title: Laparoscopic gastric rebanding for slippage with pouch dilation: results on 29 consecutive patients.
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) slippage with pouch dilation is one the most serious long-term complications and requires reoperation in most cases. It is still controversial whether banding should be offered again or a different procedure should be chosen. We report the results of synchronous de-rebanding on a prospective series of patients treated at our institution for slippage with pouch dilation.
  
  
  METHODS
  From January 2000 to May 2007, 29 consecutive patients underwent laparoscopic de-rebanding for slippage with pouch dilation. The mean age at primary operation was 38.9 +/- 8.2 years and the mean BMI was 46.4 +/- 8 kg/m(2). Twenty-eight had previous LAGB, while one had previous open gastric banding, the perigastric technique being used at that time. All the redo procedures were successfully carried out under laparoscopy, via the pars flaccida technique, and all the patients were followed-up according to the usual schedule.
  
  
  RESULTS
  The mean time from the original LAGB was 45.3 +/- 30.3 months, and the mean follow-up after rebanding was 26.9 +/- 20.6 months. At rebanding, the mean BMI was 34.3 +/- 7.6, percent excess weight loss (%EWL) 54.5 +/- 31, and percent excess BMI loss (%EBL) 58.3 +/- 33, respectively. After 1 year, BMI was 36.3 +/- 7.9, %EWL 40.8 +/- 30.5, and %EBL 43.9 +/- 32.7, respectively. After 2 years, BMI was 37.13 +/- 7.4, %EWL 36.9 +/- 29.4, and %EBL 39.6 +/- 31.6, respectively, and after 3 years, BMI was 33.5 +/- 5.6, %EWL 51.9 +/- 24.3, and %EBL 55.7 +/- 25.7, respectively. One patient had re-rebanding after 6 months for a new slippage, two had band removal with refusal to switch to another procedure, one had biliopancreatic diversion for slippage recurrence, and one underwent sleeve gastrectomy for insufficient weight loss after 6 months.
  
  
  CONCLUSIONS
  Although this is a limited series, our results show that good outcomes can be expected after rebanding in properly assessed patients with slippage and pouch dilation. Larger series and longer follow-up are needed to confirm these findings.
authors.affiliation: Clinica Chirurgica II, Padua University, Via Giustiniani 2, Padua, Italy. mirto.foletto@unipd.it
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
authors.forename: Paolo
authors.initials: P
authors.lastname: Bernante
authors.forename: Luca
authors.initials: L
authors.lastname: Busetto
authors.forename: Fabio
authors.initials: F
authors.lastname: Pomerri
authors.forename: Gianluca
authors.initials: G
authors.lastname: Vecchiato
authors.forename: Luca
authors.initials: L
authors.lastname: Prevedello
authors.forename: Stefania
authors.initials: S
authors.lastname: Famengo
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
mesh_terms: D000328:Adult; D015331:Cohort Studies; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D013271:Gastric Dilatation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome