Laparoscopic sleeve gastrectomy as a revisional procedure for failed laparoscopic gastric banding with a "2-step approach": a multicenter study.
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) has been proposed as an alternative revisional procedure for failed/complicated gastric banding. This is a retrospective cohort study of a prospectively maintained database of revisional LSG after band removal for insufficient weight loss and/or band-related complications, using a 2-step approach. The outcomes were compared with a control group of primary LSG. The study was conducted at a university hospital (Sapienza University of Rome-Polo Pontino, Icot, Latina, Italy) and 2 community general hospitals (Hospital Andosilla Civita Castellana, Viterbo, Italy and Hospital Villa D'Agri, Potenza, Italy).


METHODS
A total of 76 revisional LSG procedures was recorded; a control group of 279 LSG patients was selected. The primary endpoint was to compare the perioperative complication rate between the revisional versus the control group. Secondary endpoints were operative time, conversion rate, postoperative length of stay and percentage excess weight loss (%EWL) at 6, 12, and 24 months.


RESULTS
The indications for band removal were inadequate weight loss (47 patients), slippage (10 patients), erosion (7 patients), and pouch dilation (12 patients). All procedures were completed laparoscopically. The median operative time was 78 minutes for the revision LSG and 65 minutes for the control LSG (P<.05). In the revision group, the overall complication rate was 17.1%, and the median postoperative length of stay was 4 days; in the control group, the overall complication rate was 10.7%, and the median postoperative length of stay was 3. No complications requiring reoperation or readmission occurred in the revision group. In the control group, there were 5 cases of major complications. All the patients completed the follow-up. A total of 56 patients in the revision group and 184 patients in the control group were followed-up for at least 24 months. The %EWL at 6, 12, and 24 months was 46.5%, 66.4%, and 78.5%, respectively, in the revision group, and 49.8%, 78.2%, and 78%, respectively, in the control group.


CONCLUSIONS
Results confirmed that LSG, performed in 2 steps, is an effective revision procedure for failed or complicated laparoscopic adjustable gastric banding with good perioperative outcomes and 2-year weight loss.
Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnology, "Sapienza" University of Rome, Latina, Italy. Electronic address: gianfranco.silecchia@uniroma1.it.
Gianfranco
G
Silecchia
Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnology, "Sapienza" University of Rome, Latina, Italy.
Mario
M
Rizzello
Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnology, "Sapienza" University of Rome, Latina, Italy.
Francesco
F
De Angelis
Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnology, "Sapienza" University of Rome, Latina, Italy.
Luigi
L
Raparelli
Division of General Surgery , Hospital Andosilla, Civita Castellana - Viterbo, Italy.
Francesco
F
Greco
Division of General Surgery, Hospital of Villa d'Agri, Villa d'Agri Potenza, Italy.
Nicola
N
Perrotta
Division of General Surgery, Department of Medico-Surgical Sciences and Biotechnology, "Sapienza" University of Rome, Latina, Italy.
Maria Antonietta
MA
Lerose
Division of General Surgery , Hospital Andosilla, Civita Castellana - Viterbo, Italy.
Fabio Cesare
FC
Campanile
D000328:Adult; D000368:Aged; D020878:Device Removal; D005260:Female; D005743:Gastrectomy; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D015431:Weight Loss; D055815:Young Adult
Bariatric surgery; Gastric banding; Laparoscopy; Morbid obesity; Revisional surgery; Sleeve gastrectomy; Weight regain