title: Revision of laparoscopic adjustable gastric banding: success or failure?
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) is a safe and frequently performed bariatric procedure. Unfortunately, re-operations are often necessary. Reports on the success of revisional procedures are scarce and show variable results, either supporting or declining the idea of revising LAGB. This study describes a large cohort of re-operations after failed LAGB to determine the success of revision.
  
  
  METHODS
  By use of a prospective cohort, all LAGB revisions performed between 1996 and 2008 were identified. From 301 primary LAGB procedures in our centre, 43 patients (14.3%) required a band revision. In addition, 51 patients were referred from other centres. Our analysis included in total 94 patients with a mean follow-up period of 38 months after revision.
  
  
  RESULTS
  Revision was mainly necessary due to anterior slippage (46%) and symmetrical pouch dilatation (36%), which could be resolved by replacing (70%) or refixating the band (27%). Weight loss significantly increased after revision (excess BMI loss (EBMIL), 37.2 ± 36.3% versus 47.5 ± 30.4%, P < 0.05). After revision, 23 patients (24%) needed a second re-operation. Patients converted to other procedures (16%) during the second re-operation showed larger weight loss than the revised group (EBMIL, 64.3 ± 28.1% versus 44.3 ± 28.7%, P < 0.05).
  
  
  CONCLUSIONS
  We report on a large cohort of LAGB revisions with 38 months of follow-up. Revision of failed LAGB by either refixation or replacement of the band is successful and further increases weight loss.
authors.affiliation: Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands. g.vijgen@maastrichtuniversity.nl
authors.forename: G H E J
authors.initials: GH
authors.lastname: Vijgen
authors.forename: R
authors.initials: R
authors.lastname: Schouten
authors.forename: L
authors.initials: L
authors.lastname: Pelzers
authors.forename: J W
authors.initials: JW
authors.lastname: Greve
authors.forename: S H
authors.initials: SH
authors.lastname: van Helden
authors.forename: N D
authors.initials: ND
authors.lastname: Bouvy
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D013369:Subphrenic Abscess / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology / Q000601:surgery; D015431:Weight Loss
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