title: Re-operation after laparoscopic adjustable gastric banding leads to a further decrease in BMI and obesity-related co-morbidities: results in 33 patients.
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) is a safe technique with few direct postoperative complications. However, long-term complications such as slippage and pouch dilatation are a well-known problem and re-operations are necessary in a substantial number of patients. In this study, the results of laparoscopic re-operations after LAGB are evaluated.
  
  
  METHODS
  33 patients had a re-operation because of failed LAGB. 29 patients had major re-operation and 4 patients minor re-operation under local anesthesia. The charts of these patients were retrospectively studied.
  
  
  RESULTS
  Mean time between the first band placement and re-operation was 28.1 +/- 17.6 months. The cause of band dysfunction was anterior slippage (n=17), band erosion (n=5), band intolerance (n=3), posterior slippage (n=2) and band leakage (n=2). Symptoms of band dysfunction were vomiting (n=16), pyrosis (n=13), nausea (n=8), retrosternal pain (n=11) and regurgitation (n=5). Laparoscopic refixation of the band was performed in 19 patients: the band was replaced in 4 patients while in 1 patient the band was removed; in 3 patients, the laparoscopic procedure was converted to open surgery; 5 patients underwent conversion to a bypass procedure (biliopancreatic diversion in 3 and gastric bypass in 2). There were no direct postoperative complications except for wound infections (n=2). Postoperative follow-up was 100% with a mean period of 34 +/- 19 months. BMI decreased further from 37.5 +/- 6.4 kg/m(2) before re-operation to 33 +/- 7 kg/m(2). Obesity-related co-morbidity also decreased further or completely dissolved. 3 patients (9%) again developed anterior slippage and a second laparoscopic re-operation was necessary.
  
  
  CONCLUSIONS
  A laparoscopic re-operation for band-related complications after LAGB is safe and feasible. With band slippage, a laparoscopic refixation was possible in 89%. Re-operation leads to further decrease in BMI and obesity-related co-morbidities.
authors.affiliation: Department of General Surgery, University Hospital Maastricht, The Netherlands. r.schouten@surgery.azm.nl
authors.forename: R
authors.initials: R
authors.lastname: Schouten
authors.forename: F M H
authors.initials: FM
authors.lastname: van Dielen
authors.forename: J W M
authors.initials: JW
authors.lastname: Greve
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data*; D013997:Time Factors; D017211:Treatment Failure; D015430:Weight Gain