Abstract
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.
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References
Frezza EE, Wachtel MS (2009) The economic impact of morbid obesity. Surg Endosc 23:677–679
Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH (2009) The incidence of comorbidities related to obesity and overweight: a systematic review and metaanalysis. BMC Public Health 9:88
Lanthaler M, Aigner F, Kinzl J, Sieb M, Cakar-Beck F, Nehoda H (2010) Long-term results and complications following adjustable gastric banding. Obes Surg 20:1078–1085
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
Weiss HG, Kirchmayr W, Klaus A, Bonatti H, Mühlmann G, Nehoda H, Himpens J, Aigner F (2004) Surgical revision after failure of laparoscopic adjustable gastric banding. Br J Surg 91:235–241
Gagner M, Gumbs AA (2007) Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc 21:1931–1935
Weber M, Müller 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 238:827–833
Mognol P, Chosidow D, Marmuse JP (2004) Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg 14:1349–1353
Bueter M, Thalheimer A, Wierlemann A, Fein M (2009) Reoperations after gastric banding: replacement or alternative procedures? Surg Endosc 23:334–340
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 7:33–37
Calmes JM, Giusti V, Suter M (2005) Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg 15:316–322
Lanthaler M, Mittermair R, Erne B, Weiss H, Aigner F, Nehoda H (2006) Laparoscopic gastric rebanding versus laparoscopic gastric bypass as a rescue operation for patients with pouch dilatation. Obes Surg 16:484–487
Srikanth MS, Oh KH, Fox SR (2011) Revision to malabsorptive Roux-en-Y gastric bypass (MRNYGBP) provides long-term (10 years) durable weight loss in patients with failed anatomically intact gastric restrictive operations: long-term effectiveness of a malabsorptive Roux-en-Y gastric bypass in salvaging patients with poor weight loss or complications following gastroplasty and adjustable gastric bands. Obes Surg 21:825–831
Westling A, Ohrvall M, Gustavsson S (2002) Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery. J Gastrointest Surg 6:206–211
Elnahas A, Graybiel K, Farrokhyar F, Gmora S, Anvari M, Hong D (2013) Revisional surgery after failed laparoscopic adjustable gastric banding: a systematic review. Surg Endosc 27:740–745
Weiss H, Nehoda H, Labeck B, Peer R, Aigner F (2000) Gastroscopic band removal after intragastric migration of adjustable gastric band: a new minimal invasive technique. Obes Surg 10:167–170
Chapman AE, Kiroff G, Game P, Foster B, O’Brien P, Ham J, Maddern GJ (2004) Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery 135:326–351
Cunneen SA, Phillips E, Fielding G, Banel D, Estok R, Fahrbach K, Sledge I (2008) Studies of Swedish adjustable gastric band and Lap-Band: systematic review and metaanalysis. Surg Obes Relat Dis 4:174–185
Hii MW, Lake AC, Kenfield C, Hopkins GH (2012) Laparoscopic conversion of failed gastric banding to Roux-en-Y gastric bypass: short-term follow-up and technical considerations. Obes Surg 22:1022–1028
van Wageningen B, Berends FJ, Van Ramshorst B, Janssen IF (2006) Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg 16:137–141
Robert M, Poncet G, Boulez J, Mion F, Espalieu P (2011) Laparoscopic gastric bypass for failure of adjustable gastric banding: a review of 85 cases. Obes Surg 21:1513–1519
Sanchez H, Cabrera A, Cabrera K, Zerrweck C, Mosti M, Sierra M, Dominguez G, Herrera MF (2008) Laparoscopic Roux-en-Y gastric bypass as a revision procedure after restrictive bariatric surgery. Obes Surg 18:1539–1543
Suter M (2001) Laparoscopic band repositioning for pouch dilatation/slippage after gastric banding: disappointing results. Obes Surg 11:507–512
Behrns KE, Smith CD, Kelly KA, Sarr MG (1993) Reoperative bariatric surgery: lessons learned to improve patient selection and results. Ann Surg 218:646–653
Müller MK, Attigah N, Wildi S, Hahnloser D, Hauser R, Clavien PA, Weber M (2008) High secondary failure rate of rebanding after failed gastric banding. Surg Endosc 22:448–453
Spivak H, Beltran OR, Slavchev P, Wilson EB (2007) Laparoscopic revision from LAP-BAND to gastric bypass. Surg Endosc 21:1388–1392
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 18:1381–1386
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 21:501–505
Disclosures
Alexander Perathoner, Matthias Zitt, Monika Lanthaler, Johann Pratschke, Matthias Biebl, Reinhard Mittermair have no conflicts of interest or financial ties to disclose.
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Perathoner, A., Zitt, M., Lanthaler, M. et al. Long-term follow-up evaluation of revisional gastric bypass after failed adjustable gastric banding. Surg Endosc 27, 4305–4312 (2013). https://doi.org/10.1007/s00464-013-3047-8
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DOI: https://doi.org/10.1007/s00464-013-3047-8