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Perioperative outcomes of revisional laparoscopic gastric bypass after failed adjustable gastric banding and after vertical banded gastroplasty: experience with 107 cases and subgroup analysis

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Abstract

Background

A growing number of revision procedures are to be expected in bariatric surgery after failed restrictive procedures such as failed adjustable gastric banding (AGB) or vertical banded gastroplasty (VBG). Conversion to revisional laparoscopic Roux-en-Y gastric bypass (ReLRYGBP) has been advocated as the procedure of choice.

Methods

The results of ReLRYGBP were reviewed in a retrospective chart review. A subgroup analysis compared perioperative results after VBG and after AGB. A second subgroup analysis compared perioperative results of ReLRYGBP immediately after AGB removal and after a delay as a two-step procedure.

Results

Between 2003 and 2009, ReLRYGBP was performed for 107 patients. Of these 107 operations, 21 were performed after failed VBG and 86 after failed AGB. The mean body mass index (BMI) was 42 kg/m2. The causes of failure were mainly insufficient weight loss or reflux disease-related symptoms. During a median follow-up period of 44 months, there was no mortality, and morbidity was 34 %, including late complications. Major early complications occurred in 11 % of the cases (n = 12). Conversions and major early complications occurred significantly more frequently after VBG than after AGB (p < 0.05). In 59 % of the cases (n = 50), ReLRYGBP was performed as a single-stage procedure immediately after removal of AGB and in 41 % of the cases (n = 36) as a delayed two-step procedure. The outcomes did not differ significantly (p > 0.5).

Conclusions

The perioperative outcomes of ReLRYGBP are worse after VBG than after AGB. The ReLRYGBP operation can be performed safely as a one-step procedure after AGB removal.

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Acknowledgments

We thank Dr. J. F. M. Lange for his contribution to the illustrations.

Disclosures

Dr. Apers, Dr. Wens, Dr. van Vlodrop, Dr. Michiels, Dr. Ceulemans, Dr. van Daele and Dr. Jacobs have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Digestive Surgery, Heilig Hart Ziekenhuis, Mol, Belgium

    J. A. Apers, C. Wens, V. van Vlodrop, M. Michiels, R. Ceulemans & I. Jacobs

  2. Department of Digestive Surgery, Sint Franciscus Ziekenhuis, Heusden-Zolder, Belgium

    G. van Daele

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  1. J. A. Apers
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  2. C. Wens
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  3. V. van Vlodrop
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  4. M. Michiels
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  7. I. Jacobs
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Correspondence to J. A. Apers.

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Apers, J.A., Wens, C., van Vlodrop, V. et al. Perioperative outcomes of revisional laparoscopic gastric bypass after failed adjustable gastric banding and after vertical banded gastroplasty: experience with 107 cases and subgroup analysis. Surg Endosc 27, 558–564 (2013). https://doi.org/10.1007/s00464-012-2483-1

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  • DOI: https://doi.org/10.1007/s00464-012-2483-1

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