title: Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is considered an effective multipurpose operation for morbid obesity, although long-term results are still lacking. Also, the best procedure to be offered in the case of failed restrictive procedures is still debated. We here reported our results of LSG as a revisional procedure for inadequate weight loss and/or complications after adjustable gastric banding or gastroplasty.
  
  
  METHODS
  Since April 2005, 57 patients (20 men and 37 women), with a mean age of 49.9 +/- 11.9 years, underwent revisional LSG, 52 after laparoscopic adjustable gastric banding/adjustable gastric banding and 5 after vertical banded gastroplasty at our institution. The mean interval from the primary procedure to LSG was 7.54 +/- 4.8 years. The LSG was created using a 34F bougie with an endostapler, after removing the laparoscopic adjustable gastric band or the anterior portion of the band in those who had undergone vertical banded gastroplasty. An upper gastrointestinal contrast study was performed within 3 days after surgery and, if the findings were negative, a soft diet was promptly started.
  
  
  RESULTS
  A total of 41 patients had undergone concurrent band removal and LSG and 16 had undergone band removal followed by an interval LSG. Three cases required conversion to open surgery because of a large incisional hernia. The mean operative time was 120 minutes (range 90-180). One patient died of multiple organ failure from septic shock. Three patients (5.7%) developed a perigastric hematoma, 3 (5.7%) had leaks, and 1 had mid-gastric short stenosis. The median hospital stay was 5 days. The mean body mass index at revisional LSG was 45.7 +/- 10.8 kg/m(2) and had decreased to 39 +/- 8.5 kg/m(2) after 2 years, with a mean percentage of the estimated excess body mass index lost of 41.6% +/- 24.4%. Two patients required a duodenal switch for insufficient weight loss.
  
  
  CONCLUSIONS
  LSG seems to be effective as revisional procedure for failed LAGB/vertical banded gastroplasty, although with greater complication rates than the primary procedures. Larger series and longer follow-up are needed to confirm these promising results.
authors.affiliation: Bariatric Unit, Azienda Ospedaliera Universita' di Padova, Padova, Italy. mirto.foletto@unipd.it
authors.forename: Mirto
authors.initials: M
authors.lastname: Foletto
authors.forename: Luca
authors.initials: L
authors.lastname: Prevedello
authors.forename: Paolo
authors.initials: P
authors.lastname: Bernante
authors.forename: Busetto
authors.initials: B
authors.lastname: Luca
authors.forename: Roberto
authors.initials: R
authors.lastname: Vettor
authors.forename: Francesco
authors.initials: F
authors.lastname: Francini-Pesenti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Scarda
authors.forename: Filippo
authors.initials: F
authors.lastname: Brocadello
authors.forename: Michele
authors.initials: M
authors.lastname: Motter
authors.forename: Stefania
authors.initials: S
authors.lastname: Famengo
authors.forename: Donato
authors.initials: D
authors.lastname: Nitti
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome; D015431:Weight Loss