title: Lap banding as a redo surgery: "restriction over restriction" may be a relevant bariatric strategy.
abstract: BACKGROUND
  The redo issue is a growing and debated issue in bariatric surgery. From the experience of failed vertical banded gastroplasty (VBG), we suggest that adjustable gastric band is a relevant method in many cases.
  
  
  METHODS
  Ninety-eight patients have been operated on in a 13-year period (07/1995-07/2008). The cause of VBG failure has been staple disruption in 58% of cases and an outlet enlargement in 37% of cases. In the meantime, two gastric bypasses have been performed. Mean body mass index has been 38 (28-48) and was less than 35 in 37% of the cases.
  
  
  RESULTS
  Postoperative complications occurred in seven cases, and the band had to be removed in five cases. Mean excess weight loss has been 52% at 8 years, yet 22% of the patients have been lost for follow-up. Slippage occurred in two patients and erosion in one. A final removal of the band has been necessary in two patients.
  
  
  CONCLUSIONS
  VBG failures are highly common in the long run. Lap banding represents an interesting option for redo in a majority of cases, providing good long-term results and demonstrating that "restriction over restriction" can be a relevant strategy. The initial response to VBG has been a key information: if it has been successful in terms of weight loss and food tolerance, then lap banding was a valuable option. VBG has represented an interesting model because it has historical value and could be a procedure for the future if performed through endoscopic channels.
authors.affiliation: Polyclinique de Rillieux, 941, Rue Capitaine Julien, 69165 Rillieux-la-Pape Cedex, France. jerome.dargent@polyclinique-rillieux.fr
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dargent
mesh_terms: D015331:Cohort Studies; D020878:Device Removal; D004868:Equipment Failure; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome; D015431:Weight Loss