Obesity Surgery

, Volume 28, Issue 2, pp 520–525 | Cite as

Outcomes of Two-Step Revisional Bariatric Surgery: Reasons for the Gastric Banding Explantation Matter

  • Savio George Barreto
  • Jacob Chisholm
  • Ann Schloithe
  • Jane Collins
  • Lilian Kow
Original Contributions



The purpose of this study is to determine whether the reason for gastric band explantation would influence percentage excess weight loss (%EWL) following revisional Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).

Materials & Methods

This is a retrospective cohort study, whose data are maintained in a prospective surgical database. The study period was from January 2012 to March 2017. Revisional surgeries were performed in a two-step manner, namely, first surgery LAGB explantation and second surgery (RYGB or SG). Two-way between-groups analysis of variance was used to examine effects of reason for band explantation (failed versus complication) and type of revisional surgery (RYGB versus SG) on %EWL at 10 months, 1 and 2 years.


Cohort included 171 patients—146 women (85.4%) and 25 men, median age 51 years (range 22–76). Band-related complications accounted for 55% of explantations. Overall, 95 patients (56%) underwent a revisional RYGB, and 76 patients underwent a revisional SG. There was no difference in age or gender in terms of reason for band explantation or choice of revisional surgery. There was no difference in morbidity between the two groups (SG 2.6% versus RYGB 4.2%; p = .464). Patients undergoing revisional RYGB for failed weight loss had a significantly lower %EWL at 2 years compared to patients undergoing an SG for failed weight loss (p = .014) or an RYGB for band-related complications (p = .021).


Patients undergoing revisional RYGB following band explantation for failed weight loss have a significantly lower %EWL at 2 years compared to patients undergoing an SG for failed weight loss or an RYGB for band-related complications.


Adjustable gastric banding Band erosion Conversion Revisional surgery Slippage Weight regain 


Compliance with Ethical Standards

Conflict of Interest

Savio Barreto, Jacob Chisholm, Ann Schloithe, Jane Collins and Lilian Kow have no conflict of interest to declare. Signed statements to this effect have been uploaded along with the manuscript

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Human and Animal Rights Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


SGB is currently the OSSANZ fellow supported by an educational grant from Ethicon.


  1. 1.
    O'Brien PE, MacDonald L, Anderson M, et al. Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg. 2013;257(1):87–94.CrossRefPubMedGoogle Scholar
  2. 2.
    Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;8:CD003641.Google Scholar
  3. 3.
    Belachew M, Legrand M, Vincenti VV, et al. Laparoscopic placement of adjustable silicone gastric band in the treatment of morbid obesity: how to do it. Obes Surg. 1995;5(1):66–70.CrossRefPubMedGoogle Scholar
  4. 4.
    Anwar M, Collins J, Kow L, et al. Long-term efficacy of a low-pressure adjustable gastric band in the treatment of morbid obesity. Ann Surg. 2008;247(5):771–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Toouli J, Kow L, Ramos AC, et al. International multicenter study of safety and effectiveness of Swedish adjustable gastric band in 1-, 3-, and 5-year follow-up cohorts. Surg Obes Relat Dis. 2009;5(5):598–609.CrossRefPubMedGoogle Scholar
  6. 6.
    McBride CL, Kothari V. Evolution of laparoscopic adjustable gastric banding. Surg Clin North Am. 2011;91(6):1239–47. viii-ixCrossRefPubMedGoogle Scholar
  7. 7.
    Chisholm J, Kitan N, Toouli J, et al. Gastric band erosion in 63 cases: endoscopic removal and rebanding evaluated. Obes Surg. 2011;21(11):1676–81.CrossRefPubMedGoogle Scholar
  8. 8.
    Ibrahim AM, Thumma JR, Dimick JB. Reoperation and Medicare expenditures after laparoscopic gastric band surgery. JAMA Surg. 2017.Google Scholar
  9. 9.
    Altieri MS, Yang J, Telem DA, et al. Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York. Surg Endosc. 2016;30(5):1725–32.CrossRefPubMedGoogle Scholar
  10. 10.
    Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery worldwide 2013. Obes Surg. 2015;25(10):1822–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Aarts EO, Dogan K, Koehestanie P, et al. What happens after gastric band removal without additional bariatric surgery? Surg Obes Relat Dis. 2014;10(6):1092–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Carandina S, Maldonado PS, Tabbara M, et al. Two-step conversion surgery after failed laparoscopic adjustable gastric banding. Comparison between laparoscopic Roux-en-Y gastric bypass and laparoscopic gastric sleeve. Surg Obes Relat Dis. 2014;10(6):1085–91.CrossRefPubMedGoogle Scholar
  13. 13.
    Carandina S, Genser L, Bossi M, Polliand C, Tabbara M, Barrat C. Laparoscopic sleeve gastrectomy after failed gastric banding: is it really effective? Six years of follow-up. Surg Obes Relat Dis. 2017;13(7):1165–1173.Google Scholar
  14. 14.
    Marin-Perez P, Betancourt A, Lamota M, et al. Outcomes after laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy or Roux-en-Y gastric bypass. Br J Surg. 2014;101(3):254–60.CrossRefPubMedGoogle Scholar
  15. 15.
    Moon RC, Teixeira AF, Jawad MA. Conversion of failed laparoscopic adjustable gastric banding: sleeve gastrectomy or Roux-en-Y gastric bypass? Surg Obes Relat Dis. 2013;9(6):901–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Sharples AJ, Charalampakis V, Daskalakis M, Tahrani AA, Singhal R. Systematic review and meta-analysis of outcomes after revisional bariatric surgery following a failed adjustable gastric band. Obes Surg. 2017.Google Scholar
  17. 17.
    Ramly E, Alami R, Tamim H, et al. Concomitant removal of gastric band and sleeve gastrectomy: analysis of outcomes and complications from the ACS-NSQIP database. Surg Obes Relat Dis. 2016;12:984–90.CrossRefPubMedGoogle Scholar
  18. 18.
    Schneck A, Lazzati A, Audureau E, et al. One or two steps for laparoscopic conversion of failed adjustable gastric banding to sleeve gastrectomy: a nationwide French study on 3357 morbidly obese patients. Surg Obes Relat Dis. 2016;12:840–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Kirshtein B, Kirshtein A, Perry Z, et al. Laparoscopic adjustable gastric band removal and outcome of subsequent revisional bariatric procedures: a retrospective review of 214 consecutive patients. Int J Surg. 2016;27:133–7.CrossRefPubMedGoogle Scholar
  20. 20.
    Zundel N, Hernandez JD. Revisional surgery after restrictive procedures for morbid obesity. Surg Laparosc Endosc Percutan Tech. 2010;20(5):338–43.CrossRefPubMedGoogle Scholar
  21. 21.
    Park JY, Song D, Kim YJ. Causes and outcomes of revisional bariatric surgery: initial experience at a single center. Ann Surg Treat Res. 2014;86(6):295–301.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Kassir R, Lointier P, Tiffet O, et al. Revision bariatric surgery: what technical choices should be taken depending on the first intervention? Int J Surg. 2017;44:7–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310(22):2416–25.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Karmali S, Brar B, Shi X, et al. Weight recidivism post-bariatric surgery: a systematic review. Obes Surg. 2013;23(11):1922–33.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Savio George Barreto
    • 1
    • 2
  • Jacob Chisholm
    • 1
    • 3
  • Ann Schloithe
    • 2
  • Jane Collins
    • 3
  • Lilian Kow
    • 1
    • 2
    • 3
  1. 1.Hepatobiliary and Oesophagogastric Unit, Division of Surgery and Perioperative MedicineFlinders Medical CentreAdelaideAustralia
  2. 2.School of Medicine, Faculty of Medicine, Nursing and Health SciencesFlinders UniversityAdelaideAustralia
  3. 3.Adelaide Bariatric CentreFlinders Private HospitalAdelaideAustralia

Personalised recommendations