title: Revisional weight loss surgery after failed laparoscopic gastric banding: an institutional experience.
abstract: BACKGROUND
  Increasing experience with laparoscopic adjustable gastric banding (LAGB) has demonstrated a high rate of complications and inadequate weight loss. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have been reported to be safe and effective in selected patients. The purpose of our study was to evaluate the incidence and outcomes of revisional weight loss surgery (RWLS) after laparoscopic gastric banding at our institution.
  
  
  METHODS
  From June 2006 to February 2013, all patients who underwent LAGB and those who required revision were retrospectively analyzed. All procedures were performed by two surgeons with extensive experience in bariatric surgery. Parametric data are presented as mean ± SD; nonparametric data are presented as median and interquartile range (IQR).
  
  
  RESULTS
  During the study period, 256 patients underwent LAGB. A total of 111 patients (43 %) required reoperation. Sixty-one patients (56 women, age = 43.7 ± 12 years) with a BMI of 45.4 ± 6 kg/m(2) successfully underwent RWLS (53 RYGB, 8 LSG). Indications for RWLS included dysphagia (40 patients, 63 %), inadequate weight loss (17 patients, 27 %), GERD (2 patients, 3 %), gastric prolapse (2 patients, 3 %), and needle phobia (1 patient, 2 %). Two required conversion to an open RYGB due to extensive adhesions. RWLS was undertaken approximately 36.3 [25-45] months after LAGB. Removal of the gastric band and the RWLS were performed in 15 patients with an interval of 3 [1.5-7] months between procedures. Median operative time was 165 [142-184] min. Median hospital length of stay was 2 [2-3] days. Early complications occurred in 11 patients (18 %), including 4 anastomotic leaks. Twelve patients (20 %) presented with late complications requiring intervention. There was one death. At a median follow-up of 12.4 months, excess weight loss was 47.5 ± 27 %, and 48 % of patients achieved a BMI < 33.
  
  
  CONCLUSIONS
  LAGB is associated with a high incidence of reoperation. Reoperative weight loss surgery can be performed in selected patients with a higher rate of complications than primary surgery. Good short-term weight loss outcomes can be achieved.
authors.affiliation: Division of Minimally Invasive/Bariatric Surgery, Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA, tung.tran@mail.mcgill.ca.
authors.forename: Tung T
authors.initials: TT
authors.lastname: Tran
authors.forename: Eric
authors.initials: E
authors.lastname: Pauli
authors.forename: Jerome R
authors.initials: JR
authors.lastname: Lyn-Sue
authors.forename: Randy
authors.initials: R
authors.lastname: Haluck
authors.forename: Ann M
authors.initials: AM
authors.lastname: Rogers
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology; D050110:Bariatric Surgery / Q000379:methods; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D015390:Gastric Bypass / Q000379:methods; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D015431:Weight Loss