title: Revisional surgery after failed adjustable gastric banding: institutional experience with 90 consecutive cases.
abstract: BACKGROUND
  Revisional surgery may be required in a high percentage of patients (up to 30 %) after laparoscopic adjustable gastric banding (LAGB). We report our institutional experience with revisional surgery.
  
  
  METHODS
  From January 1996 to November 2011, 90 patients underwent revisional surgery after failed LAGB. Both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were proposed. In the presence of gastroesophageal reflux disease, esophageal dysmotility, hiatal hernia, or diabetes, RYGB was preferentially proposed.
  
  
  RESULTS
  In two cases, revisional surgery was aborted due to local severe adhesions. Eighty-eight patients (74 females; mean age 42.79 ± 10.03 years; mean BMI 44.73 ± 6.19 kg/m(2)) successfully underwent revisional SG (n = 48) or RYGB (n = 40). One-stage surgery was performed in 29 cases. Follow-up rate was 78.2 % (n = 61) and 40.9 % (n = 36) at 12 and 24 months respectively. One major complication after SG (staple-line leakage) was observed. Overall postoperative excess weight loss (%EWL) was 31.24, 40.92, 52.41, and 51.68 % at 3, 6, 12, and 24 months of follow-up respectively. There was a statistically significant higher %EWL at 1 year in patients <50 years old (55.9 vs. 41.5 % in patients >50 years old; p = 0.01), of female gender (55.22 vs. 40.73 % in male; p = 0.04), and in patients in which the AGB was in place for <5 years (57.09 vs. 47.43 % if >5 years p = 0.02).
  
  
  CONCLUSIONS
  Revisional surgery is safe and effective. Patients <50 years, of female gender, and with the AGB in place for <5 years had better %EWL after revisional surgery.
authors.affiliation: Department of General, Digestive and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, 1, Place de l'Hôpital, 67091, Strasbourg, France.
authors.forename: Keng-Hao
authors.initials: KH
authors.lastname: Liu
authors.forename: Michele
authors.initials: M
authors.lastname: Diana
authors.forename: Michel
authors.initials: M
authors.lastname: Vix
authors.forename: Didier
authors.initials: D
authors.lastname: Mutter
authors.forename: Hurng-Sheng
authors.initials: HS
authors.lastname: Wu
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D015154:Esophageal Motility Disorders / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D015390:Gastric Bypass / Q000379:methods; D005764:Gastroesophageal Reflux / Q000209:etiology; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D006551:Hernia, Hiatal / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D017792:Surgical Stapling / Q000009:adverse effects; D000267:Tissue Adhesions / Q000209:etiology; D017211:Treatment Failure; D016896:Treatment Outcome; D015431:Weight Loss