Laparoscopic gastric re-banding versus laparoscopic gastric bypass as a rescue operation for patients with pouch dilatation.
BACKGROUND
The authors assessed whether laparoscopic rebanding or laparoscopic Roux-en-Y gastric bypass (LRYGBP) is the best approach for failed gastric banding after pouch dilatation.


METHODS
Between January 2000 and June 2005, 489 patients underwent laparoscopic gastric banding, and of these, 33 (6.7%) required rescue procedures for pouch dilatation. Each reoperated patient was contacted to obtain information about their postoperative course. Additionally, preoperative weight and BMI, weight loss at 1 year postoperatively, weight at time of pouch dilatation and the time-period between the primary operation and pouch dilatation were analyzed.


RESULTS
The most common operation for pouch dilatation was band repositioning or rebanding (16 patients). Band removal without replacement was performed in 7 patients. 8 patients underwent conversion to a LRYGBP. 1 patient underwent laparoscopic gastric sleeve resection and 1 patient received an intragastric balloon. Patients who underwent conversion to LRYGBP are very content and, although weight loss has been nearly the same as after gastric banding, they would prefer the gastric bypass operation to the gastric banding.


CONCLUSIONS
Conversion to LRYGBP appears to offer significant advantages, and appears to be the rescue therapy of choice after failed laparoscopic gastric banding.
Lanthaler
M
M
Department of General and Transplant Surgery, University Hospital Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
Mittermair
R
R
Erne
B
B
Weiss
H
H
Aigner
F
F
Nehoda
H
H
D004108:Dilatation, Pathologic; D015390:Gastric Bypass / Q000379:methods; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology*; D017211:Treatment Failure