title: Gastric banding as a salvage procedure for patients with weight loss failure after Roux-en-Y gastric bypass.
abstract: BACKGROUND
  This study reviews outcomes after laparoscopic adjustable gastric band (LAGB) placement in patients with weight loss failure after Roux-en-Y gastric bypass (RYGBP).
  
  
  METHODS
  All data was prospectively collected and entered into an electronic registry. Characteristics evaluated for this study included pre-operative age and body mass index (BMI), gender, conversion rate, operative (OR) time, length of stay (LOS), percentage excess weight loss (EWL), and postoperative complications.
  
  
  RESULTS
  11 patients (seven females, four males) were referred to our program for weight loss failure after RYGBP (six open, five laparoscopic). Mean age and BMI pre-RYGBP were 39.5 years (24-58 years) and 53.2 kg/m(2) (41.2-71 kg/m(2)), respectively. Mean EWL after RYGBP was 38% (19-49%). All patients were referred to us for persistent morbid obesity due to weight loss failure or weight regain. The average time between RYGBP and LAGB was 5.5 years (1.8-20 years). Mean age and BMI pre-LAGB were 46.1 years (29-61 years) and 43.4 kg/m(2) (36-57 kg/m(2)), respectively. Vanguard (VG) bands were placed laparoscopically in most patients. There was one conversion to open. Mean OR time and LOS were 76 minutes and 29 hours, respectively. The 30-day complication rate was 0% and mortality was 0%. There were no band slips or erosions; however, one patient required reoperation for a flipped port. The average follow-up after LAGB was 13 months (2-32 months) with a mean BMI of 37.1 kg/m(2 )(22.7-54.5 kg/m(2)) and an overall mean EWL of 59% (7-96%). Patients undergoing LAGB after failed RYGBP lost an additional 20.8% EWL (6-58%).
  
  
  CONCLUSIONS
  Our experience shows that LAGB is a safe and effective solution to failed RYGBP.
authors.affiliation: Department of Surgery, New York University School of Medicine, New Bellevue 15 North 1, 550 First Avenue, New York, New York, 10016, USA gobblr01@med.nyu.edu
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Gobble
authors.forename: Manish S
authors.initials: MS
authors.lastname: Parikh
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Greives
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Ren
authors.forename: George A
authors.initials: GA
authors.lastname: Fielding
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D015431:Weight Loss