title: Caution in using a unique technique of banded revision gastric bypass: Successful endosopic and surgical management of a rare complication.
abstract: BACKGROUND
  Revision surgery is increasingly performed as result of the increase in primary bariatric procedures. We describe a new technique of revision Roux-en-Y gastric bypass (RYGB) acombining stapled gastroenterostomy with fixed band placement. We report two cases of unique complications and its successful endoscopic and surgical management.
  
  
  METHODS
  Two out of twenty patients undergoing this revision RYGB procedure presented with gastric outlet obstruction due to band erosion within 10 weeks. Endoscopic band retrieval was successful in the first patient but the second patient required surgical removal.
  
  
  CONCLUSIONS
  We report the new complication of band erosion in 10% patients using a unique revision RYGB technique combining restriction of the gastric outlet and band placement. We advise using one or the other technique but not both in combination. Surgeons need to be aware of this as erosion which occurs early due to close proximity of band with fresh staple line. We report successful endoscopic and surgical management.
  
  
  CONCLUSIONS
  Revision surgery using this technique predisposes to bande erosion, presenting as gastric outlet obstruction. Endoscopic management should be attempted prior to surgical removal.
authors.affiliation: Department of Surgery, St James University Teaching Hospital, Beckett Street, LS9 7 Leeds, United Kingdom. Electronic address: aravindsuppiah@hotmail.com.
authors.forename: Aravind
authors.initials: A
authors.lastname: Suppiah
authors.forename: Mazin
authors.initials: M
authors.lastname: Hamed
authors.forename: Charles
authors.initials: C
authors.lastname: Millson
authors.forename: Stephen
authors.initials: S
authors.lastname: Pollard