title: Adjustable gastric banding as revisional bariatric procedure after failed gastric bypass--intermediate results.
abstract: BACKGROUND
  Although gastric bypass is the most common bariatric procedure in the United States, it is has been associated with a failure rate of 15% (range 5-40%). The addition of an adjustable gastric band to Roux-en-Y gastric bypass has been reported to be a useful revision strategy in a small series of patients with inadequate weight loss after proximal gastric bypass.
  
  
  METHODS
  We report on 22 patients who presented with inadequate weight loss or significant weight regain after proximal gastric bypass. All patients underwent revision with the placement of an adjustable silicone gastric band around the proximal gastric pouch. The bands were adjusted at 6 weeks postoperatively and beyond, as needed. Complications and weight loss at the most recent follow-up visit were evaluated.
  
  
  RESULTS
  The mean age and body mass index at revision was 41.27 years (range 25-58) and 44.8 +/- 6.34 kg/m(2), respectively. Patients had experienced a loss of 19%, 27%, 47.3%, 42.3%, 43%, and 47% of their excess weight at 6, 12, 24, 36, 48, and 60 months after the revisional procedure, respectively. Three major complications occurred requiring reoperation. No band erosions have been documented.
  
  
  CONCLUSIONS
  The results from this larger series of patients have also indicated that the addition of the adjustable silicone gastric band causes significant weight loss in patients with poor weight loss outcomes after gastric bypass. That no anastomosis or change in absorption is required makes this an attractive revisional strategy. As with all revisional procedures, the complication rates appear to be increased compared with a similar primary operation.
authors.affiliation: Center for Obesity Surgery, Columbia University, New York-Presbyterian Hospital and Lawrence Hospital, New York, NY 10032, USA. mb28@columbia.edu
authors.forename: Marc
authors.initials: M
authors.lastname: Bessler
authors.forename: Amna
authors.initials: A
authors.lastname: Daud
authors.forename: Mary F
authors.initials: MF
authors.lastname: DiGiorgi
authors.forename: William B
authors.initials: WB
authors.lastname: Inabnet
authors.forename: Beth
authors.initials: B
authors.lastname: Schrope
authors.forename: Lorraine
authors.initials: L
authors.lastname: Olivero-Rivera
authors.forename: Daniel
authors.initials: D
authors.lastname: Davis
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D012086:Reoperation; D017211:Treatment Failure; D015431:Weight Loss