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A Comparison of One- and Two-Stage Laparoscopic Sleeve Gastrectomy Following Failed Laparoscopic Adjustable Gastric Banding Using the BAROS Score



Revision of a failed band can be done by laparoscopic sleeve gastrectomy (LSG). It can be performed synchronously with band removal or during two separate procedures.


Comparing single- and two-staged LSG following a failed LAGB in terms of short- and mid-term outcomes, with an emphasis on postoperative quality of life.


A retrospective cohort study comparing revisional LSG’s safety and efficacy after failed LAGB removal. Data included patients’ medical files, as telephone interviews. We compared demographics, weight loss, complications, long-term outcomes, and quality-of-life measures, including the Bariatric Analysis and Reporting Outcome System (BAROS).


Ninety-three patients were enrolled, of which 68 (73.1%) underwent a single-stage revisional LSG. Of these, 40 were males (35.1%) with a mean age of 44.9 years (± 12.9). The two-staged group were older. The reasons for band removal differed between the groups: whereas in the two-stage surgery, the common causes were slippage (29.2%) or band intolerance (25%); in the single-stage group, it was weight gain (51%). There were no differences in short- and mid-term complications, weight loss, and quality of life.


In selected cases, laparoscopic sleeve gastrectomy as a revision of failed gastric banding in one stage is as safe as a two-stage procedure in terms of short- and mid-term complications, weight loss, and quality of life. We believe that there is little benefit in performing elective surgery in two stages unless there are clinical indications. Exceptions for two-stage revision should include cases of band erosion and acute slippage with patient preference for band removal.

Graphical Abstract

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Correspondence to Zvi H. Perry.

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Key Points

• Single-stage LSG as a revision after a failed LAGB is feasible and has similar results in terms of morbidity and leak rate to a 2-staged procedure.

• This is seen in areas like short- and mid-term complications, weight loss, and quality of life, as measured by the standardized BAROS questionnaire.

• Patient’s advantages of the one-stage procedure include single admission and single surgery with good weight loss and quality of life.

• We believe that there is no benefit in performing elective surgery in two stages unless there are clinical indications such as band erosion.

Appendix: Bariatric Analysis and Reporting Outcome System (BAROS)

Appendix: Bariatric Analysis and Reporting Outcome System (BAROS)

BAROSy [11, 13] presents results of bariatric surgery in a simple, objective, and non-biased manner, and consists of five main sections (see Appendix):

  1. a.

    Weight loss—calculated as the percentage of decrease relative to excess weight over ideal weight. Maximum score can be given to an overweight drop of 75—100%.

  2. b.

    Improvement in obesity-related morbidity—hypertension, dyslipidemia, cardiac problems, diabetes, obstructive sleep apnea, menstrual disorders, osteoarthritis, and incontinence. Score is given based on decrease in the severity of the problem or its elimination.

  3. c.

    Quality of life (QOL) indices—6 sections: (A) Self-esteem, (B) physical ability, (C) social ability, (D) functioning at work, (E) sexual function, (F) attitude toward food. Each section is scored on a scale from significant aggravation to significant improvement.

  4. d.

    Complications. Early: conversion to laparotomy, infection, suture leakage, bleeding. Late: sleeve stenosis, difficulty eating and drinking (no stenosis). Score drops with level of complication.

  5. e.

    Recurrent surgery—points subtracted for each surgery.

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Perry, Z., Zioni, T., Netz, U. et al. A Comparison of One- and Two-Stage Laparoscopic Sleeve Gastrectomy Following Failed Laparoscopic Adjustable Gastric Banding Using the BAROS Score. OBES SURG 32, 1243–1250 (2022).

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  • Laparoscopic adjustable gastric band (LAGB)
  • Laparoscopic sleeve gastrectomy (LSG)
  • Outcomes
  • Postoperative complications
  • Quality of life