title: Revisional surgery for laparoscopic minigastric bypass.
abstract: BACKGROUND
  Laparoscopic minigastric bypass (LMGB), a sleeved gastric tube with Billroth II anastomosis, has been proposed as an alternative to laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity. However, the data regarding revision surgery after LMGB during long-term follow-up is not clear.
  
  
  METHODS
  From January 2001 to December 2009, 1322 patients (996 women and 326 men, mean age 31.6 ± 9.1 years, mean body mass index 40.2 ± 7.4 kg/m(2)), who were enrolled in a surgically supervised weight loss program and had undergone LMGB were included. All the patients received regular yearly follow-up, and all the clinical data were prospectively collected and stored. The reasons and type of surgery for revision surgery were identified and analyzed.
  
  
  RESULTS
  The excess weight loss and mean body mass index at 5 years after LMGB was 72.1% and 27.1 ± 4.6 kg/m(2). Of the 1322 patients, 23 (1.7%) had undergone revision surgery during a follow-up of 9 years. The estimated accumulated revision rate of 9 years was 2.69% for LMGB. The most common cause of revision was malnutrition in 9 (39.1%), followed by inadequate weight loss in 8 (34.7%), and intractable bile reflux and dissatisfaction each in 3 (13.0%). The type of revision surgery was LRYGB in 11 (47.8%), sleeve gastrectomy in 10 (43.5%), and conversion to a normal anatomic state in 2 (8.6%). All the revision procedures were performed using a laparoscopic approach, without major complications. Two patients underwent repeat second revision surgery to duodenal switch and biliopancreatic diversion each in 1 patient. All patients had satisfactory results after revision surgery. No patients had undergone revision surgery for internal hernia or ileus during the follow-up period.
  
  
  CONCLUSIONS
  LMGB resulted in significant and sustained weight loss with an acceptably low revision rate at long-term follow-up. Revision surgery after LMGB can be performed using a laparoscopic approach with a low risk.
authors.affiliation: Department of Surgery, Min-Sheng General Hospital, National Taiwan University, Taipei, Taiwan. wjlee_obessurg_tw@yahoo.com.tw
authors.forename: Wei-Jei
authors.initials: WJ
authors.lastname: Lee
authors.forename: Yi-Chih
authors.initials: YC
authors.lastname: Lee
authors.forename: Kong-Han
authors.initials: KH
authors.lastname: Ser
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Chen
authors.forename: Jung-Chien
authors.initials: JC
authors.lastname: Chen
authors.forename: Yen-How
authors.initials: YH
authors.lastname: Su
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss