title: Perioperative outcomes of revisional laparoscopic gastric bypass after failed adjustable gastric banding and after vertical banded gastroplasty: experience with 107 cases and subgroup analysis.
abstract: BACKGROUND
  A growing number of revision procedures are to be expected in bariatric surgery after failed restrictive procedures such as failed adjustable gastric banding (AGB) or vertical banded gastroplasty (VBG). Conversion to revisional laparoscopic Roux-en-Y gastric bypass (ReLRYGBP) has been advocated as the procedure of choice.
  
  
  METHODS
  The results of ReLRYGBP were reviewed in a retrospective chart review. A subgroup analysis compared perioperative results after VBG and after AGB. A second subgroup analysis compared perioperative results of ReLRYGBP immediately after AGB removal and after a delay as a two-step procedure.
  
  
  RESULTS
  Between 2003 and 2009, ReLRYGBP was performed for 107 patients. Of these 107 operations, 21 were performed after failed VBG and 86 after failed AGB. The mean body mass index (BMI) was 42 kg/m(2). The causes of failure were mainly insufficient weight loss or reflux disease-related symptoms. During a median follow-up period of 44 months, there was no mortality, and morbidity was 34 %, including late complications. Major early complications occurred in 11 % of the cases (n = 12). Conversions and major early complications occurred significantly more frequently after VBG than after AGB (p < 0.05). In 59 % of the cases (n = 50), ReLRYGBP was performed as a single-stage procedure immediately after removal of AGB and in 41 % of the cases (n = 36) as a delayed two-step procedure. The outcomes did not differ significantly (p > 0.5).
  
  
  CONCLUSIONS
  The perioperative outcomes of ReLRYGBP are worse after VBG than after AGB. The ReLRYGBP operation can be performed safely as a one-step procedure after AGB removal.
authors.affiliation: Department of Digestive Surgery, Heilig Hart Ziekenhuis, Mol, Belgium. j.a.apers@znb.nl
authors.forename: J A
authors.initials: JA
authors.lastname: Apers
authors.forename: C
authors.initials: C
authors.lastname: Wens
authors.forename: V
authors.initials: V
authors.lastname: van Vlodrop
authors.forename: M
authors.initials: M
authors.lastname: Michiels
authors.forename: R
authors.initials: R
authors.lastname: Ceulemans
authors.forename: G
authors.initials: G
authors.lastname: van Daele
authors.forename: I
authors.initials: I
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult