Revisional surgery after failed laparoscopic adjustable gastric banding

BackgroundLaparoscopic adjustable gastric banding (LAGB) is a restrictive procedure that achieves weight loss without anatomic alteration. However, morbidity requiring surgical reintervention can occur.MethodsA retrospective review of a prospectively maintained database of primary LAGB and revisional surgery after failed LAGB was performed from January 2001 to October 2006 at an academic private clinic.ResultsOf 2467 bariatric procedures, primary LAGB was performed in 242 patients. A total of 53 revisional procedures were performed in 40 patients and 16 in 9 patients who were referred from other centers after failed primary LAGB. The mean follow-up was 45.7 ± 15.8 months (range 9.5–70). The early surgical reintervention rate was 6.1%. The revisional procedures included band removal only in 27 (39%), band removal and conversion to sleeve gastrectomy in 10 (14.5%), band removal and conversion to Roux-en-Y gastric bypass in 5 (7.2%), band repositioning in 7 (10%), device-related reintervention in 6 (8.7%), subsequent conversion to another bariatric procedure in 3 (4.3%), and other procedures in 11 (15.9%). Of the 49 patients, 21 (43%) presented with acute band-related morbidity. A total of 55 procedures (96.5%), amenable to minimal invasive surgery, excluding wound and port site-related procedures, were completed laparoscopically. The major early and late complication rate was 4.1% and 2%, respectively.ConclusionPrimary LAGB was associated with acceptable major early complication and surgical reintervention rates. However, a late surgical reintervention rate of 15.2% was observed. Band removal was required in 14% of our primary LAGB patients because of band-related morbidity, with conversion to another bariatric procedure in 6.2%. Our results have shown that LAGB can be associated with significant morbidity and that revisional surgery is common.     

Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty

BackgroundLaparoscopic sleeve gastrectomy (LSG) is considered an effective multipurpose operation for morbid obesity, although long-term results are still lacking. Also, the best procedure to be offered in the case of failed restrictive procedures is still debated. We here reported our results of LSG as a revisional procedure for inadequate weight loss and/or complications after adjustable gastric banding or gastroplasty.MethodsSince April 2005, 57 patients (20 men and 37 women), with a mean age of 49.9 ± 11.9 years, underwent revisional LSG, 52 after laparoscopic adjustable gastric banding/adjustable gastric banding and 5 after vertical banded gastroplasty at our institution. The mean interval from the primary procedure to LSG was 7.54 ± 4.8 years. The LSG was created using a 34F bougie with an endostapler, after removing the laparoscopic adjustable gastric band or the anterior portion of the band in those who had undergone vertical banded gastroplasty. An upper gastrointestinal contrast study was performed within 3 days after surgery and, if the findings were negative, a soft diet was promptly started.ResultsA total of 41 patients had undergone concurrent band removal and LSG and 16 had undergone band removal followed by an interval LSG. Three cases required conversion to open surgery because of a large incisional hernia. The mean operative time was 120 minutes (range 90–180). One patient died of multiple organ failure from septic shock. Three patients (5.7%) developed a perigastric hematoma, 3 (5.7%) had leaks, and 1 had mid-gastric short stenosis. The median hospital stay was 5 days. The mean body mass index at revisional LSG was 45.7 ± 10.8 kg/m² and had decreased to 39 ± 8.5 kg/m² after 2 years, with a mean percentage of the estimated excess body mass index lost of 41.6% ± 24.4%. Two patients required a duodenal switch for insufficient weight loss.ConclusionLSG seems to be effective as revisional procedure for failed LAGB/vertical banded gastroplasty, although with greater complication rates than the primary procedures. Larger series and longer follow-up are needed to confirm these promising results.     

Management of slipped adjustable gastric bands

BACKGROUND: A small percentage of patients undergoing laparoscopic adjustable gastric banding (LAGB) experience band slippage that might require subsequent surgical intervention. We present our experience with band slippage in 660 consecutive LAGBs performed since November 2001 in order to determine the optimal management for slipped gastric bands. METHODS: The treatment options for patients with slipped bands include band removal, gastric reduction and reapplication of the original band, and band replacement. Data from electronic medical records, as well as telephone interviews, were collected and tabulated. The original weight and body mass index, weight and body mass index before the revisional procedure, and the most recent weight, body mass index, and percentage of excess weight loss are presented. RESULTS: Of the 660 LAGB patients, 34 (5%) experienced band slippage and required 40 subsequent operative procedures. Of the 34 patients, 6 underwent multiple procedures for their slipped band. Overall, 10 removals, 13 gastric reductions, and 17 replacements were performed (40 total procedures). Of the 34 patients, 28 (82%) were available for follow-up. This group of 28 patients underwent 34 operative procedures (7 removals, 11 gastric reductions, and 16 replacements). No complications were associated with these 34 operations. Of the 11 patients with gastric reduction, 6 (55%) had subsequent recurrence of band slippage, resulting in 6 additional operations (5 replacements and 1 removal). CONCLUSION: After band slippage, all 3 management options result in maintenance of most of the lost weight. However, because a large number of patients who undergo gastric reduction experience repeated slippage and require additional surgical intervention, gastric reduction should not be routinely performed in this population. Given the overall experience with revisional surgery after band slippage, additional investigation of the etiology of band slippage and its prevention is warranted.     

Two-step conversion surgery after failed laparoscopic adjustable gastric banding. Comparison between laparoscopic Roux-en-Y gastric bypass and laparoscopic gastric sleeve

BackgroundDespite its worldwide popularity, laparoscopic adjustable gastric banding (LAGB) requires revisional surgery for failures or complications, in 20–60% of cases. The purpose of this study was to compare in terms of efficacy and safety, the conversion of failed LAGB to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy. (LSG).MethodsThe bariatric database of our institution was reviewed to identify patients who had undergone conversion of failed LAGB to LRYGB or to LSG, from November 2007 to June 2012.ResultsA total of 108 patients were included. Of these, 74 (68.5%) underwent conversion to LRYGB and 34 to LSG. All of the procedures were performed in 2-stage and laparoscopically. The mean follow-up for the LRYGB group was 29.1±17.9 months while for the LSG patients was 24.2±14.3 months. The mean body mass index (BMI) prior LRYGB and LSG was 45.6±7.8 and 47.5±5.6 (P = .09), respectively. Postoperative complications occurred in 16.2% of the LRYGB patients and in 2.9% of the LSG group (P = .04). Mean percentage of excess weight loss was 59.9%±16.2% and 70.2%±16.7% in LRYGB, and it was 52.2%±11.4% and 59.9%±14.4% in LSG at 12 months (P = .007) and 24 months (P = .01) after conversion.ConclusionIn this series, LRYGB and LSG are both effective and adequate revisional procedure after failure of LAGB. While LRYGB seems to ensure greater weight loss at 24 months follow-up, LSG is associated with a lower postoperative morbidity.     

Revisional surgery after failed gastric banding: results of one-stage conversion to RYGB in 195 patients

BackgroundThe most performed restrictive bariatric procedure is the laparoscopic adjustable gastric band (LAGB). With many patients still receiving a LAGB in Europe and the United States, inevitably, the number of complications also increases. For many complications revisional bariatric surgery is necessary. In this study, the outcomes of one-stage LAGB conversion to a Roux-en-Y gastric bypass (RYGB) at our institution are presented. The objective of this study was to investigate the safety and efficiency of RYGB performed as a one-stage procedure after failed LAGB.MethodsPatients were retrospectively selected using a prospectively collected database. The gastric band had to be in situ for at least 1 year and minimum postoperative follow-up was 12 months. The revisional RYGB had to be performed as a 1-step procedure.ResultsA total of 195 patients were included while 3 were lost to follow up. Overall, 178 (91%) procedures were performed without perioperative complications, and only 8 (4%) patients required reoperation within 30 days. The mean follow-up was 40 months (±24) after RYGB. Mean excess weight loss (EWL) increased from 25% (±26/-50- 120%) to 60% (±21.2/0- 130), 65% (±23.5/0- 131), 63% (±24.2/2- 132), 60% (±24.1/0- 111) and 53% (±28.7/-39- 109) in the first 5 postoperative years.ConclusionConverting a gastric band to a RYGB in a one-stage procedure is safe and feasible, with acceptable complication rates when performed in a specialized institution. The RYGB conversion results in a good EWL of 65% after 2 years. However, proper patient selection is of the utmost importance.     

Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients

BackgroundTo determine whether the medium-term outcome of secondary gastric bypass (SGB) after laparoscopic adjustable gastric banding (LAGB) is comparable to the outcome of primary gastric bypass (PGB) in morbidly obese patients in terms of complications and weight loss. Controversy exists among bariatric surgeons regarding the choice of primary operation for morbid obesity. Some prefer to start with LAGB as a low-risk operation for all patients and perform revisional surgery in the case of failure. Others prefer to tailor the primary operation to the individual patient.MethodsA total of 55 patients who had undergone SGB after failed LAGB from 2002 to 2006 were compared with 81 patients who had undergone PGB for morbid obesity during the same period in our hospital by a single surgeon.ResultsThe mean operative time in the PGB group was shorter (73 ± 22 min, range 50–100) compared with the SGB group (99 ± 32 min, range 55–180; P <.001). The median length of admission did not differ significantly between the PGB and SGB groups (4 ± 6.6 d, range 3–55, versus 4 ± 2.9 d, range 3–16, respectively; P = .13). No significant differences were found in the occurrence of complications between the PGB and SGB groups (29.6% versus 30.9%, respectively, P = .87). No patient died. At 2 and 3 years postoperatively, no significant difference was found in percentage of patients treated with good or excellent outcomes using the criteria of MacLean (2 y, PGB 60.0% versus SGB 58.8%, P = .94; 3 y, PGB 75.0% versus SGB 72.7%, P = .91).ConclusionIn this series, gastric bypass as a secondary procedure after failed LAGB was as safe and effective as PGB. Conversion to gastric bypass appears to be the treatment of choice after failed LAGB.     

Management of Gastric Perforations During Laparoscopic Gastric Banding

Background

Gastric perforations are one of the intraoperative complications of laparoscopic gastric banding (LAGB). Delayed diagnosis can increase the mortality and morbidity rates.

Methods

Retrospective analysis of surgery outcome and long-term follow-up of the patients with gastric perforations during primary LAGB and revisional band procedures was performed.

Results

Twenty-four patients with gastric perforations were identified during 15?years of LAGB surgeries. Half of these had primary LAGB and half had revisional procedures (five emergent and seven elective). Gastric tear was found at surgery in 19 patients; the band was preserved and LAGB was completed in 18 of these. Five patients had delayed diagnosis and underwent re-exploration 24?C72?h after surgery. During the surgery, 23 anterior, 8 posterior, 1 esophageal, and 1 small bowel tears were found. Laparoscopic repair was successful in 19 (83?%) cases. The mean surgery time and mean hospital stay were 56.3?min and 7.8?days, respectively. Morbidity and mortality rates were 25 and 4.1?%, respectively. Two patients underwent later band replacement following removal. Band erosion was observed in one patient. At least 17 patients had no complications during mean follow-up of 52.2?months.

Conclusions

Band preservation is recommended following primary repair of gastric tear. Early intra- and postoperative diagnosis of gastric tear in LAGB is essential for successful management of this iatrogenic injury and decreases occurrence of complications.     

Trends in revisional bariatric surgery using the MBSAQIP database 2015-2017

BackgroundThe third most common bariatric surgery is revisional bariatric surgery. The American College of Surgeons tracks outcomes using the Metabolic and Bariatric Surgery Accreditation Quality Initiative Program database. We used this database to examine trends in revisional bariatric surgery.ObjectiveTo evaluate how trends in bariatric revisional surgery have changed in recent years.SettingUniversity Hospital, United States.MethodsThe Metabolic and Bariatric Surgery Accreditation Quality Initiative Program database for 2015 to 2017 was examined for revisions of bariatric surgery. Patients who underwent revisional bariatric surgery were identified by the primary Current Procedural Terminology code, the REVCONV and PREVIOUS_SURGERY field as well as secondary Current Procedural Terminology codes. There is no exact code for sleeve gastrectomy (SG) to laparoscopic Roux-en-Y gastric bypass (LRYGB), so we used 43644 (GB)+REVCONV+PREVIOUS_SURGERY for this.ResultsFor the years 2015 to 2017 there were 57,683 revisions/conversions of 528,081 patients. The number of revisions increased over the study period by 5213 cases. The most common revision was laparoscopic adjustable gastric band (LAGB) to SG with 15,433 cases and the second was LAGB to LRYGB with 10,485 cases. There were 14,715 LAGB removals. It is more difficult to track SG to LRYGB but there were 8491 unlisted cases, which may have been sleeve to bypass.ConclusionLAGBs are being taken out or converted, and this group makes up the largest portion of revisions and conversions. It is difficult to track SG to LRYGB, but the number of unlisted cases continues to climb. This will likely surpass LAGB conversions with time. The Metabolic and Bariatric Surgery Accreditation Quality Initiative Program should be modified to capture revisions/conversions of SG.     

Revisional versus primary Roux-en-Y gastric bypass: a case-matched analysis

Background

Laparoscopic adjustable gastric banding (LAGB) has been a widely performed bariatric procedure. Unfortunately, revisional surgery is required in 20–30 % of cases. Data comparing revisional and primary gastric bypass procedures are scarce. This study compared revisional malabsorptive laparoscopic very very long limb (VVLL) Roux-en-Y gastric bypass (RYGB) with primary VVLL RYGB and tested the hypothesis that one-stage revisional laparoscopic VVLL RYGB is an effective procedure after failed LAGB.

Methods

In this study, 48 revisional VVLL RYGBs were matched one-to-one with 48 primary VVLL RYGBs. The outcome measures were operating time, conversion to open surgery, excess weight loss (EWL), and early and late morbidity.

Results

Surgical and medical morbidities did not differ significantly. No conversions occurred. The revisional group showed an EWL of 41.8 % after 12 months of follow-up evaluation and 45.1 % after 24 months based on the pre-revisional weight. The total EWL based on the weight before the LAGB was calculated to be 54.3 % after 12 months and 57.2 % after 24 months. The EWL in the primary RYGB group was significantly higher for both types of calculation: 41.8 %/54.3 % versus 64.1 % (p < 0.001 and <0.01) after 12 months and 45.1 %/57.2 % versus 70.4 % (p < 0.001 and <0.002) after 24 months.

Conclusions

Revisional laproscopic VVLL RYGB can be performed as a one-stage procedure by experienced bariatric surgeons but shows less effective EWL than primary RYGB procedures.     

Is there a relation between number of adjustments and results after gastric banding?

BackgroundLaparoscopic adjustable gastric banding (LAGB) is a standard restrictive bariatric procedure. Previous studies have shown that patients lost to follow-up do worse than patients who remain in follow-up. However, it is unknown if this is purely because of a lack of band adjustments. The aim of this study was to study the relation between number of adjustments and results.MethodsPatients who underwent primary LAGB from October 2006 until March 2009 were included. The following parameters were collected: demographic characteristics, preoperative and postoperative weight, preoperative and postoperative status of co-morbidities, type of band, short- and long-term complications, reoperations, date, number and volume of adjustments, total amount of inserted volume, and last measured volume.ResultsOne hundred seventy-four patients underwent primary LAGB. Twelve patients did not attend follow-up visits after 24 months (8.1%). Mean follow-up was 46 months, and excess weight loss, 47%. Eleven patients (8.1%) developed long-term complications, and 12 patients (8.8%) underwent revisional surgery. Patients underwent a mean number of 5 adjustments with a range of 0 to 18. The mean volume of totally inserted milliliters was 8 mL, with a range of 0 to 14 mL. There was a strong positive relation between number of adjustments and weight loss as well as reduction in obesity-related co-morbidities (r = .22; P<.01). There was no significant relation between number of adjustments and complications or revisional surgery.ConclusionThere is a strong relation between the number of band adjustments and weight loss, whereas complications and reoperations seem to be independent of the number of adjustments. A continual and lifelong follow-up of LAGB patients, including regular band volume adjustments, is necessary.     

Cost and validity of early postoperative contrast swallow after laparoscopic adjustable gastric banding

BackgroundTo assess the validity and cost of early routine upper gastrointestinal (UGI) studies after laparoscopic adjustable gastric banding (LAGB) at a university hospital in the United States. Today, although there is widespread use of LAGB, and it is considered a safe procedure, it also can result in some specific early complications. In most centers, an UGI series after bariatric surgery is performed to rule out these potentially dangerous complications.MethodsFrom March 2006 to July 2010, 183 LAGB procedures were performed by a single surgeon. All data were collected prospectively in a computerized database and reviewed retrospectively. The patients underwent water-soluble UGI studies during the early postoperative phase (2–24 h) to exclude gastrointestinal perforation, obstruction, and gastric band malposition.ResultsNo intraoperative complications occurred. One conversion to an open procedure was required because of massive adhesions. A total of 21 postoperative complications (11.5%) occurred. None of the 183 patients who underwent an early UGI series experienced leakage, gastric band malposition, or slippage. The only radiologic abnormality was a stomal obstruction (.5%) requiring reoperation. The total cost for the 183 UGI studies was $54,900. The mean hospital stay was .5 day (range .1–5.6). Approximately 90% of patients were discharged within the first 24 hours.ConclusionThe fear of acute perforation or obstruction has been the rationale for obtaining UGI studies after LAGB. We found this to be expensive and of limited value in an experienced center and have created a decisional algorithm to determine when its use is appropriate for symptomatic patients.     

Laparoscopic Removal of Poor Outcome Gastric Banding with Concomitant Sleeve Gastrectomy

Background

Laparoscopic adjustable gastric banding (LAGB) has a significant incidence of long-term failure, which may require an alternative revisional bariatric procedure to remediate. Unfortunately, there is few data pinpointing which specific revisional procedure most effectively addresses failed gastric banding. Recently, it has been observed that laparoscopic sleeve gastrectomy (LSG) is a promising primary bariatric procedure; however, its use as a revisional procedure has been limited. This study aims to evaluate the safety and efficacy of LSG performed concomitantly with removal of a poor-outcome LAGB.

Methods

A retrospective review was performed on patients who underwent LAGB removal with concomitant LSG at King Saud University in Saudi Arabia between September 2007 and April 2012. Patient body mass index (BMI), percentage of excess weight loss (%EWL), duration of operation, length of hospital stay, complications after LSG, and indications for revisional surgery were all reviewed and compared to those of patients who underwent LSG as a primary procedure.

Results

Fifty-six patients (70 % female) underwent conversion of LAGB to LSG concomitantly, and 128 (66 % female) patients underwent primary LSG surgery. The revisional and primary LSG patients had similar preoperative ages (mean age 33.5?±?10.7 vs. 33.6?±?9.0 years, respectively; p?=?0.43). However, revisional patients had a significantly lower BMI at the time of surgery (44.4?±?7.0 kg/m² vs. 47.9?±?8.2; p?<?0.01). Absolute BMI postoperative reduction at 24 months was 14.33 points in the revision group and 18.98 points in the primary LSG group; similar %EWL was achieved by both groups at 24 months postoperatively (80.1 vs. 84.6 %). Complications appeared in two (5.5 %) revisional patients and in nine (7.0 %) primary LSG patients. No mortalities occurred in either group.

Conclusions

Conversion of LAGB by means of concomitant LSG is a safe and efficient procedure and achieves similar outcomes as primary LSG surgery alone.     

Roux-en-Y gastric bypass after successful weight loss with a laparoscopic adjustable gastric band: rationales and early outcomes in patients of body mass index<35 kg/m2

BackgroundLaparoscopic adjustable gastric banding (LAGB) has a number of well-established acute and chronic issues that can require revisional surgical procedures. There is no existing data to evaluate conversion of band patients with body mass index (BMI)<35 kg/m² from LAGB to a Roux-en-Y gastric bypass (RYGB). This study aims to report on the indications for and the safety profile of conversion of the LAGB to RYGB in patients with BMI<35 kg/m².MethodsA review of data from 200 consecutive conversions of LAGB to RYGB was conducted. Fifty-two patients whose BMI was<35 kg/m² were included in this analysis. Indications for conversion, technical details, early morbidity, length of hospital stay, and weight loss data were assessed.ResultsLaparoscopic conversion to RYGB was performed in 100% of patients. The median BMI pre-RYGB was 32.8 kg/m². The most common indication for surgery was weight regain after removal of LAGB (28.8%). There was no mortality. Early morbidity was seen in 25% of patients; the most common complication was stricture of the gastrojejunal anastomosis (9 patients).ConclusionMorbidity resulting from conversion of LAGB to RYGB in patients with BMI <35 kg/m² is similar to that seen in the BMI>35 kg/m² population. The procedure is technically challenging and morbidity rates are higher than those reported for surgically ‘naïve’ patients. It is recommended that this procedure be undertaken by appropriately trained surgeons in high-volume bariatric centers to optimize safety and outcomes.     

A one-step conversion from gastric banding to laparoscopic Roux-en-Y gastric bypass is as safe as a two-step conversion: A comparative analysis of 885 patients

Aims: To achieve additional weight loss or to resolve band-related problems, a laparoscopic adjustable gastric banding (LAGB) can be converted to a laparoscopic Roux-en-Y gastric bypass (RYGB). There is limited data on the feasibility and safety of routinely performing a single-step conversion. We assessed the efficacy of this revisional approach in a large cohort of patients operated in a high-volume bariatric institution.

Methods: Between October 2004 and December 2015, a total of 885 patients who underwent LAGB removal with RYGB were identified from a prospectively collected database. In all cases, a single-stage conversion procedure was planned. The feasibility of this approach and peri-operative outcomes of these patients were evaluated and analyzed.

Results: A single-step approach was successfully achieved in 738 (83.4%) of the 885 patients. During the study period, there was a significant increase in performing the conversion from LAGB to RYGB single-staged. No mortality or anastomotic leakage was observed in both groups. Only 45 patients (5.1%) had a 30-d complication: most commonly hemorrhage (N?=?20/45), with no significant difference between the groups.

Conclusion: Converting a LAGB to RYGB can be performed with a very low morbidity and zero-mortality in a high-volume revisional bariatric center. With increasing experience and full standardization of the conversion, the vast majority of operations can be performed as a single-stage procedure. Only a migrated band remains a formal contraindication for a one-step approach.     

Gastric prolapse with pseudocysts following laparoscopic adjustable gastric banding

Introduction:

Laparoscopic adjustable gastric banding (LAGB) is a reversible method of surgical gastric restriction. Following LAGB, the adverse event most commonly necessitating subsequent reoperation is prolapse of the gastric corpus or fundus above the band. A review of the medical literature reveals no reports of nonpancreatic pseudocysts being associated with this adverse event. Nonpancreatic pseudocysts, encountered during revisional bariatric surgery should be considered a cause of irreducible gastric prolapse.

Case Report:

We report the case of a 41-year-old Caucasian female who underwent laparoscopic surgery to revise an adjustable gastric band and to repair an anterior gastric prolapse. Intraoperatively, 2 pseudocysts were found on the gastric fundus above the band in association with the gastric prolapse. The pseudocysts were resected, the gastric prolapse was reduced, and the band was left in place. The patient recovered uneventfully.

Conclusion:

Nonpancreatic pseudocysts may be associated with gastric prolapse in patients who have undergone LAGB. These pseudocysts can often be excised laparoscopically without violating the gastric lumen. This atypical presentation of gastric prolapse may pose a diagnostic and therapeutic challenge as these patients may present to an outpatient clinic or emergency room with nonspecific symptoms.     

What happens after gastric band removal without additional bariatric surgery?

BackgroundThe laparoscopic adjustable gastric band (LAGB) is widely used for the treatment of morbid obesity. Many patients benefit from this procedure initially, but experience complications after a few years. The treatment for many complications is revisional bariatric surgery. A number of patients, however, request only band removal without secondary bariatric surgery. The aim of this study was to assess the perioperative and medium term outcomes of patients who had their LAGB removed without secondary bariatric surgery.MethodsPatients were retrospectively selected using a prospectively collected database. The LAGB had to be in situ for at least 1 year, and minimum postoperative follow-up had to be 12 months.ResultsThirty-eight patients who had their LAGB laparoscopically removed between 2000 and 2010 were included. Median follow-up after LAGB removal was 3.0 (1.4 to 8.9) years. Only 2 complications (5%) and no mortality occurred perioperatively. In the 21 patients who did not undergo additional bariatric surgery, the median excess weight loss (EWL) decreased from 41% (–12% to –100%) at band removal to 9% (–10% to 90%), 0% (–20% to 78%), and –11% (–12% to 56%) after 1, 2, and 5 years, respectively. Percentage weight loss (%WL) was 17% (–54% to –5%), 4% (–47% to –9%), 0% (–41% to 11%), and –5% (–29% to 9%) after these same time intervals, respectively.After a median 2.1 (.5 to 9.9) years, 17 patients underwent either a Roux-en-Y gastric bypass (14 patients) or a Scopinaro (3 patients) all because of weight regain. The current EWL and %WL in these patients is 67% (24% to 113%) and 30% (12% to 53%), respectively compared with –11% (–33% to 57%) and –4% (–14% to 34%) in patients without a secondary bariatric procedure (P< .001).ConclusionPatients who have their LAGB removed are guaranteed to suffer from weight regain. It is inadvisable to only remove the LAGB without performing an additional bariatric procedure when deemed technically feasible and safe. In this study, no patient was able to maintain the weight loss achieved with the LAGB after its removal.     

Revisional Laparoscopic Roux-en-Y Gastric Bypass Following Failed Laparoscopic Adjustable Gastric Banding

Background

Obesity is a worldwide epidemic and surgery is the only proven long-term treatment. The two most commonly performed bariatric procedures are laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB). There are advocates of both procedures but LAGB is associated with potentially high failure rates and may require conversion to an alternative procedure.

Methods

This study reports our unit results for failed LAGB converted to LRYGB and compares them to primary LRYGB patients. All patients undergoing revisional LRYGB from July 2006 to December 2011 were included in the study. Comparisons were made to patients undergoing primary LRYGB over the same time period for post-operative weight loss, complications and length of stay.

Results

Of the patients, 722 were analysed of which 55 underwent revisional surgery. There was no statistical difference in percentage of excess weight loss at 6 months, 1 year or 2 years following surgery between the primary and revisional surgery cohorts (54.5, 63.7, 65.2 vs 51.6, 59.5, 59.4, p?=?NS). There was no difference in morbidity, mortality or length of stay between the two groups. Revisional LRYGB was carried out as a single surgery in 43 (78 %) patients.

Conclusions

Revisional LRYGB surgery can be carried out safely and efficiently in experienced bariatric units. Good short- and medium-term weight loss can be achieved with no increase in morbidity, mortality or length of hospital stay. This study adds weight to the argument that LRYGB is the revisional procedure of choice following failed LAGB.     

Long-term follow-up in patients undergoing open gastric bypass as a revisional operation for previous failed restrictive procedures

BackgroundWe have previously described our early experience with Roux-en-Y gastric bypass (RYGB) as a revisional procedure. The favorable results have stimulated us to continue using RYGB as our standard operating procedure after failed bariatric surgery. Our objective was to evaluate the perioperative risks, weight result, and abdominal symptoms 5 years after revisional RYGB surgery at a university hospital in Sweden.MethodsWe studied 121 patients undergoing revisional open RYGB (age 42.0 yr, body mass index 37.7 kg/m², 101 women) 5 years after RYGB surgery. The patients underwent reoperation because of either intolerable side effects or inferior weight loss. The initial procedures were horizontal gastroplasty (n = 2), vertical banded gastroplasty (n = 34), gastric banding (n = 21), and silicone adjustable gastric banding (n = 64). The mean interval between the first surgery and revision was 5 years. The 5-year follow-up data were obtained annually using a questionnaire survey.ResultsThe average operating time was 162 minutes (range 75–355). In these 121 cases, 10 (8%) reoperations were performed in the first 30-day period (4 for leakage). No perioperative mortality occurred, and the 5-year follow-up rate was 91%. The mean body mass index was 30.7 kg/m². Seven patients (5.7%) had undergone subsequent surgery because of complications. At follow-up, 93% reported being very satisfied or satisfied with the revisional procedure. Disturbing abdominal symptoms after RYGB were rare.ConclusionThe perioperative risks of revisional RYGB are greater than those for primary RYGB. However, because the long-term weight results and patient satisfaction are very good, we believe that the 8% reoperative rate is acceptable. We consider RYGB to be a suitable procedure for patients in whom previous bariatric procedures have failed.     

Conversion from laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) to one anastomosis gastric bypass (OAGB): preliminary data from a multicenter retrospective study

BackgroundLaparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure, while laparoscopic adjustable gastric banding (LAGB) has been for a decade one of the most popular interventions for weight loss. After LSG and LAGB, some patients may require a second surgery due to weight regain or late complications. One anastomosis gastric bypass (OAGB) is a promising bariatric procedure, which provides effective long-term weight loss and has a favorable effect on type 2 diabetes.ObjectivesTo retrospectively analyze data from 10 Italian centers on conversion from LAGB and LSG to OAGB.SettingHigh-volume centers for bariatric surgery.MethodsProspectively collected data from 10 high-volume centers were retrospectively reviewed. Body mass index (BMI), percentage of excess BMI loss, reasons for redo, remission from co-morbidities (hypertension, diabetes, gastroesophageal reflux, and dyslipidemia), and major complications were recorded.ResultsThree hundred patients were included in the study; 196 patients underwent conversion from LAGB to OAGB and 104 were converted from LSG. BMI was 45.1 ± 7 kg/m² at the time of first intervention, 41.8 ± 6.3 kg/m² at redo time, and 30.5 ± 5.5 kg/m² at last follow-up appointment. Mean percentage of excess BMI loss was 13.2 ± 28.2 at conversion and 73.4 ± 27.5 after OAGB. Remission rates from hypertension, diabetes, gastroesophageal reflux, and dyslipidemia were 40%, 62.5%, 58.7% and 52%, respectively. Mean follow-up was 20.8 (range, 6–156) months and overall complications rate was 8.6%.ConclusionOur data show that OAGB is a safe and effective revisional procedure after failed restrictive bariatric surgery.