title: Revisional versus primary Roux-en-Y gastric bypass: a case-matched analysis.
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) has been a widely performed bariatric procedure. Unfortunately, revisional surgery is required in 20-30% of cases. Data comparing revisional and primary gastric bypass procedures are scarce. This study compared revisional malabsorptive laparoscopic very very long limb (VVLL) Roux-en-Y gastric bypass (RYGB) with primary VVLL RYGB and tested the hypothesis that one-stage revisional laparoscopic VVLL RYGB is an effective procedure after failed LAGB.
  
  
  METHODS
  In this study, 48 revisional VVLL RYGBs were matched one-to-one with 48 primary VVLL RYGBs. The outcome measures were operating time, conversion to open surgery, excess weight loss (EWL), and early and late morbidity.
  
  
  RESULTS
  Surgical and medical morbidities did not differ significantly. No conversions occurred. The revisional group showed an EWL of 41.8% after 12 months of follow-up evaluation and 45.1% after 24 months based on the pre-revisional weight. The total EWL based on the weight before the LAGB was calculated to be 54.3% after 12 months and 57.2% after 24 months. The EWL in the primary RYGB group was significantly higher for both types of calculation: 41.8%/54.3% versus 64.1 % (p < 0.001 and <0.01) after 12 months and 45.1%/57.2% versus 70.4% (p < 0.001 and <0.002) after 24 months.
  
  
  CONCLUSIONS
  Revisional laproscopic VVLL RYGB can be performed as a one-stage procedure by experienced bariatric surgeons but shows less effective EWL than primary RYGB procedures.
authors.affiliation: Department of Surgery, Limmattal Hospital Zurich-Schlieren, Zurich, Switzerland, tarik.delko@gmail.com.
authors.forename: Tarik
authors.initials: T
authors.lastname: Delko
authors.forename: Thomas
authors.initials: T
authors.lastname: Köstler
authors.forename: Miroslav
authors.initials: M
authors.lastname: Peev
authors.forename: Adrian
authors.initials: A
authors.lastname: Esterman
authors.forename: Daniel
authors.initials: D
authors.lastname: Oertli
authors.forename: Urs
authors.initials: U
authors.lastname: Zingg
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D013997:Time Factors; D015431:Weight Loss