title: Roux-en-Y gastric bypass after successful weight loss with a laparoscopic adjustable gastric band: rationales and early outcomes in patients of body mass index<35 kg/m(2.).
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) has a number of well-established acute and chronic issues that can require revisional surgical procedures. There is no existing data to evaluate conversion of band patients with body mass index (BMI)<35 kg/m(2) from LAGB to a Roux-en-Y gastric bypass (RYGB). This study aims to report on the indications for and the safety profile of conversion of the LAGB to RYGB in patients with BMI<35 kg/m(2).
  
  
  METHODS
  A review of data from 200 consecutive conversions of LAGB to RYGB was conducted. Fifty-two patients whose BMI was<35 kg/m(2) were included in this analysis. Indications for conversion, technical details, early morbidity, length of hospital stay, and weight loss data were assessed.
  
  
  RESULTS
  Laparoscopic conversion to RYGB was performed in 100% of patients. The median BMI pre-RYGB was 32.8 kg/m(2). The most common indication for surgery was weight regain after removal of LAGB (28.8%). There was no mortality. Early morbidity was seen in 25% of patients; the most common complication was stricture of the gastrojejunal anastomosis (9 patients).
  
  
  CONCLUSIONS
  Morbidity resulting from conversion of LAGB to RYGB in patients with BMI <35 kg/m(2) is similar to that seen in the BMI>35 kg/m(2) population. The procedure is technically challenging and morbidity rates are higher than those reported for surgically 'naïve' patients. It is recommended that this procedure be undertaken by appropriately trained surgeons in high-volume bariatric centers to optimize safety and outcomes.
authors.affiliation: Royal Brisbane and Women's Hospital, Herston, Australia. Electronic address: danielwalker79@hotmail.com.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Walker
authors.affiliation: Departments of Upper GI and Obesity Surgery, Eastern Health - Box Hill Hospital, Box Hill, Australia.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Hii
authors.affiliation: Holy Spirit Northside Private Hospital, Chermside, Australia.
authors.forename: Christine E
authors.initials: CE
authors.lastname: Skinner
authors.affiliation: Royal Brisbane and Women's Hospital, Herston, Australia; Holy Spirit Northside Private Hospital, Chermside, Australia.
authors.forename: George H
authors.initials: GH
authors.lastname: Hopkins
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Gastrojejunostomy; LAGB failure; LAGB to RYGB conversion; Laparoscopic adjustable gastric band; Revisional bariatric surgery; Roux-en-Y gastric bypass