title: Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results.
abstract: BACKGROUND
  Of patients who have undergone gastric banding, 11-25% will require a major reoperation with band removal and conversion to another bariatric procedure after they have failed to lose sufficient weight or have developed dysphagia or reflux. The aim of this study was to evaluate the respective benefits of Roux-en-Y gastric band (RYGB) or biliopancreatic diversion with duodenal switch (BPD-DS) after failed gastric banding and whether 1 of the 2 procedures might be a better procedure for such cases.
  
  
  METHODS
  RYGB or BPD-DS was performed according to the institutional protocols with synchronous band removal, irrespective of the reason for failure.
  
  
  RESULTS
  Of the 53 patients, 32 underwent laparoscopic RYGB for a body mass index (BMI) of 43.1 +/- 6.4 kg/m(2) (BMI 45.8 +/- 6.4 kg/m(2) before laparoscopic adjustable gastric banding) and 21 underwent BPD-DS for a BMI of 46.0 +/- 5.5 kg/m(2) (BMI 49.6 +/- 5.2 kg/m(2) before laparoscopic adjustable gastric banding). BPD-DS required significantly longer operative times (239.7 +/- 55.8 versus 135 +/- 26.7 minutes) and resulted in more complications (62% versus 12.5%; P <.002). No patients died postoperatively. The 2 groups of patients had a similar BMI at 12 and 18 months after revision (BMI 33.4 +/- 5.6 kg/m(2) and 31.4 +/- 3.5 kg/m(2)). The weight loss was greater after BPD-DS than after RYGB compared with the prerevision weight loss (66.2% versus 58.8% excess weight loss) or initial weight (73% versus 61.8%), although this was not significant.
  
  
  CONCLUSIONS
  Despite an excessive rate of complications that were, in part, related to the learning curve in this series, BPD-DS resulted in greater weight loss compared with RYGB. However, both procedures were successful after failed gastric banding. A more accurate definition of failure could help to determine the respective indications for revisional surgery.
authors: Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France. philippetopart@wanadoo.fr
authors: Philippe
authors: P
authors: Topart
authors: Guillaume
authors: G
authors: Becouarn
authors: Patrick
authors: P
authors: Ritz
mesh_terms: D000328:Adult; D015904:Biliopancreatic Diversion / Q000009:adverse effects / Q000379:methods*; D015992:Body Mass Index; D020878:Device Removal; D004386:Duodenum / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D015431:Weight Loss