Abstract
Background
Laparoscopic adjustable gastric banding (LAGB) has emerged as one of the most commonly performed bariatric procedures worldwide. Unfortunately, revisional surgery is required in 20–30 % of cases. Several revisional strategies have been proposed, but there is no consensus regarding the best surgical option. This systematic review was designed to determine which revisional surgery (laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, or laparoscopic biliopancreatic diversion with duodenal switch) is best suited to enhance weight loss following failed LAGB due to complications or inadequate weight loss.
Methods
EMBASE, MEDLINE, PsycINFO, and Cochrane Clinical Trials were searched using the most comprehensive timeline for each database. A total of 24 relevant articles were identified. Two investigators independently extracted data, and differences were resolved by consensus. The weighted means were calculated for weight loss measurements.
Results
A total of 106, 514, and 71 patients underwent conversion from LAGB to laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic biliopancreatic diversion and duodenal switch (BPDDS), respectively. Before revisional surgery, the weighted mean body mass index (BMI) was 38.8 (6.9), 43.3 (8.1), and 41.3 (7.2) kg/m2 for the LSG, LRYGB, and BPDDS groups, respectively. The majority of data was reported at 12–24 months follow-up. The mean BMI within this interval was 28 (10.5), 32.2 (6.4), and 33 (5.7) kg/m2 for the LSG, LRYGB, and BPDDS groups, respectively. In addition, the mean excess weight loss (EWL) was 22 % (2.8), 57.8 % (11.7), 47.1 % (14) for the LSG, LRYGB, and BPDDS groups, respectively. The EWL reached 78.4 % (35) in the BPPDS group after 2-year follow-up.
Conclusions
Failed LAGB is best managed with conversion to another bariatric procedure. Stable weight loss occurs with salvage LRYGB. Although results for revisional BPPDS appear promising, additional research, with higher methodological quality, is needed.
Similar content being viewed by others
References
Cunneen SA, Phillips E, Fielding G (2008) Studies of Swedish adjustable gastric band and Lap-Band: systematic review and meta-analysis. Surg Obes Relat Dis 4:174–185
Gagner M, Gentileschi P, De Csepel J, Kini S, Patterson E, Inabnet WB, Pomp A (2002) Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg 12(2):254–260
Mittermair RP, Obermüller S, Perathoner A, Sieb M, Aigner F, Margreiter R (2009) Results and complications after Swedish adjustable gastric banding: 10 years’ experience. Obes Surg 19:1636–1641
Suter M, Calmes JM, Paroz A, Giusti V (2006) A 10-year experience with laparoscopic gastric banding for morbid obesity: High long-term complication and failure rates. Obes Surg 16(7):829–835
Zundel N, Hernandez JD (2010) Revisional surgery after restrictive procedures for morbid obesity. Surg Laparosc Endosc Percutan 20(5):338–343
Acholonu E, McBean E, Court I, Bellorin O, Szomstein S, Rosenthal RJ (2009) Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity. Obes Surg 19(12):1612–1616
Reinhold RB (1982) Critical analysis of long term weight loss following gastric bypass. Surg Gynecol Obstet 155:385–394
Van Wageningen B, Berends FJ, Van Ramshorst B, Janssen IFM (2006) Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg 16(2):137–141
Gagner M, Gumbs AA (2007) Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc 21(11):1931–1935
Awruch D, Yez R, Crovari F, Raddatz A, Pimentel F, Boza C, Escalona A (2009) Revisional surgery after failed laparoscopic adjustable gastric banding. Conversion to Roux-en-Y gastric bypass versus sleeve gastrectomy. International Federation for the Surgery of Obesity and Metabolic Disorders. XIV World Congress, Paris, France, August 26–29, 2009. Obes Surg 19(8):973–974
Ardestani A, Lautz DB, Tavakkolizadeh A (2011) Band revision versus Roux-en-Y gastric bypass conversion as salvage operation after laparoscopic adjustable gastric banding. Surg Obes Relat Dis 7(1):33–37
te Riele WW, Sze YK, Wiezer MJ, van Ramshorst B (2008) Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis 4(6):735–739
Espalieu P, Robert M (2010) Laparoscopic gastric bypass for failure of adjustable gastric banding: a review of 78 cases. 15th World Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders, IFSO 2010, Long Beach, CA, United States, September 3–7, 2010. Obes Surg 20(8):1006
Topart P, Becouarn G, Ritz P (2009) One-year weight loss after primary or revisional Roux-en-Y gastric bypass for failed adjustable gastric banding. Surg Obes Relat Dis 5(4):459–462
Fronza JS, Prystowsky JB, Hungness ES, Nagle AP (2010) Revisional bariatric surgery at a single institution. Am J Surg 200(5):651–654
Muller MK, Attigah N, Wildi S, Hahnloser D, Hauser R, Clavien P, Weber M (2008) High secondary failure rate of rebanding after failed gastric banding. Surg Endosc 22(2):448–453
Weber A, Vega F, Garteiz D, Carb R, Altamirano C (2010) Laparoscopic sleeve gastrectomy (LSG): a useful alternative to failed gastric banding (AGB). 15th World Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders, IFSO 2010 Long Beach, CA United States. September 3–7, 2010. Obes Surg 20(8):1076
Spivak H, Beltran OR, Slavchev P, Wilson EB (2007) Laparoscopic revision from LAP-BAND to gastric bypass. Surg Endosc 21(8):1388–1392
Mognol P, Chosidow D, Marmuse J (2004) Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg 14(10):1349–1353
Langer FB, Bohdjalian A, Shakeri-Manesch S, Felberbauer FX, Ludvik B, Zacherl J, Prager G (2008) Inadequate weight loss vs. secondary weight regain: laparoscopic conversion from gastric banding to Roux-en-Y gastric bypass. Obes Surg 18(11):1381–1386
Van Nieuwenhove Y, Ceelen W, Van Renterghem K, Van De Putte D, Henckens T, Pattyn P (2011) Conversion from band to bypass in two steps reduces the risk for anastomotic strictures. Obes Surg 21(4):501–505
Bernante P, Foletto M, Busetto L, Pomerri F, Pesenti FF, Pelizzo MR, Nitti D (2006) Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg 16(10):1327–1330
Frezza EE, Jaramillo-de la Torre EJ, Calleja Enriquez C, Gee L, Wachtel MS, Lopez Corvala JA (2009) Laparoscopic sleeve gastrectomy after gastric banding removal: a feasibility study. Surg Innov 16(1):68–72
Dapri G, Cadiere GB, Himpens J (2009) Feasibility and technique of laparoscopic conversion of adjustable gastric banding to sleeve gastrectomy. Surg Obes Relat Dis 5(1):72–76
Arapis K, Fournier P, Chosidow D, Ribeiro-Parmenti L, Kousouri M, Marmuse JP (2010) 4-Year results of laparoscopic sleeve gastrectomy in 26 patients after failed adjustable gastric banding. 15th World Congress of the International Federation for the Surgery of Obesity and Metabolic Disorders, IFSO 2010, Long Beach, CA, United States. September 3–7, 2010. Obes Surg 20(8):1015
Berry M, Villagran R, Lamoza P, Urrutia L, Cooman H (2009) Gastric banding (LAGB) removal and laparoscopic sleeve gastrectomy (LSG) in one surgical time. International Federation for the Surgery of Obesity and Metabolic Disorders. XIV World Congress, Paris, France, August 26–29, 2009. Obes Surg 19(8):975
Dapri G, Cadiere GB, Himpens J (2009) Laparoscopic conversion of adjustable gastric banding and vertical banded gastroplasty to duodenal switch. Surg Obes Relat Dis 5(6):678–683
Dolan K, Fielding G (2004) Bilio pancreatic diversion following failure of laparoscopic adjustable gastric banding. Surg Endosc 18:60–63
Topart P, Becouarn G, Ritz P (2007) Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. Surg Obes Relat Dis 3(5):521–525
Weber M, Muller MK, Michel JM, Belal R, Horber F, Hauser R, Clavien PA (2003) Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg 238(6):827–833
Disclosures
Drs. A. Elnahas, K. Graybiel, M. Anvari, S. Gmora, and D. Hong have no conflict of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Elnahas, A., Graybiel, K., Farrokhyar, F. et al. Revisional surgery after failed laparoscopic adjustable gastric banding: a systematic review. Surg Endosc 27, 740–745 (2013). https://doi.org/10.1007/s00464-012-2510-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-012-2510-2