title: Salvage of gastric restriction following staple-line dehiscence after vertical banded gastroplasty by insertion of an adjustable gastric band.
abstract: BACKGROUND
  Vertical banded gastroplasty (VBG) has been a common and safe surgical treatment for morbid obesity. However, the complication of staple-line dehiscence (SLD) results in VBG failure. We present a minimally invasive revision procedure when SLD occurs: gastric restriction is salvaged by adjustable gastric banding (AGB), usually laparoscopically, providing that the previous restriction had achieved sufficient weight loss initially and was well-tolerated.
  
  
  METHODS
  13 patients with unexplained weight regain after VBG were found to have SLD on endoscopy. AGB was performed to re-establish restriction. Weight loss and complications were compared with two control groups: the first undergoing uncomplicated VBG, and the second undergoing AGB alone. Follow-up of 4.3+/-0.1 (mean+/-SEM) years after salvage reoperation, including complications, reoperations and weight loss, were studied.
  
  
  RESULTS
  Insertion of the band through the retrogastric tunnel was feasible in all cases, despite adhesions in the area of the VBG Marlex band, the proximal stomach, and left lobe of liver. There was no surgeryrelated mortality. Following "salvage AGB", weight loss and overall complication rates were similar between the study group and the two control groups.
  
  
  CONCLUSIONS
  Salvage of gastric restriction by AGB after SLD secondary to VBG is safe and reliable, despite the possibility of adhesions. Morbidity is low and intermediate-term weight loss is comparable to patients with uncomplicated VBG.
authors.affiliation: Department of Visceral Surgery, Hirslanden Group, Klinik Beau-Site, Bern, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Wenger
authors.forename: Grazyna
authors.initials: G
authors.lastname: Piec
authors.forename: Ruth
authors.initials: R
authors.lastname: Branson
authors.forename: Natascha
authors.initials: N
authors.lastname: Potoczna
authors.forename: Fritz F
authors.initials: FF
authors.lastname: Horber
authors.forename: Rudolf
authors.initials: R
authors.lastname: Steffen
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D011336:Probability; D012086:Reoperation; D018570:Risk Assessment; D016879:Salvage Therapy; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome