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Redo Laparoscopic Gastric Bypass: One-Step or Two-Step Procedure?

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Abstract

Background

The adjustable gastric band (AGB) is a bariatric procedure that used to be widely performed. However, AGB failure—signifying band-related complications or unsatisfactory weight loss, resulting in revision surgery (redo operations)—frequently occurs. Often this entails a conversion to a laparoscopic Roux-en-Y gastric bypass (LRYGB). This can be performed as a one-step or two-step (separate band removal) procedure.

Methods

Data were collected from patients operated from 2012 to 2014 in a single bariatric centre. We compared 107 redo LRYGB after AGB failure with 1020 primary LRYGB. An analysis was performed of the one-step vs. two-step redo procedures. All redo procedures were performed by experienced bariatric surgeons.

Results

No difference in major complication rate was seen (2.8 vs. 2.3 %, p = 0.73) between redo and primary LRYGB, and overall complication severity for redos was low (mainly Clavien–Dindo 1 or 2). Weight loss results were comparable for primary and redo procedures. The one-step and two-step redos were comparable regarding complication rates and readmissions. The operating time for the one-step redo LRYGB was 136 vs. 107.5 min for the two-step (median, p < 0.001), excluding the operating time of separate AGB removal (mean 61 min, range 36–110).

Conclusions

Removal of a failed AGB and LRYGB in a one-step procedure is safe when performed by experienced bariatric surgeons. However, when erosion or perforation of the AGB occurs, we advise caution and would perform the redo LRYGB as a two-step procedure. Equal weights can be achieved at 1 year post redo LRYGB as after primary LRYGB procedures.

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Acknowledgments

We would like to thank Dr. Olga Husson for her contributions to the statistical analysis of our data.

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Authors and Affiliations

  1. Department of Surgery, Elisabeth-TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD, Tilburg, The Netherlands

    Caroline M. J. Theunissen, Nele Guelinckx, John K. Maring & Barbara S. Langenhoff

Authors
  1. Caroline M. J. Theunissen
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  2. Nele Guelinckx
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  3. John K. Maring
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  4. Barbara S. Langenhoff
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Corresponding author

Correspondence to Caroline M. J. Theunissen.

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Ethical Approval

For this type of retrospective study no formal consent was required. All data were gathered and analysed in accordance with the privacy and ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Permission for this study was granted by the hospital’s research committee.

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The authors declare that they have no conflict of interest.

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Theunissen, C.M.J., Guelinckx, N., Maring, J.K. et al. Redo Laparoscopic Gastric Bypass: One-Step or Two-Step Procedure?. OBES SURG 26, 2675–2682 (2016). https://doi.org/10.1007/s11695-016-2193-1

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  • DOI: https://doi.org/10.1007/s11695-016-2193-1

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