title: Hand-assisted laparoscopic revision of previous restrictive operations to vertical banded gastroplasty.
abstract: BACKGROUND
  Revision of failed gastric restrictive procedures to proximal Roux-en-Y gastric bypass (RYGBP) is the standard for many bariatric surgeons. Where the patient is not a suitable candidate or simply refuses gastric bypass, an alternative is herewith proposed.
  
  
  METHODS
  3 patients had undergone a gastric banding as the original operation and 1 patient had had a vertical banded gastroplasty (VBG). 1 patient presented with insufficient weight loss, 1 with regain of weight and 2 with complaints of food intolerance and vomiting. The gastric bands were removed by hand-assisted laparoscopy (HALS), with conversion to a VBG. In the patient with stomal stenosis after a VBG, HALS interposition of PTFE was performed to enlarge the collar.
  
  
  RESULTS
  In 2 patients, further weight reduction was achieved. In the other 2 patients, relief of symptoms was achieved. There were no complications during or after the revisional surgery.
  
  
  CONCLUSIONS
  HALS conversion of a gastric banding to a VBG, or PTFE interposition in the case of stomal stenosis after a VBG, can be a valuable alternative for patients unsuitable for or refusing proximal RYGBP.
authors.affiliation: Multidisciplinary Team for the Treatment of Obesity and Obesity-Related Problems, AZ, Volkskliniek, Gent, Belgium. peter.vandewalle@skynet.be
authors.forename: Peter
authors.initials: P
authors.lastname: Van De Walle
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006225:Hand; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation / Q000379:methods; D017211:Treatment Failure