title: Prospective study of a two-stage operative concept in the treatment of morbid obesity: primary lap-band followed if needed by sleeve gastrectomy with duodenal switch.
abstract: BACKGROUND
  We investigated the success rate of a two-stage operative concept for treatment of morbid obesity: primary laparoscopic adjustable gastric banding (LAGB, Lap-Band) for all morbidly obese patients, followed by sleeve gastrectomy with biliopancreatic diversion (duodenal switch or DS) in case of failure.
  
  
  METHODS
  From Dec 1996 to May 2004, 366 consecutive patients (female 78%, mean age 41 (17-66) years, BMI 44.3 (35-75) kg/m2 were prospectively evaluated, using the two-stage operative concept. The follow-up rate after a mean of 4.1 (1-8.4) years was 98%. Primary outcome measure was BAROS score, defined according to weight loss, quality of life, reduction in co-morbidities, complications and re-operations.
  
  
  RESULTS
  A very good-to-excellent result was found in 118 patients (32%), 141 (39%) had a good results, 76 (21%) a fair result, and 31 (8%) were failures. 39 patients needed re-banding due to slippage, 68 a DS, and 11 patients had band removal. Early morbidity of the Lap-Band was 3.8%, that of DS 13%, and mortality was zero. The excess weight loss at last follow-up of all the patients was 44% (40% after Lap-Band/rebanding, and 82% 2 years after DS).
  
  
  CONCLUSIONS
  The two-stage concept with primary LAGB, followed by DS in case of failure, leads to a good result in 71% of morbidly obese patients. LAGB alone does not appear to be an adequate procedure for every morbidly obese patient.
authors.affiliation: Department of Surgery, St. Claraspital, Basel, Switzerland. Ralph.peterli@claraspital.ch
authors.forename: Ralph
authors.initials: R
authors.lastname: Peterli
authors.forename: Bettina K
authors.initials: BK
authors.lastname: Wölnerhanssen
authors.forename: Thomas
authors.initials: T
authors.lastname: Peters
authors.forename: Beatrice
authors.initials: B
authors.lastname: Kern
authors.forename: Christoph
authors.initials: C
authors.lastname: Ackermann
authors.forename: Markus
authors.initials: M
authors.lastname: von Flüe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss