title: Management of failed adjustable gastric banding.
abstract: BACKGROUND
  About 100,000 adjustable gastric band placements have been performed worldwide, but more than 10% of patients have needed reoperation for insufficient weight loss or device-related complications. This study investigates the complications following gastric banding, and the outcome using a structured management strategy.
  
  
  METHODS
  In the period April 1996 to January 2002, 824 severely obese patients (body mass index 43 +/- 1 kg/m 2 [mean +/- standard error under the mean], age 43 +/- 1 years; 77% women) underwent gastric banding in a single institution and were followed prospectively. Complications, insufficient weight loss, and subsequent management were analyzed.
  
  
  RESULTS
  By the fifth treatment year, excess weight loss (EWL) was 54.8 +/- 1.7%; 72.8% of patients lost weight continuously or attained EWL of at least 50%. Insufficient weight loss occurred in 143 patients, and band-related complications occurred in 131 patients, with a mean annual rate of 5.0%. Major reoperation was necessary in 121 patients, and the annual reoperation rate was 4.7%. Following major reoperation, band- and bypass-related complication rates ranged from 6.3% to 11.7% per year. Three deaths occurred, 1 after reoperation and 2 due to preexisting cardiovascular disease.
  
  
  CONCLUSIONS
  Applying a structured reoperation algorithm, 5% annual failure after banding was corrected in most patients, and 72.8% of patients attained sufficient weight loss. Reoperation-related mortality was low (.8%), and its annual morbidity was acceptable (4.6%).
authors.affiliation: Department of Surgery and Internal Medicine, Hirslanden Clinics, Bern and Zürich, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Biertho
authors.forename: Rudolf
authors.initials: R
authors.lastname: Steffen
authors.forename: Ruth
authors.initials: R
authors.lastname: Branson
authors.forename: Natascha
authors.initials: N
authors.lastname: Potoczna
authors.forename: Thomas
authors.initials: T
authors.lastname: Ricklin
authors.forename: Grazyna
authors.initials: G
authors.lastname: Piec
authors.forename: Fritz F
authors.initials: FF
authors.lastname: Horber
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods* / Q000706:statistics & numerical data; D017211:Treatment Failure; D015431:Weight Loss