title: Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure.
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) is an effective bariatric procedure with low morbidity and mortality. Unfortunately, it is fraught with high failure rates in long-term follow-up. Laparoscopic sleeve gastrectomy (LSG) is an emerging procedure, quickly gaining momentum in the arsenal of bariatric practice as a first step toward gastric bypass/biliopancreatic diversion or as a stand-alone operation. Recently, it has been described as a revisional option for previous bariatric surgery failures. We report our early experience with LSG as a revisional procedure for failed LAGB.
  
  
  METHODS
  From January 2007 to April 2010, 46 patients, who had undergone LAGB, underwent LSG. Patient demographics, reason for band removal, interval between removal and LSG, operative times, estimated blood loss, complications, length of hospital stay, and percent of excess weight loss were collected.
  
  
  RESULTS
  Of the 46 patients, 20 (43%) had their bands removed before LSG (median time interval, 2 years; range, 2 months to 9 years); the rest had concomitant band removal and LSG. Twelve patients were men (26%). Mean age and BMI were 40 (range, 20-60) years and 43.1 kg/m(2) (range, 33-57), respectively. In two cases, surgery was converted to an open procedure due to extensive adhesions related to previous surgeries. Median operative time, estimated blood loss, and length of hospital stay were 118 (range, 70-250) minutes, 41 (range, 5-600) ml, and 3 (range, 1-100) days, respectively. Major morbidity was encountered in three patients (6%; leak in 2 and bleeding in 1). There were no mortalities. Mean follow-up time for our cohort is 17 (range, 1-39) months. Percent of excess weight loss at 2, 6, 12, 24, and 36 months was 24, 37, 53, 51, and 48%, respectively.
  
  
  CONCLUSIONS
  Our results suggest that LSG is safe, feasible, and effective as a revisional procedure for failed LAGB and can be considered as an appealing option in these cases. Larger series and longer follow-up are needed to confirm this.
authors.affiliation: Department of Surgery C, Chaim Sheba Medical Center, 56261, Tel Hashomer, Israel. david.goitein@sheba.health.gov.il
authors.forename: David
authors.initials: D
authors.lastname: Goitein
authors.forename: Anya
authors.initials: A
authors.lastname: Feigin
authors.forename: Gabriella
authors.initials: G
authors.lastname: Segal-Lieberman
authors.forename: Orly
authors.initials: O
authors.lastname: Goitein
authors.forename: Moshe Zvi
authors.initials: MZ
authors.lastname: Papa
authors.forename: Dov
authors.initials: D
authors.lastname: Zippel
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult