGB conversion [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This rate is comparable to the complication rate of 2.6% following secondary procedures reported by the Dutch Audit for Treatment of Obesity (DATO) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn addition to the low short-term complication rate, this study provides insights into long-term safety outcomes. A total of 33 patients (13.8%) had a complication after the 30-day period. After primary RYGB with a long-term follow-up of more than ten years a range from 19.5\u0026ndash;23% complication rate was found [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The weighted late complication rate in the meta-analysis by Buchwald et al. was 20% [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Among these studies the majority was due to internal herniation, as is the case in our study. A three-year follow-up after either primary RYGB or SG showed a slightly lower complication rate of 11% [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Our rate of 13.8% is comparable to these primary MBS long-term results. The rate is also comparable to published long-term complication rate after conversional MBS as a 15% long-term complication rate was found after conversion from AGB to SG or RYGB [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA notable feature of our surgical strategy was the single-stage approach, where band removal and conversion to raRYGB are performed during the same procedure. In our study all patients were operated following a single-stage approach. Some centers prefer a two-stage approach to reduce perioperative risks, especially in cases with severe adhesions. Our findings demonstrate that a single-stage approach can be performed safely. The early complication rate of 3.3% is lower than those reported in previous studies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In recent literature, there is more evidence that shows no difference in complications between one- or two-stage conversions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study has a number of limitations. First, the retrospective aspect should be taken into account when interpreting the results. Second, although short-term follow-up rates were high with 95% at 1-year, the follow-up decreased over time. After 5 years of follow-up almost 50% was loss to follow-up. However, this loss to follow-up is consistent with trends observed in other bariatric surgery literature where long-term follow-up has drastically decreased even to 10% \u0026minus;\u0026thinsp;29% [\u003cspan additionalcitationids=\"CR28 CR29\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates that conversion from AGB to raRYGB using a single-stage surgical approach is safe and effective. The cumulative weight loss outcomes are comparable to those of primary raRYGB and superior to standard RYGB. The low short-term complication rate of 3.3% and the long-term rate of 13.8% are both favorable compared to the literature. Additionally, the very low rate of ring-specific adverse events (0.8%) supports the safety of the MiniMizer ring in this type of surgical conversion.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of interest\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eThe authors confirm contribution to the paper as follows: Study conception and design: EJB, JWG and KVD Data collection: KVDAnalysis and interpretation of results: KVD and EJB Draft manuscript preparation: KVDSubstantial revision manuscript: KVD, EJB, JWG All authors reviewed the manuscript critically. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003eFor this study type formal consent is not required\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOrtega FB, Lavie CJ, Blair SN. Obesity and Cardiovascular Disease. \u003cem\u003eCirc Res.\u003c/em\u003e 2016 May 27;118(11):1752-70.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Obesity and overweight. Fact sheet. 2021. Available from:\u0026nbsp;https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight\u003c/li\u003e\n \u003cli\u003eJakobsen GS, Sm\u0026aring;stuen MC, Sandbu R, et al. Association of bariatric surgery vs medical obesity treatment with long-term medical complications and obesity-related comorbidities. \u003cem\u003eJAMA\u003c/em\u003e.\u0026nbsp;2018;319(3):291\u0026ndash;301.\u003c/li\u003e\n \u003cli\u003eLecot FP, Boerma EJG, Sigterman-Nelissen R, et al. Conversion of adjustable gastric banding to adjustable banded Roux-en-Y gastric bypass: Should we leave the band in place?\u0026nbsp;\u003cem\u003eObes Surg\u003c/em\u003e. 2019;29:3912\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eMarin-Perez P, Betancourt A, Lamota M, et al. Outcomes after laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass.\u0026nbsp;\u003cem\u003eBr J Surg.\u003c/em\u003e 2014;101(3):254\u0026ndash;60.\u003c/li\u003e\n \u003cli\u003eArapis K, Tammaro P, Parenti LR, et al.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eLong-term results after laparoscopic adjustable gastric banding for morbid obesity: 18-year follow-up in a single university unit. \u003cem\u003eObes Surg\u003c/em\u003e. 2017;27:630\u0026ndash;40.\u003c/li\u003e\n \u003cli\u003eRafols JP, Al Abbas AI, Devriendt S, et al. Roux-en-Y gastric bypass, sleeve gastrectomy, or one anastomosis gastric bypass as rescue therapy after failed adjustable gastric banding: a multicenter comparative study.\u0026nbsp;\u003cem\u003eSurg Obes Relat Dis.\u003c/em\u003e 2018;14(11):1659\u0026ndash;66.\u003c/li\u003e\n \u003cli\u003eJense MTF, Palm-Meinders IH, Sigterman-Nelissen R, et al. The benefits of banded over non-banded Roux-en-Y gastric bypass in patients with morbid obesity: a multi-center study. \u003cem\u003eObes Surg.\u003c/em\u003e 2022;32(6):1856\u0026ndash;63.\u003c/li\u003e\n \u003cli\u003eLemmens L. Banded gastric bypass: better long-term results? A cohort study with minimum 5-year follow-up.\u0026nbsp;\u003cem\u003eObes Surg\u003c/em\u003e. 2017;27:864\u0026ndash;72.\u003c/li\u003e\n \u003cli\u003ePavone G, Chierici A, Drai C, et al. Banded versus non-banded Roux-en-Y gastric bypass: short, mid, and long-term surgical outcomes\u0026mdash;a systematic review and meta-analysis.\u0026nbsp;\u003cem\u003eSurg Obes Relat Dis.\u003c/em\u003e 2024.\u003c/li\u003e\n \u003cli\u003evan Dam KAM, de Witte E, Broos PPHL, et al. Short-term safety and effectiveness of conversion from sleeve gastrectomy to ring augmented Roux-en-Y gastric bypass.\u0026nbsp;\u003cem\u003eBMC Surg.\u003c/em\u003e 2024;24(1):266.\u003c/li\u003e\n \u003cli\u003evan Dam KAM, Verkoulen GHJM, de Witte E, et al. Setting the standard: cumulative total weight loss as outcome measure after secondary bariatric metabolic surgery. \u003cem\u003eObes Surg.\u003c/em\u003e 2024;34(9):3521\u0026ndash;2.\u003c/li\u003e\n \u003cli\u003eMiyamoto S, Nakao J, Higashino T, et al. Clavien\u0026ndash;Dindo classification for grading complications after total pharyngolaryngectomy and free jejunum transfer.\u0026nbsp;\u003cem\u003ePLoS One.\u003c/em\u003e 2019;14(9):e0222570.\u003c/li\u003e\n \u003cli\u003eCorcelles R, Boules M, Froylich D, et al. Total weight loss as the outcome measure of choice after Roux-en-Y gastric bypass.\u0026nbsp;\u003cem\u003eObes Surg.\u003c/em\u003e 2016;26:1794\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003ePujol-Rafols J, Al Abbas AI, Devriendt S, et al. Conversion of adjustable gastric banding to Roux-en-Y gastric bypass in one or two steps: what is the best approach? Analysis of a multicenter database concerning 832 patients. \u003cem\u003eObes Surg.\u003c/em\u003e 2020;30:5026\u0026ndash;32.\u003c/li\u003e\n \u003cli\u003eCreange C, Collin J, Verkindt H, et al.\u0026nbsp;Gastric band conversion to Roux-en-Y gastric bypass shows greater weight loss than conversion to\u0026nbsp;sleeve gastrectomy: 5-year outcomes.\u0026nbsp;\u003cem\u003eSurg Obes Relat Dis.\u003c/em\u003e 2018;14(10):1531\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003ePerathoner A, Zitt M, Lanthaler M, et al. Long-term follow-up evaluation of revisional gastric bypass after failed adjustable gastric banding.\u0026nbsp;\u003cem\u003eSurg Endosc.\u003c/em\u003e 2013;27:4305\u0026ndash;12.\u003c/li\u003e\n \u003cli\u003evan Wezenbeek MR, van Oudheusden TR, de Zoete JPJG, et al. Conversion to gastric bypass after either failed gastric band or failed sleeve gastrectomy.\u0026nbsp;\u003cem\u003eObes Surg.\u003c/em\u003e 2017;27:83\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eDutch Audit for Treatment of Obesity (DATO). Jaarverslag 2023. 2023. Available from:\u0026nbsp;https://dica.nl/wp-content/uploads/2024/07/DATO-jaarverslag-2023.pdf\u003c/li\u003e\n \u003cli\u003eObeid NR, Malick W, Concors SJ, et al. Long-term outcomes after Roux-en-Y gastric bypass: 10- to 13-year data. \u003cem\u003eSurg Obes Relat Dis.\u003c/em\u003e 2016;12(1):11\u0026ndash;20.\u003c/li\u003e\n \u003cli\u003eJense MTF, Meuwissen N, Galal AM, et al. Convincing 10-year follow-up results of the Banded Roux-en-Y gastric bypass. \u003cem\u003eObes Surg.\u003c/em\u003e 2024;34(4):1286\u0026ndash;94.\u003c/li\u003e\n \u003cli\u003eBuchwald, H., Buchwald, J.N. \u0026amp; McGlennon, T.W. Systematic Review and Meta-analysis of Medium-Term Outcomes After Banded Roux-en-Y Gastric Bypass. \u003cem\u003eObes Surg\u003c/em\u003e\u003cstrong\u003e24\u003c/strong\u003e, 1536\u0026ndash;1551 (2014). https://doi.org/10.1007/s11695-014-1311-1\u003c/li\u003e\n \u003cli\u003eIbrahim R, Fadel A, Ahmad L, et al. Long-term outcomes of bariatric surgery: an eight-year study at a tertiary care hospital in Lebanon. \u003cem\u003eSurg Open Dig Adv.\u003c/em\u003e 2024;14:100135.\u003c/li\u003e\n \u003cli\u003eMarin-Perez P, Betancourt A, Lamota M, et al. Outcomes after laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass.\u0026nbsp;\u003cem\u003eBr J Surg.\u003c/em\u003e 2014;101(3):254\u0026ndash;60.\u003c/li\u003e\n \u003cli\u003eSch\u0026auml;fer A, Gehwolf P, Umlauft J, et al. Revisional gastric bypass after failed adjustable gastric banding\u0026mdash;one-stage or two-stage procedure? \u003cem\u003eObes Surg.\u003c/em\u003e 2019;29:943\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eZadeh J, Le C, Ben-David K. Safety of adjustable gastric band conversion surgery: a systematic review and meta-analysis of the leak rate in 1-and 2-stage procedures. \u003cem\u003eSurg Obes Relat Dis\u003c/em\u003e. 2020;16(3):437\u0026ndash;44.\u003c/li\u003e\n \u003cli\u003eAuge M, Dejardin O, Menahem B, et al. Analysis of the lack of follow-up of bariatric surgery patients: experience of a reference center.\u0026nbsp;\u003cem\u003eJ Clin Med.\u003c/em\u003e 2022;11(21):6310.\u003c/li\u003e\n \u003cli\u003eHiga KD, Himpens J. The reality of long-term follow-up of bariatric/metabolic surgery patients\u0026mdash;A conundrum. \u003cem\u003eJAMA Surg\u003c/em\u003e. 2018;153(5):435.\u003c/li\u003e\n \u003cli\u003eThereaux J, Lesuffleur T, Pa\u0026iuml;ta M, et al. Long-term follow-up after bariatric surgery in a national cohort. \u003cem\u003eBr J Surg.\u003c/em\u003e 2017;104(10):1362\u0026ndash;71.\u003c/li\u003e\n \u003cli\u003eClapp B, Wynn M, Martyn C, et al. Long term (7 or more years) outcomes of the sleeve gastrectomy: a meta-analysis. \u003cem\u003eSurg Obes Relat Dis\u003c/em\u003e. 2018;14(6):741\u0026ndash;7.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. baseline characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 240\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eAge (years)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e49 \u003cu\u003e+\u003c/u\u003e 9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cem\u003eMale\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cem\u003eFemale\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e45 (18.8)\u003c/p\u003e\n \u003cp\u003e195 (81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eHeight (cm)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e168.6 \u003cu\u003e+\u003c/u\u003e 0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eWeight at initial procedure (kg)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e128.7 \u003cu\u003e+\u003c/u\u003e 19.8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eBMI at initial procedure (kg/m\u003csup\u003e2\u003c/sup\u003e)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e45 \u003cu\u003e+\u003c/u\u003e 5.5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eWeight at screening for conversion (kg)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e114.2 \u003cu\u003e+\u003c/u\u003e 19.5\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 324px;\"\u003e\n \u003cp\u003eBMI at screening for conversion (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e40.3 \u003cu\u003e+\u003c/u\u003e 5.8\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eData are presented as mean \u003cu\u003e+\u003c/u\u003e\u003c/em\u003e \u003cem\u003estandard deviation or N (%)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Surgery details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 240\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eTime between AGB and conversion (years)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e11 (8 \u0026ndash; 15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eIndication for conversion\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eRecurrent weight gain\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eBand/functional problems\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003eBand/functional problems and recurrent weight gain\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e184 (76.6)\u003c/p\u003e\n \u003cp\u003e28 (11.7)\u003c/p\u003e\n \u003cp\u003e28 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eSurgery duration (min)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e93 (77 \u0026ndash; 115)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003eClosing position MiniMizer\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;7 cm\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;7.5 cm\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;8 cm\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 242px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (9.6)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e208 (86.7)\u003c/p\u003e\n \u003cp\u003e4 (1.7)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eData are presented as median (IQR) or N (%)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;%TWL and cumulative %TWL during 5-year follow-up after conversion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"704\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%TWL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecumulative %TWL (from primary procedure)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-conversion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e10.6 \u003cu\u003e+\u0026nbsp;\u003c/u\u003e11.6\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-month follow-up\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e237/240 (98.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e15.3 \u003cu\u003e+\u003c/u\u003e 6.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e24.4 \u003cu\u003e+\u003c/u\u003e 9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6-month follow-up\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e234/240 (97.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e21.2 \u003cu\u003e+\u003c/u\u003e 7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e30 \u003cu\u003e+\u003c/u\u003e 9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1-year follow-up\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e228/240 (95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e25.4 \u003cu\u003e+\u003c/u\u003e 10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e33.7 \u003cu\u003e+\u003c/u\u003e 10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2-year follow-up\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e188/215 (87.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e25.3 \u003cu\u003e+\u003c/u\u003e 11.7\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e33.8 \u003cu\u003e+\u003c/u\u003e 11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3-year follow-up\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e124/213 (58.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e23.3 \u003cu\u003e+\u003c/u\u003e 11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e31.6 \u003cu\u003e+\u003c/u\u003e 10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4-year follow-up\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e90/137 (65.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e21.2 \u003cu\u003e+\u0026nbsp;\u003c/u\u003e12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e30.6 \u003cu\u003e+\u003c/u\u003e 10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5-year follow-up\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e55/100 (55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e18.9 \u003cu\u003e+\u003c/u\u003e 10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e30.2 \u003cu\u003e+\u003c/u\u003e 10.4\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eFollow-up based on number of patients who reached the specific time-point. %TWL is calculated based on weight at screening for conversion (n = 240), cumulative %TWL is calculated based on weight for initial AGB (n = 201).\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Short- and long-term complications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 240\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eMiniMizer in situ at last FU\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e232 (96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eMiniMizer related complications\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eRing slippage\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eRing erosion\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003eDysphagia\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003ePatients with complications\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e40 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eShort-term complications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003ePatients with short-term complications\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e8 (3.3)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eShort-term (\u003cu\u003e\u0026lt;\u003c/u\u003e 30 days) complications according to Clavien-Dindo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003e2\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003e3a\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u003cem\u003e3b\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003cp\u003e5 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLong-term complications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003ePatients with long-term complications\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e33 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 353px;\"\u003e\n \u003cp\u003eLong-term (\u0026gt;30 days) complications according to Clavien-Dindo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3a\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3b\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (0.8)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (1.7)\u003c/p\u003e\n \u003cp\u003e26 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\n\u003cp\u003e\u003cstrong\u003eTable 5. Types of complications\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 240\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eShort-term\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Anastomotic leakage\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Bleeding\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Gastro-gastric fistula\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Food impaction\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 (1.7)\u003c/p\u003e\n \u003cp\u003e2 (0.8\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLong-term\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Internal herniation\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Pouch-related problems\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Marginal ulcers\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Diagnostic laparoscopies\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Impending blow-out of excluded stomach\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Food impaction\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Gastro-gastric fistula\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Hematoma\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Stenosis\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eMiniMizer related\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Dysphagia\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Erosion \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 257px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (5.4)\u003c/p\u003e\n \u003cp\u003e5 (2.1)\u003c/p\u003e\n \u003cp\u003e5 (2.1)\u003c/p\u003e\n \u003cp\u003e3 (1.3)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003cp\u003e1 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Adjustable Gastric Band, Ring augmented Roux-en-Y Gastric Bypass, MiniMizer, Conversional surgery ","lastPublishedDoi":"10.21203/rs.3.rs-7119358/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7119358/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLaparoscopic Adjustable Gastric Band (AGB) has shown suboptimal long-term results with a non-success rate of 20\u0026ndash;56% with an accompanying removal rate of 10\u0026ndash;50% due to suboptimal clinical response or complications. Conversion to RYGB is proven to be a safe and effective option. However, current literature contains no studies which use additional placement of a silicone ring (MiniMizer) around the pouch. Therefore, this study aims to evaluate the safety and effectiveness of conversion from AGB to ring augmented RYGB (raRYGB).\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll consecutive laparoscopic AGB to raRYGB conversions performed between January 2016 and October 2023 were included. All procedures were performed by a one-stage approach. The primary outcome was percentage total weight loss (%TWL) after 1-year follow-up. Secondary outcomes consisted of %TWL after 2, 3, 4, and 5 years, cumulative %TWL, and early and late complications.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe included a total of 240 patients of whom 195 were female (81.3%). Mean pre-conversion BMI was 40.3 kg/m\u003csup\u003e2\u003c/sup\u003e. The average %TWL 1- and 5-year after the conversion was 25.4% and 18.9%. Cumulative %TWL, calculated from before AGB, was 33.7% after 1 and 30.2% after 5 years. 8 complications occurred within 30 days, 3 of which were \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e\u0026thinsp;CD3a and 5\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;CD3b. A total of 8 MiniMizers were removed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eConversion from laparoscopic AGB to raRYGB is a valid one-stage conversion method with significant weight loss after 1 and durable weight loss up to 5 years of follow-up. The short- and long-term complication rate is low and ring-specific complications are rare.\u003c/p\u003e","manuscriptTitle":"Safety and effectiveness of conversion from adjustable gastric band to ring augmented Roux-en-Y Gastric Bypass","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-04 11:11:16","doi":"10.21203/rs.3.rs-7119358/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-24T16:21:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-19T14:16:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-14T10:16:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218345103113035272778754027698399668145","date":"2025-08-06T23:04:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210640601002565618800024722707611724287","date":"2025-07-31T19:36:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-30T00:54:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-26T12:45:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-25T13:27:06+00:00","index":"","fulltext":""},{"type":"submitted","content":"Obesity Surgery","date":"2025-07-14T09:16:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"obesity-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"obsu","sideBox":"Learn more about [Obesity Surgery](https://link.springer.com/journal/11695)","snPcode":"11695","submissionUrl":"https://submission.springernature.com/new-submission/11695/3","title":"Obesity Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"6830dce8-2dde-47c2-ae38-38485631fdf0","owner":[],"postedDate":"August 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T16:46:37+00:00","versionOfRecord":{"articleIdentity":"rs-7119358","link":"https://doi.org/10.1007/s11695-025-08463-7","journal":{"identity":"obesity-surgery","isVorOnly":false,"title":"Obesity Surgery"},"publishedOn":"2026-01-14 16:29:48","publishedOnDateReadable":"January 14th, 2026"},"versionCreatedAt":"2025-08-04 11:11:16","video":"","vorDoi":"10.1007/s11695-025-08463-7","vorDoiUrl":"https://doi.org/10.1007/s11695-025-08463-7","workflowStages":[]},"version":"v1","identity":"rs-7119358","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7119358","identity":"rs-7119358","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}