Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass.
BACKGROUND
The most common bariatric surgical operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported to have a high incidence of long-term complications. Also, insufficient weight loss is reported. We investigated whether revision to Roux-en-Y gastric bypass (RYGBP) is a safe and effective therapy for failed LAGB and for further weight loss.


METHODS
From Jan 1999 to May 2004, 613 patients underwent LAGB. Of these, 47 underwent later revisional Roux-en-Y gastric bypass (RYGBP). Using a prospectively collected database, we analyzed these revisions. All procedures were done by two surgeons with extensive experience in bariatric surgery.


RESULTS
All patients were treated with laparoscopic (n=26) or open (n=21) RYGBP after failed LAGB. Total follow-up after LAGB was 5.5+/-2.0 years. For the RYGBP, mean operating time was 161+/-53 minutes, estimated blood loss was 219+/-329 ml, and hospital stay was 6.7+/-4.5 days. There has been no mortality. Early complications occurred in 17%. There was only one late complication (2%)--a ventral hernia. The mean BMI prior to any form of bariatric surgery was 49.2+/-9.3 kg/m2, and decreased to 45.8+/-8.9 kg/m2 after LAGB and was again reduced to 37.7+/-8.7 kg/m2 after RYGBP within our follow-up period.


CONCLUSIONS
Conversion of LAGB to RYGBP is effective to treat complications of LAGB and to further reduce the weight to healthier levels in morbidly obese patients.
Department of Surgery, Rijnstate Hospital, The Netherlands. basvw@yahoo.com
B
B
van Wageningen
F J
FJ
Berends
B
B
Van Ramshorst
I F M
IF
Janssen
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery; D011336:Probability; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome