Safety and feasibility of revisional laparoscopic surgery for morbid obesity: conversion of open silastic vertical banded gastroplasty to laparoscopic adjustable gastric banding.
BACKGROUND
Since the 1980s, bypass operations have been largely replaced by gastric restrictive operations. One of the most commonly performed operations for gastric restriction is vertical banded gastroplasty (VBG). However, the results are often disappointing. Adjustable gastric banding (AGB) is a viable alternative to VBG, and the ability to perform this surgery laparoscopically makes it an attractive option for patients in need of revisional surgery. It allows for refashioning of the gastric pouch in patients with a dilation of the pouch or disruption of the staple line.


METHODS
A total of 48 patients were referred to our center due to post-VBG weight gain. All patients underwent preoperative evaluation to determine the cause for failure of the operation. All patients found suitable for revisional surgery underwent laparoscopic placement of an adjustable band.


RESULTS
All but one of the operations were completed laparoscopically; one patient required conversion to open surgery prior to band placement via laparoscopy. This patient needed a blood transfusion. Postoperative band erosion occurred in one patient; laparoscopy surgery was used successfully for removal of the band and suturing of the stomach.


CONCLUSIONS
Our short-term results indicate that revisional operation for morbid obesity using laparoscopic AGB is a safe procedure when performed cautiously. It enables early patient mobilization and discharge with good functional results and fewer perioperative complications.
Gavert
N
N
Department of General Surgery B, Tel Aviv Sourasky Medical Center, 6 Weizmann Sreet, Tel Aviv 64239, Israel.
Szold
A
A
Abu-Abeid
S
S
D000328:Adult; D015992:Body Mass Index; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D015391:Gastroplasty / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D015430:Weight Gain