title: Laparoscopic sleeve gastrectomy as a revisional procedure for failed gastric banding: lessons from 300 consecutive cases.
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) is a common bariatric procedure associated with a high rate of weight loss failure and/or complications in the long term. The objective of this study was to test the hypothesis that the conversion of failed LAGB into laparoscopic sleeve gastrectomy (LSG) is not associated with an increased risk of postoperative complications and leads to weight loss results that are comparable to those obtained with a primary LSG.
  
  
  METHODS
  We retrospectively analyzed the results of a prospective series of 1360 LSG regarding patient demographics, the indication for revision morbidity, the percentage of excess weight loss, and the rate of postoperative complications.
  
  
  RESULTS
  The primary LSG group contained 1060 patients and the LAGB to LSG group contained 300 patients. The rate of postoperative complications was 4.5% in the primary LSG group and 2% in the LAGB to LSG group. Two patients died in the LSG group (1 pulmonary embolus, 1 myocardial infarction). There was no significant difference with respect to the rate of leak, which was 1% in the LAGB to LSG group and 1.6% in the primary LSG group. There was a greater weight loss after primary LSG, mean % excess weight loss of 75.9%±21.4 at a mean interval of 29±19.8 months, versus 62.6%±22.2 at a mean interval of 35±24 months after LAGB to LSG (P = .008). There were 72.1% and 59.2% of patients available for follow-up after primary LSG at 24 and 60 months respectively, versus 69.3% and 55.4% after LAGB to LSG.
  
  
  CONCLUSIONS
  This study indicates that the risk of leak after LSG was not increased after conversion failed LAGB into LSG when performed as a 2-step procedure.
authors.affiliation: Clinique la Casamance, Aubagne, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Noel
authors.affiliation: Université de Nice Sophia Antipolis - Service de Chirurgie Digestive et Transplantation Hépatique, Nice, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Schneck
authors.affiliation: Clinique la Casamance, Aubagne, France.
authors.forename: Marius
authors.initials: M
authors.lastname: Nedelcu
authors.affiliation: Université de Nice Sophia Antipolis - Service de Chirurgie Digestive et Transplantation Hépatique, Nice, France.
authors.forename: Ji-Wann
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Université de Nice Sophia Antipolis - Service de Chirurgie Digestive et Transplantation Hépatique, Nice, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Gugenheim
authors.affiliation: Department of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, FL and Hôpital du Sacré Coeur, Montreal, Québec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.affiliation: Université de Nice Sophia Antipolis - Service de Chirurgie Digestive et Transplantation Hépatique, Nice, France. Electronic address: iannelli.a@chu-nice.fr.
authors.forename: Antonio
authors.initials: A
authors.lastname: Iannelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / 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; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D061646:Operative Time; D061214:Patient Safety; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
keywords: Failed gastric banding; Laparoscopic sleeve gastrectomy; Revision procedure