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Laparoscopic Conversion of Failed Gastric Banding to Roux-en-Y Gastric Bypass. Short-term Follow-up and Technical Considerations

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Abstract

Background

The most common bariatric procedure in Australia is laparoscopic adjustable gastric banding (LAGB). Although successful, there is a substantial long-term complication and failure rate. Band removal and conversion to Roux-en-Y gastric bypass (RYGB) can be an effective treatment for complicated or failed bands. There is increasing evidence supporting good weight loss and resolution of band-related complications after conversion.

Methods

A prospective database of all bariatric procedures is maintained. Patients having revision of LAGB to RYGB between December 2007 and April 2011 were included in this study. Indications for surgery, operative details, morbidity and mortality, weight loss data, and post-operative symptoms were recorded.

Results

Eighty-two patients were included. Indications for surgery were inadequate weight loss (n = 42), adverse symptoms (reflux = 8, dysphagia = 2), and band complications (band erosion = 7, band sepsis = 1, band slip = 11, esophageal dilatation = 11). Seventy-eight percent of procedures were completed in a single stage and 96.3% laparoscopically. There was no 30-day mortality. Total morbidity was 46.3% (minor complications = 32.9%, major complications = 13.4%). Median BMI was 43 kg/m2 pre-RYGB and 34 kg/m2 after 12 months. All patients with adverse band-related symptoms had resolution.

Conclusions

LAGB has a considerable complication and failure rate. Conversion of these patients to RYGB results in further weight loss and resolution of adverse symptoms. This is a challenging procedure, but can usually be performed in a single stage with acceptable morbidity and mortality. These patients should be treated in high-volume, subspecialty bariatric units.

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References

  1. O’Brien PE, Dixon JB, Brown W. Obesity is a surgical disease: overview of obesity and bariatric surgery. ANZ J Surg. 2004;74(4):200–4. Review.

    Article  PubMed  Google Scholar 

  2. Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am J Surg. 2002;184(6B):9S–16S. Review.

    Article  PubMed  Google Scholar 

  3. Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93. Clinical Trial Comparative Study Controlled Clinical Trial Research Support, Non-U.S. Gov’t.

    Article  PubMed  Google Scholar 

  4. Cameron AJ, Welborn TA, Zimmet PZ, et al. Overweight and obesity in Australia: the 1999–2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Med J Aust. 2003;178(9):427–32. Research Support, Non-U.S. Gov’t.

    PubMed  Google Scholar 

  5. Padwal R, Klarenbach S, Wiebe N, et al. Bariatric surgery: a systematic review of the clinical and economic evidence. J Gen Intern Med. 2011;26:1183–94.

    Article  PubMed  Google Scholar 

  6. Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. [Review]. 2009(2):CD003641.

  7. Brown W, Korin A, Burton P, et al. Laparoscopic adjustable gastric banding. Aust Fam Physician. 2009;38(12):972–6. Research Support, Non-U.S. Gov’t.

    PubMed  Google Scholar 

  8. Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004;135(3):326–51. Comparative Study Research Support, Non-U.S. Gov’t Review.

    Article  PubMed  Google Scholar 

  9. Tucker ON, Szomstein S, Rosenthal R. Laparoscopic management of chronic pouch fistula after a leak following staple line dehiscence after laparoscopic revision of a dilated pouch following Roux-en-Y gastric bypass. Obes Surg. 2008;18(2):228–32. Case Reports.

    Article  PubMed  Google Scholar 

  10. Tice JA, Karliner L, Walsh J, et al. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121(10):885–93. Comparative Study Research Support, Non-U.S. Gov’t Review.

    Article  PubMed  Google Scholar 

  11. Boza C, Gamboa C, Perez G, et al. Laparoscopic adjustable gastric banding (LAGB): surgical results and 5-year follow-up. Surg Endosc. 2011;25(1):292–7.

    Article  PubMed  Google Scholar 

  12. Himpens J, Cadiere GB, Bazi M, et al. Long-term outcomes of laparoscopic adjustable gastric banding. Arch Surg. 2011;146(7):802–7.

    Article  PubMed  Google Scholar 

  13. Jan JC, Hong D, Pereira N, et al. Laparoscopic adjustable gastric banding versus laparoscopic gastric bypass for morbid obesity: a single-institution comparison study of early results [comparative study research support, Non-U.S. Gov’t]. J Gastrointest Surg. 2005;9(1):30–9. discussion 40–1.

    Article  PubMed  Google Scholar 

  14. Van Nieuwenhove Y, Ceelen W, Stockman A, et al. Long-term results of a prospective study on laparoscopic adjustable gastric banding for morbid obesity. Obes Surg. 2011;21(5):582–7.

    Article  PubMed  Google Scholar 

  15. Lanthaler M, Aigner F, Kinzl J, et al. Long-term results and complications following adjustable gastric banding. Obes Surg. 2010;20(8):1078–85.

    Article  PubMed  Google Scholar 

  16. Scozzari G, Farinella E, Bonnet G, et al. Laparoscopic adjustable silicone gastric banding vs laparoscopic vertical banded gastroplasty in morbidly obese patients: long-term results of a prospective randomized controlled clinical trial. Obes Surg. 2009;19(8):1108–15. Randomized Controlled Trial.

    Article  PubMed  Google Scholar 

  17. Rogers AM. Improvement of esophageal dysmotility after conversion from gastric banding to gastric bypass. Surg Obes Relat Dis. 2010;6(6):681–3.

    Article  PubMed  Google Scholar 

  18. Stroh C, Hohmann U, Schramm H, et al. Fourteen-year long-term results after gastric banding. J Obes. 2011;2011:128451.

    PubMed  Google Scholar 

  19. Suter M, Calmes JM, Paroz A, et al. A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg. 2006;16(7):829–35.

    Article  PubMed  CAS  Google Scholar 

  20. Suter M. Laparoscopic band repositioning for pouch dilatation/slippage after gastric banding: disappointing results. Obes Surg. 2001;11(4):507–12.

    Article  PubMed  CAS  Google Scholar 

  21. Weiner R, Blanco-Engert R, Weiner S, et al. Outcome after laparoscopic adjustable gastric banding—8 years experience. Obes Surg. 2003;13(3):427–34. Comparative Study Evaluation Studies.

    Article  PubMed  CAS  Google Scholar 

  22. Westling A, Ohrvall M, Gustavsson S. Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery. J Gastrointest Surg. 2002;6(2):206–11. Comparative Study.

    Article  PubMed  Google Scholar 

  23. Muller MK, Attigah N, Wildi S, et al. High secondary failure rate of rebanding after failed gastric banding. Surg Endosc. 2008;22(2):448–53.

    Article  PubMed  CAS  Google Scholar 

  24. Moore R, Perugini R, Czerniach D, et al. Early results of conversion of laparoscopic adjustable gastric band to Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(4):439–43. Research Support, Non-U.S. Gov’t.

    Article  PubMed  Google Scholar 

  25. Mognol P, Chosidow D, Marmuse JP. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding in the super-obese: a comparative study of 290 patients. Obes Surg. 2005;15(1):76–81. comparative study.

    Article  PubMed  Google Scholar 

  26. Burton PR, Brown WA, Laurie C, et al. Pathophysiology of laparoscopic adjustable gastric bands: analysis and classification using high-resolution video manometry and a stress barium protocol. Obes Surg. 2010;20(1):19–29.

    Article  PubMed  Google Scholar 

  27. Forestieri P, Meucci L, De Luca M, et al. Two years of practice in adjustable silicone gastric banding (LAP-BAND): evaluation of variations of body mass index, percentage ideal body weight and percentage excess body weight. Obes Surg. 1998;8(1):49–52.

    Article  PubMed  CAS  Google Scholar 

  28. Kothari SN, DeMaria EJ, Sugerman HJ, et al. Lap-band failures: conversion to gastric bypass and their preliminary outcomes. Surgery. 2002;131(6):625–9.

    Article  PubMed  Google Scholar 

  29. Perathoner A, Weiss H, Santner W, et al. Is a pouch compulsory in Roux-en-Y gastric bypass after failed adjustable gastric banding? Obes Surg. 2008;18(12):1544–50.

    Article  PubMed  CAS  Google Scholar 

  30. DeMaria EJ, Sugerman HJ, Meador JG, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001;233(6):809–18. Comparative Study.

    Article  PubMed  CAS  Google Scholar 

  31. Mognol P, Chosidow D, Marmuse JP. Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg. 2004;14(10):1349–53. Comparative Study Review.

    Article  PubMed  Google Scholar 

  32. Bueter M, Thalheimer A, Wierlemann A, et al. Reoperations after gastric banding: replacement or alternative procedures? Surg Endosc. 2009;23(2):334–40.

    Article  PubMed  Google Scholar 

  33. Srikanth MS, Oh KH, Fox SR. 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. 2010;21(7):825–31.

    Article  Google Scholar 

  34. Schouten R, van Dielen FM, Greve JW. Re-operation after laparoscopic adjustable gastric banding leads to a further decrease in BMI and obesity-related co-morbidities: results in 33 patients. Obes Surg. 2006;16(7):821–8.

    Article  PubMed  CAS  Google Scholar 

  35. Ardestani A, Lautz DB, Tavakkolizadeh A. Band revision versus Roux-en-Y gastric bypass conversion as salvage operation after laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2011;7(1):33–7.

    Article  PubMed  Google Scholar 

  36. Calmes JM, Giusti V, Suter M. Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg. 2005;15(3):316–22.

    Article  PubMed  CAS  Google Scholar 

  37. Lanthaler M, Mittermair R, Erne B, et al. Laparoscopic gastric re-banding versus laparoscopic gastric bypass as a rescue operation for patients with pouch dilatation. Obes Surg. 2006;16(4):484–7. Comparative Study.

    Article  PubMed  CAS  Google Scholar 

  38. Suter M, Giusti V, Heraief E, et al. Band erosion after laparoscopic gastric banding: occurrence and results after conversion to Roux-en-Y gastric bypass. Obes Surg. 2004;14(3):381–6.

    Article  PubMed  Google Scholar 

  39. Deitel M, Gawdat K, Melissas J. Reporting weight loss 2007. Obes Surg. 2007;17(5):565–8. Editorial Review.

    Article  PubMed  Google Scholar 

  40. Spivak H, Beltran OR, Slavchev P, et al. Laparoscopic revision from LAP-BAND to gastric bypass. Surg Endosc. 2007;21(8):1388–92.

    Article  PubMed  Google Scholar 

  41. Cunneen SA. Review of meta-analytic comparisons of bariatric surgery with a focus on laparoscopic adjustable gastric banding. Surg Obes Relat Dis. 2008;4(3 Suppl):S47–55. Meta-Analysis Review.

    Article  PubMed  Google Scholar 

  42. Langer FB, Bohdjalian A, Shakeri-Manesch S, et al. Inadequate weight loss vs secondary weight regain: laparoscopic conversion from gastric banding to Roux-en-Y gastric bypass. Obes Surg. 2008;18(11):1381–6.

    Article  PubMed  CAS  Google Scholar 

  43. Keus F, de Jong JA, Gooszen HG, et al. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. [Meta-Analysis Research Support, Non-U.S. Gov’t Review]. 2006(4):CD006231.

  44. McCormack K, Scott NW, Go PM, et al. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. [Review]. 2003(1):CD001785.

  45. Van Nieuwenhove Y, Ceelen W, Van Renterghem K, et al. Conversion from band to bypass in two steps reduces the risk for anastomotic strictures. Obes Surg. 2011;21(4):501–5.

    Article  PubMed  Google Scholar 

  46. Zingg U, McQuinn A, DiValentino D, et al. Revisional vs. primary Roux-en-Y gastric bypass—a case-matched analysis: less weight loss in revisions. Obes Surg. 2010;20(12):1627–32. Comparative Study.

    Article  PubMed  Google Scholar 

  47. Weber M, Muller MK, Michel JM, et al. Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding [clinical trial comparative study controlled clinical trial]. Ann Surg. 2003;238(6):827–33. discussion 33–4.

    Article  PubMed  Google Scholar 

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Disclosures

Dr. Michael Hii has received a Johnson and Johnson Scholarship. Dr. George Hopkins has received travel support from Johnson and Johnson and Ethicon Endo Surgery. Dr. Alexis Lake and Dr. Christian Kenfield have no conflict of interest.

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Authors and Affiliations

  1. Royal Brisbane and Women’s Hospital, Cnr. Butterfield St and Bowen Bridge Rd, Herston, QLD, 4029, Australia

    M. W. Hii, C. Kenfield & G. H. Hopkins

  2. Holy Spirit Northside Private Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia

    M. W. Hii, A. C. Lake & G. H. Hopkins

  3. 6 Studley Ave, Kew, VIC, Australia, 3101

    M. W. Hii

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  1. M. W. Hii
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Correspondence to M. W. Hii.

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Hii, M.W., Lake, A.C., Kenfield, C. et al. Laparoscopic Conversion of Failed Gastric Banding to Roux-en-Y Gastric Bypass. Short-term Follow-up and Technical Considerations. OBES SURG 22, 1022–1028 (2012). https://doi.org/10.1007/s11695-012-0594-3

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