Bilio pancreatic diversion following failure of laparoscopic adjustable gastric banding.
BACKGROUND
This study examines the failure rate with laparoscopic adjustable gastric banding (LABG) and results of band removal with synchronous biliopancreatic diversion without (BPD) or with duodenal switch (BPDDS).


METHODS
Failure of LAGB was defined as removal of the band due to insufficient weight loss or a complication.


RESULTS
The band was removed in 85 of 1,439 patients (5.9%), most commonly for persistent dysphagia and recurrent slippage. The removal rate and slippage rate decreased from 10.8 and 14.2% to 2.8 and 1.3%, respectively, following introduction of the pars flaccida technique. Fifteen of 27 patients with previous open vertical banded gastroplasty (VBG) required removal of the band. Mean percentage excess weight loss 12 months following open BPD, laparoscopic BPD, open BPDDS, and laparoscopic BPDDS was 44, 37, 35, and 28%, respectively.


CONCLUSIONS
LAGB fails in 6% of patients and removal of the band with synchronous BPD or BPDDS can be performed laparoscopically. Patients with failed primary VBG have a high failure rate with LAGB.
Dolan
K
K
Department of Surgery, Royal Brisbane Hospital, Queensland 4029, Australia.
Fielding
G
G
D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects; D015992:Body Mass Index; D003082:Colectomy; D003248:Constipation / Q000209:etiology / Q000601:surgery; D003680:Deglutition Disorders / Q000209:etiology; D020878:Device Removal; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008531:Megacolon / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology; D017211:Treatment Failure; D016896:Treatment Outcome