title: Five-year weight loss in primary gastric bypass and revisional gastric bypass for failed adjustable gastric banding: results of a case-matched study.
abstract: BACKGROUND
  Despite their now frequent use, the long-term results for adjustable gastric bands are variable and often less than gastric bypass. Laparoscopic Roux-en-Y gastric bypass (LRYGB) provides good early results and seems to be the revisional procedure of choice. Nevertheless, the long-term outcomes following revisional LRYGB (rLRYGB) for failed adjustable gastric banding have not been compared with those for primary LRYGB (pLRYGB).
  
  
  METHODS
  The objective was to compare weight loss and changes in obesity related co-morbidities 5 years after pLRYGB and rLRYGB for failed adjustable gastric banding. The prospective database of a single surgery university center (Paris, France) was queried for clinical and other relevant data. From January 2004 to September 2008, 58 and 272 patients have undergone rLRYGB and pLRYGB, respectively. Rate of lost to follow-up was 13.3%. We matched 45 patients undergoing rLRYGB (case group) with 45 undergoing pLRYGB (control group) for age, sex, and initial body mass index (BMI).
  
  
  RESULTS
  Case and control groups did not differ for initial BMI (46.9±7.2 versus 46.9±7.5 kg/m²; P=.99), age (43.4±9.4 versus 43.6±9.8y; P=.91), or sex ratio (91.1% female, P=.99). The rates of coexisting conditions in the 2 groups were similar. At 5 years, weight loss (kg) (39.9±16.4 versus 31.4±15.8; P=.02), percentage of weight loss (%) (30.8±9.8 versus 24.8±11.5; P=.03), and percentage of excess weight loss (%) (68.4±20.6 versus 55.7±26.3; P=.007) were higher for pLRYGB than rLRYGB. Rates of remission and improvement of coexisting conditions were similar.
  
  
  CONCLUSIONS
  After 5 years of follow-up, pLRYGB provides greater weight loss than rLRYGB with similar rates of improvement and remission of coexisting conditions. Patients and surgeons should be aware of such results before primary and revisional bariatric surgery.
authors.affiliation: Department of General, Digestive and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique- Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100 Boulogne, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Thereaux
authors.affiliation: Department of General, Digestive and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique- Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100 Boulogne, France.
authors.forename: Nicola
authors.initials: N
authors.lastname: Corigliano
authors.affiliation: Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique- Hôpitaux de Paris, Pierre-et-Marie-Curie-Paris 6 University, Human Nutrition Research Center Île-de-France (CRNH IdF), Institute of cardiometabolic disease and nutrition (ICAN), 83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Poitou
authors.affiliation: Department of Nutrition, Pitié-Salpêtrière Hospital, Assistance Publique- Hôpitaux de Paris, Pierre-et-Marie-Curie-Paris 6 University, Human Nutrition Research Center Île-de-France (CRNH IdF), Institute of cardiometabolic disease and nutrition (ICAN), 83, boulevard de l'Hôpital, 75013 Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Oppert
authors.affiliation: Department of Nutrition, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique- Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100 Boulogne, France; Centre for Research in Epidemiology and Population Health (INSERM U1018), Paul Brousse Hospital, Villejuif, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Czernichow
authors.affiliation: Department of General, Digestive and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique- Hôpitaux de Paris, 9, Avenue Charles de Gaulle, 92100 Boulogne, France. Electronic address: jl.bouillot@apr.aphp.fr.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bouillot
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D011184:Postoperative Period; D012086:Reoperation; D017211:Treatment Failure; D015431:Weight Loss
keywords: Bariatric surgery; Failed adjustable gastric banding; Gastric bypass; Midterm outcomes