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.     

Roux-en-Y gastric bypass as a re-do procedure for failed restricive gastric surgery

Background Gastric restrictive procedures such as laparoscopic gastric banding or vertical banded gastroplasty show, at longer follow up, more and more failures and complications. This study focuses on the results of Roux-en-Y gastric bypass procedure (RYGBP) done as a re-do procedure, both after a technically failed restrictive procedure or when the restrictive procedure failed to obtain substantial weight loss. Methods We reviewed data concerning the postoperative complications and weight loss of 36 patients undergoing re-do surgery for failed restrictive procedures. Results Over a period of two years, 36 patients with a mean age of 40.9 years were converted to a RYGBP. Median time to conversion was 4.9 years, median follow up after conversion was 6.6 months. Early postoperative complications (less than 30 days postoperatively) were noted in 11 patients (30%). A greater number of early complications were noticed in group A (technical complications) compared to group B (insufficient weight loss) (39% vs. 22%). Late postoperative complications were seen in six patients (16%). In this relatively short follow up period we noticed a drop in body mass index (BMI) from a mean of 38.8kg/m² to 30.9 kg/m² with a mean excess body weight loss (EBWL) of 33.1% after the re-do procedure. Body mass index decreased from a mean preoperative value of 37.6kg/m² to 28.9 kg/m² in group A patients with an EBWL 36%, while group B patients had a change in BMI from 40.1kg/m² to 32.9 kg/m² with a mean EBWL of 30%. Conclusion Based on the literature, we can presume that restrictive surgery for morbidly obese patients will require many reoperations in the future. The standard operation of choice is RYGBP. In our study this procedure showed a higher, but not significantly early morbidity rate when the indication for re-do surgery was a technical complication of the initial procedure.     

Roux-en-Y gastric bypass,sleeve gastrectomy,or one anastomosis gastric bypass as rescue therapy after failed adjustable gastric banding: a multicenter comparative study

Background

To date, laparoscopic adjustable gastric banding remains the third most commonly performed surgical procedure for weight loss. Some patients fail to get acceptable outcomes and undergo revisional surgery at rates ranging from 7% to 60%. Roux-en-Y gastric bypass (RYGB), one anastomosis gastric bypass (OAGB), and sleeve gastrectomy (SG) are among the most common salvage options for failed laparoscopic adjustable gastric banding.

Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding

OBJECTIVE: To define whether laparoscopic rebanding or Roux-en-Y gastric bypass represents the best approach for failed laparoscopic gastric banding in patients with morbid obesity. SUMMARY BACKGROUND DATA: Countless laparoscopic gastric bandings have been implanted during the recent years worldwide. Despite excellent short-term results, long-term failures and complications have been reported in more than 20% of patients. Which rescue procedures should be used remains controversial. Therefore, we analyzed our experience with the use of laparoscopic rebanding versus laparoscopic Roux-en-Y gastric bypass after failed gastric banding. METHODS: Using a prospectively collected database, we analyzed the feasibility, safety, and effectiveness of laparoscopic rebanding versus laparoscopic conversion to Roux-en-Y gastric bypass after failed laparoscopic gastric banding.RESULTS A total of 62 consecutive patients were treated in our institution between May 1995 and December 2002 for failed primary laparoscopic gastric banding, including 30 laparoscopic rebandings and 32 laparoscopic conversions to Roux-en-Y gastric bypass. Rebandings were preferably done during the initial period of the study and Roux-en-Y gastric bypass in the last period. Both groups were comparable before the initial banding procedures. At the time of redo surgery, patients receiving a gastric bypass had more esophageal dysmotility (47% vs. 7%, P = 0.002) and higher body mass index (BMI) than those elected for rebanding procedures (BMI 42.0 vs. 38.4 kg/m2, P = 0.015). Feasibility and safety: Each procedure was performed laparoscopically. Mean operating time was 215 minutes for gastric bypass and 173 minutes for rebanding (P = 0.03). Early complications occurred in one case in the rebanding group and in 2 cases in the bypass group; all underwent a laparoscopic reexploration without the need for open surgery. There was no mortality in this series. Effectiveness: BMI in the gastric bypass group decreased from 42.0 to 31.8 kg/m2 (P = 0.02) within 1 year of surgery, while it remained unchanged in the rebanding group. CONCLUSIONS: Laparoscopic conversion to a gastric bypass as well as laparoscopic rebanding are feasible and safe. Conversion to gastric bypass offers a significant advantage in terms of further weight loss after surgery. Therefore, this procedure should be considered as the rescue therapy of choice after a failed laparoscopic gastric banding.     

两种手术方式治疗2型糖尿病机制的研究

Objective To clarify mechanism of Roux-en-Y gastric bypass (RYGB) and gastric banding on diabetes induced by STZ injection. Methods 40 rats with STZ induced diabetes were randomly allocated into Roux-en-Y gastric bypass (RYGB) group (group RYGB, n=10), gastric banding group (group GB, n=10 ), diet control group (group F, n=10), control group (group C,n= 10). The fasting blood glucose, the fasting insulin IGF-1, the fasting Plasma leptin, the fasting plasma insulin level, the weight and the food-intake, the operation time, the death rate were measured and recored before and after operation on 1st , 2nd, 3 rd ,4th, 8th and 16 th week postoperatively. Results The fasting blood glucose of the group of gastric banding(GB) descended to (12.6±3.7) mmol/L, the fasting plasma insulin rose to (58.7±9.2) mIU/L, the fasting plasma leptin descended to (14.6±3.3) pg/ml, the weight was (212.6±15.1) g.There were significant differences between before and after operation on 16 th week(P<0.01). The fasting blood glucose of the group of Roux-en-Y (RYBG) descended to 8.8±4.9 mmol/L in the sixteenth week, the fasting insulin IGF-1 rose to (148.6±7.3) ng/L, the fasting plasma insulin rose to (14.1±3.5) pg/ml, the fasting plasma leptin descended to 14.1±3.5 pg/ml, the weight was (200±15.1) g. There were significant differences between before and after operation 16 th week (P<0.01). There were significant differences of the fasting plasma insulin and the the fasting plasma leptin between group F and group C during the 3 rd to 4th week after operation (P<0.05). Compared the weight of the group F and the group C on the third week of operation, there were significant differences (P<0.05), and there were no significant differences in other time. The fasting blood glucose of the group F and the group C had no sig-nificant differences between before and after operation.(P<0.05). Conclusions The fasting blood glucose and the fasting insulin level of the group F improve more than of the group GB at the same time. The plasma insulin and the plasma leptin of the two groups all work in glucose control. The diet control and the modification of the plasma insulin and the plasma leptin all play a major role in the gastric banding mechanism, and the IGF-1 may work in the descending the blood glucose after the operation of Roux-en-Y. In the operation time and die rate, the group of F surpass the group of GB.     

两种手术方式治疗2型糖尿病机制的研究

Objective To clarify mechanism of Roux-en-Y gastric bypass (RYGB) and gastric banding on diabetes induced by STZ injection. Methods 40 rats with STZ induced diabetes were randomly allocated into Roux-en-Y gastric bypass (RYGB) group (group RYGB, n=10), gastric banding group (group GB, n=10 ), diet control group (group F, n=10), control group (group C,n= 10). The fasting blood glucose, the fasting insulin IGF-1, the fasting Plasma leptin, the fasting plasma insulin level, the weight and the food-intake, the operation time, the death rate were measured and recored before and after operation on 1st , 2nd, 3 rd ,4th, 8th and 16 th week postoperatively. Results The fasting blood glucose of the group of gastric banding(GB) descended to (12.6±3.7) mmol/L, the fasting plasma insulin rose to (58.7±9.2) mIU/L, the fasting plasma leptin descended to (14.6±3.3) pg/ml, the weight was (212.6±15.1) g.There were significant differences between before and after operation on 16 th week(P<0.01). The fasting blood glucose of the group of Roux-en-Y (RYBG) descended to 8.8±4.9 mmol/L in the sixteenth week, the fasting insulin IGF-1 rose to (148.6±7.3) ng/L, the fasting plasma insulin rose to (14.1±3.5) pg/ml, the fasting plasma leptin descended to 14.1±3.5 pg/ml, the weight was (200±15.1) g. There were significant differences between before and after operation 16 th week (P<0.01). There were significant differences of the fasting plasma insulin and the the fasting plasma leptin between group F and group C during the 3 rd to 4th week after operation (P<0.05). Compared the weight of the group F and the group C on the third week of operation, there were significant differences (P<0.05), and there were no significant differences in other time. The fasting blood glucose of the group F and the group C had no sig-nificant differences between before and after operation.(P<0.05). Conclusions The fasting blood glucose and the fasting insulin level of the group F improve more than of the group GB at the same time. The plasma insulin and the plasma leptin of the two groups all work in glucose control. The diet control and the modification of the plasma insulin and the plasma leptin all play a major role in the gastric banding mechanism, and the IGF-1 may work in the descending the blood glucose after the operation of Roux-en-Y. In the operation time and die rate, the group of F surpass the group of GB.     

Long-term follow-up evaluation of revisional gastric bypass after failed adjustable gastric banding

Background

Disappointing long-term results, frequent band failure, and high rates of band-related complications increasingly necessitate revisional surgery after adjustable gastric banding. Laparoscopic conversion to gastric bypass has been recommended as the procedure of choice. This single-center retrospective study aimed to evaluate the long-term results of revisional gastric bypass after failed adjustable gastric banding.

Methods

The study included 108 consecutive patients who underwent laparoscopic conversion of gastric banding to gastric bypass from 2002 to 2012. Indications for surgery, operative data, weight development, morbidity, and mortality were analyzed. The median follow-up period was 3.4 years (maximum, 10 years).

Results

The most common indications for band removal were band migration, insufficient weight loss, and pouch dilation. The median interval between gastric banding and gastric bypass was 6.6 years. In 52 % of the cases, band removal and gastric bypass surgery were performed simultaneously as a single-stage laparoscopic procedure. The early postoperative morbidity rate was 10.2 %. The body mass index before gastric banding (43.3 kg/m²) decreased significantly to 37.9 kg/m² before gastric bypass and to 28.8 kg/m² 5 years after gastric bypass.

Conclusions

This is the first report on the long-term outcome after conversion of failed adjustable gastric banding to gastric bypass. Findings have shown revisional gastric bypass to be a feasible bariatric procedure particularly for patients with insufficient weight loss that guarantees a constant and long-lasting weight loss.     

Large series examining laparoscopic adjustable gastric banding as a salvage solution for failed gastric bypass

Background

The Roux-en-Y gastric bypass (RYGB) has long been considered the gold standard of weight loss procedures. However, there is limited evidence on revisional options with both minimal risk and long-term weight loss results.

Operative technique for converting a failed vertical banded gastroplasty to Roux-en-Y gastric bypass

BACKGROUND: Bariatric surgeons are increasingly encountering patients with failed weight-loss operations. Conversion from vertical banded gastroplasty (VBG) to Roux-en-Y gastric bypass (RYGB) is the most common revisional operation in our practice. We reviewed our experience in converting from VBG to RYGB using a basic five-step surgical technique. STUDY DESIGN: We reviewed data on all patients undergoing revisional surgery for failed VBG, defined as patients with body mass index >/=35 kg/m(2), weight gain, poor control of comorbidities, staple-line dehiscence, or band-specific complications. The five basic steps include identification of the band, delineation of the extent of the pouch, division of the stomach, preparation of the Roux limb, and completion of the cardiojejunostomy. RESULTS: We have undertaken 28 conversions from VBG to RYGB. Median age was 51 years (range 27 to 65 years), preoperative body mass index was 40 kg/m(2) (range 20 to 58 kg/m(2)), and 25 patients (89%) were women. Indications for revision were band-related complications (13 patients), staple-line disruption (9 patients), and inadequate weight loss (6 patients). Median operative time was 185 minutes (range 105 to 465 minutes), estimated blood loss was 450 mL (range 100 to 2,500 mL), postoperative complications occurred in 6 patients (21%), and length of hospitalization was 5 days (range 3 to 69 days). Median postoperative body mass index was 32 kg/m(2) (range 20 to 41 kg/m(2)) at a followup time of 16 months (range 1 to 32 months). CONCLUSIONS: The technique described facilitates the operative approach to patients with failed VBG, providing guidelines for safe dissection and division of the gastric pouch for conversion to RYGB. Revisional bariatric operations are technically difficult and are associated with relatively higher complication rates than those reported for primary operations.     

Laparoscopic Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding: five years of follow-up

BackgroundBariatric surgery is an effective treatment for morbid obesity. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are commonly performed procedures. The aim of the present study was to evaluate and compare the long-term outcomes after LRYGB and LAGB.MethodsWe studied the data from a prospective database of all patients undergoing LRYGB or LAGB with 5 years of follow-up.ResultsFrom July 2001 to September 2003, 91 and 62 patients underwent LRYGB and LAGB, respectively. Of these patients, 73.6% of the LRYGB and 91.9% of the LAGB patients had 5 years of follow-up. Of the 91 and 62 patients, 89% and 82% were women, respectively. The mean age and body mass index was 34.5 ± 11.0 years and 39.6 ± 4.9 kg/m² for the LRYGB group and 38.4 ± 13.1 years and 35.8 ± 4.0 kg/m² for the LAGB group, respectively. The mean operative time was 150 ± 58 minutes for LYRGB and 73 ± 23 minutes for LAGB (P <.05). The conversion and reoperation rate was 8% and 4.3%, respectively, for the LRYGB group versus 0% for the LAGB group. Early postoperative complications were observed in 12 and 1 patient (P = .014) after LRYGB and LAGB, respectively. Late complications developed in 33 and 17 patients after LYRGB and LAGB, respectively (P = NS). The percentage of excess weight loss at 5 years postoperatively was 92.9% ± 25.6% and 59.1% ± 46.8% (P <.001) for LRYGB and LAGB, respectively. Surgical failure (percentage of excess weight loss <50%) at 5 years was 6% for LRYGB and 45.6% for LAGB. A late reoperation was needed in 24.1% of the LAGB patients.ConclusionA greater percentage of excess weight loss at 1 and 5 years was observed after LRYGB than LAGB. The LAGB group had a >40% rate of surgical failure and a 24.1% reoperation rate at 5 years of follow-up.     

Roux-en-Y gastric bypass as revisional procedure after gastric banding: leaving the band in place

BackgroundRoux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) are frequently used bariatric procedures. With both techniques, LAGB more than RYGB, failures occur. After years of experience with both techniques, we present a series of patients who underwent RYGB after failed LAGB. The band was kept in place. Our objective was to evaluate the safety and short-term effectiveness of RYGB after failed LAGB, without removing the band. The setting was a large teaching hospital in Heerlen, The Netherlands.MethodsWe first retrospectively considered the efficacy and complication rate of adding an adjustable band to RYGB. This was safe and effective. The patients lost a median of 7.6 kg within a median period of 21 months. The complication rate was low. Observing the positive results in this group, we began to leave the band in place when converting patients from LAGB to RYGB.ResultsA total of 12 patients underwent revision of LAGB to RYGB. There was no mortality. The complication rate and severity were low. During a median period of 16 months, the patients lost a median of 23 kg or 8 points in the body mass index. Also, additional improvement in co-morbidities was observed.ConclusionOur results suggest that performing RYGB after LAGB and leaving the band in place is feasible, safe, and effective in the short term.     

Comparison of cholecystectomy cases after Roux-en-Y gastric bypass,sleeve gastrectomy,and gastric banding

BackgroundRapid weight loss after bariatric surgery has been a factor of inducing gallstones postoperatively. Many studies have reported increased gallstone formation after laparoscopic Roux-en-Y gastric bypass (LRYGB). However, not many studies have compared symptomatic gallstone frequencies between LRYGB, laparoscopic sleeve gastrectomy (LSG), and laparoscopic adjustable gastric banding (LAGB). The aim of our study is to evaluate symptomatic cholelithiasis cases requiring cholecystectomy after each bariatric procedure.MethodsBetween January 2009 and August 2011, a total of 937 patients underwent bariatric surgery at our institution. Of these patients, 598 had primary LRYGB, 197 had LSG, and 142 had LAGB. We excluded patients with previous cholecystectomy or concomitant cholecystectomy at the time of bariatric procedure. A retrospective review of a prospectively collected database was performed for all patients.ResultsOf 367 LRYGB patients, 5.7% (n = 21) had symptomatic gallstones. Of 115 LSG patients, 6.1% (n = 7) required cholecystectomy, and of 104 LAGB patients, .0% (n = 0) developed symptomatic gallstones. The differences in the occurrences of symptomatic gallstones between LRYGB and LSG were not statistically significant (P>.88). However, statistical significance was present between LRYGB and LAGB (P<.02), as well as between LSG and LAGB (P<.02). Mean percentage of excess weight loss (%EWL) at 24 months was 85.7%, 58.8%, and 38.3% in LRYGB, LSG, and LAGB patients, respectively. There was no complication related to the cholecystectomy procedure.ConclusionsFrequency of symptomatic gallstones after LRYGB and LSG was not significantly different and after LAGB was significantly lower. Slow and less amount of weight loss would have contributed to the low rate of symptomatic gallstone formation in the LAGB patients. (Surg Obes Relat Dis 2013;0:000–00.) © 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved.     

Long-term results for gastric banding as salvage procedure for patients with weight loss failure after Roux-en-Y gastric bypass

Background

Studies reporting revisionary options for weight loss failure after Roux-en-Y gastric bypass (RYGB) have been underpowered and lacking long-term data. We have previously shown that short-term (12 mo) and midterm (24 mo) weight loss is achievable with laparoscopic adjustable gastric banding (LAGB) for failed RYGB. The present study represents the largest published series with longest postoperative follow-up of patients receiving salvage LAGB after RYGB failure.