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Surgical Endoscopy

, Volume 21, Issue 8, pp 1388–1392 | Cite as

Laparoscopic revision from LAP-BAND® to gastric bypass

  • Hadar Spivak
  • Oscar R. Beltran
  • Plamen Slavchev
  • Erik B. Wilson
SAGES 2006 Oral/Original Article

Abstract

Background

While the majority of patients achieve good outcomes with the LAP-BAND®, there is a subset of patients who experience complications or fail to lose sufficient weight after the banding procedure. This study examines the feasibility and outcome of performing laparoscopic Roux-en-Y gastric bypass (RYGBP) as a single-step revision surgery after a failed LAP-BAND procedure.

Methods

In the past five years we have performed more than 1400 LAP-BAND procedures. We laparoscopically converted 33 (30 females) of these patients (mean age = 43.8 years) from LAP-BAND to RYGBP because of inadequate weight loss and/or complications. Key steps in the revision procedures were (1) identification and release of the band capsule; (2) careful dissection of the gastrogastric sutures; (3) creation of a small gastric pouch; and (4) Roux-en-Y anterior colic anterior gastric pouch-jejunum anastomosis. Revisions took place at a mean 28.2 months (range = 11–46; SD = 11.3) after the original gastric banding. Change in body mass index (BMI) between pre- and postrevision was evaluated with paired t tests.

Results

Among the 33 patients who would undergo revision surgery, the mean BMI before the LAP-BAND procedure was 45.7 kg/m2 (range = 39.9–53.0; SD = 3.4) and the mean weight was 126 kg (range = 99–155; SD = 17). The lowest BMI achieved by this group with the LAP-BAND before revision was 39.7 kg/m2 (range = 30–49.2; SD = 4.9); however, the mean BMI at the time of revision was 42.8 kg/m2 (range = 33.1–50; SD = 4.8). The mean revision operative time was 105 min (range = 85–175), and the mean hospital stay was 2.8 days (range = 1–10). Complications included one patient who underwent open reoperation and splenectomy for a bleeding spleen and one patient who required repair of an internal hernia. After conversion to RYGBP, mean BMI decreased to 33.9 kg/m2 at 6 months (p < 0.001) and 30.7 kg/m2 (range = 22–39.6; SD = 5.3) at 12 months or more of followup (average = 15.7 months; p < 0.0001).

Conclusions

Laparoscopic conversion from LAP-BAND to RYGBP is safe and can be an alternative for patients who failed the LAP-BAND procedure. However, revision surgery is technically challenging and should be performed only by surgeons who have completed the learning curve for laparoscopic RYGBP.

Keywords

Bariatric Laparoscopic Gastric bypass Revision Conversion LAP-BAND 

References

  1. 1.
    Allen JW, Coleman MG, Fielding GA (2001) Lessons learned from laparoscopic gastric banding for morbid obesity. Am J Surg 182: 10–14PubMedCrossRefGoogle Scholar
  2. 2.
    Angrisani L, Furbetta F, Doldi SB, et al. (2003) Lap Band adjustable gastric banding system: the Italian experience with 1863 patients operated on 6 years. Surg Endosc 17: 409–412PubMedCrossRefGoogle Scholar
  3. 3.
    Balsiger BM, Kennedy FP, Abu-Lebdeh HS, et al. (2000) Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity. Mayo Clin Proc 75: 673–680PubMedCrossRefGoogle Scholar
  4. 4.
    Behrns KE, Smith CD, Kelly KA, Saarr MG (1993) Reoperative bariatric surgery. Lessons learned to improve patient selection and results. Ann Surg 218: 646–653PubMedCrossRefGoogle Scholar
  5. 5.
    Belachew M, Belva PH, Desaive C (2002) Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg 12: 564–568PubMedCrossRefGoogle Scholar
  6. 6.
    Calmes JM, Giusti V, Suter M (2005) Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg 15(3): 316–322PubMedCrossRefGoogle Scholar
  7. 7.
    Carrasquilla C, English WJ, Esposito P, Gianos J (2004) Total stapled, total intra-abdominal (TSTI) laparoscopic Roux-en-Y gastric bypass: one leak in 1000 cases. Obes Surg 14: 613–617PubMedCrossRefGoogle Scholar
  8. 8.
    Cordera F, Mai JL, Thompson GB, Sarr MG (2004) Unsatisfactory weight loss after vertical banded gastroplasty: is conversion to Roux-en-Y gastric bypass successful? Surgery 136: 731–737PubMedCrossRefGoogle Scholar
  9. 9.
    Favretti F, Cadiere GB, Segato G, Himpens J, De Luca M, Busetto L, De Marchi F, Foletto M, Caniato D, Lise M, Enzi G (2002) Laparoscopic banding: selection and technique in 830 patients. Obes Surg 12: 385–390PubMedCrossRefGoogle Scholar
  10. 10.
    Gagner M, Gentileschi P, de Csepel J, Kini S, Patterson E, Inabnet WB, Herron D, Pomp A (2002) Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg 12: 254–260PubMedCrossRefGoogle Scholar
  11. 11.
    Jones KB Jr (2001) Revisional bariatric surgery-safe and effective. Obes Surg 11: 183–189PubMedCrossRefGoogle Scholar
  12. 12.
    Kothari SN, DeMaria EJ, Sugerman HJ, Kellum JM, Meador J, Wolfe L (2002) Lap-band failures: conversion to gastric bypass and their preliminary outcomes. Surgery 131: 625–629PubMedCrossRefGoogle Scholar
  13. 13.
    Martin MJ, Mullenix PS, Steele SR, See CS, Cuadrado DG, Carter PL (2004) A case-match analysis of failed prior bariatric procedures converted to resectional gastric bypass. Am J Surg 187: 666–670PubMedCrossRefGoogle Scholar
  14. 14.
    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: 1349–1353PubMedCrossRefGoogle Scholar
  15. 15.
    Murr MM, Gallagher SF (2003) Technical considerations for transabdominal loading of the circular stapler in laparoscopic Roux-en-Y gastric bypass. Am J Surg 185: 585–588PubMedCrossRefGoogle Scholar
  16. 16.
    Ren C, Weiner M, Allen J (2004) Favorable early results of gastric banding for morbid obesity. Surg Endosc 18: 543–546PubMedCrossRefGoogle Scholar
  17. 17.
    Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232: 515–529PubMedCrossRefGoogle Scholar
  18. 18.
    Spivak H, Hewitt MF, Onn A, Half EE (2005) Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedure. Am J Surg 189: 27–32PubMedCrossRefGoogle Scholar
  19. 19.
    Sugerman HJ, Kellum JM Jr, DeMaria EJ, Reines HD (1996) Conversion of failed or complicated vertical banded gastroplasty to gastric bypass in morbid obesity. Am J Surg 171: 263–269PubMedCrossRefGoogle Scholar
  20. 20.
    van Gemert WG, van Wersch MM, Greve JW, Soeters PB (1998) Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg 8: 21–28PubMedCrossRefGoogle Scholar
  21. 21.
    Vertruyen M (2002) Experience with Lap-Band System up to 7 years. Obes Surg 12: 569–572PubMedCrossRefGoogle Scholar
  22. 22.
    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: 827–833PubMedCrossRefGoogle Scholar
  23. 23.
    Wittgrove AC, Clark GW (2000) Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3-60 month follow-up. Obes Surg 10: 233–239PubMedCrossRefGoogle Scholar
  24. 24.
    Yale CE (1989) Conversion surgery for morbid obesity: complications and long-term weight control. Surgery 106: 474–480PubMedGoogle Scholar
  25. 25.
    Zinzindohoue F, Chevallier JM, Douard R, Elian N, Ferraz JM, Blanche JP, Berta JL, Altman JJ, Safran D, Cugenac PH (2003) Laparoscopic gastric banding: a minimally invasive surgical treatment for morbid obesity: prospective study of 500 consecutive patients. Ann Surg 237: 1–9PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Hadar Spivak
    • 1
  • Oscar R. Beltran
    • 1
  • Plamen Slavchev
    • 1
  • Erik B. Wilson
    • 1
  1. 1.Department of SurgeryPark-Plaza HospitalHoustonUSA

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