title: Laparoscopic Roux-en-Y gastric bypass for failed gastric banding: outcomes in 642 patients.
abstract: BACKGROUND
  Laparoscopic adjustable gastric banding (LAGB) is a well-tolerated procedure but has high long-term complication and failure rates. Laparoscopic conversion to Roux-en-Y gastric bypass (LRYGB) is one of the rescue strategies.
  
  
  OBJECTIVE
  To analyze short- and long-term results of reoperative LRYGB after failed LAGB.
  
  
  METHODS
  Three European expert bariatric center (2 university hospitals and 1 regional hospital).
  
  
  METHODS
  A retrospective review of prospectively collected data, including all consecutive patients submitted to revisional LRYGB for failed LAGB between 1999 and 2013, was performed. Complications were classified according to the Dindo-Clavien system. Long-term results in terms of weight loss were analyzed in a subgroup of patients.
  
  
  RESULTS
  A total of 642 patients (569 women and 73 men) were included. Mean±standard deviation operating time was 188±43 minutes. There was no mortality and an overall complication rate of 9.7%, including 3.6% major complications, with no difference between the 1- or 2-step approaches. Follow-up rate was 88% at 10 years for the Swiss patient cohort. The mean excess body mass index loss was between 65% and 70% throughout the study period, and the mean total weight loss was between 28% and 30% based on the maximum weight. The mean body mass index decreased from 44.7 kg/m(2) before LAGB to 31.6, 32.2, and 32.5 kg/m(2) at 1, 5, and 10 years after revision.
  
  
  CONCLUSIONS
  Revisional LRYGB is well tolerated and feasible after failed LAGB. A 1-step approach, in cases without erosion, does not increase operative morbidity. Results up to 10 years after revision are comparable to those reported after primary LRYGB.
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournier
authors.affiliation: Department of Digestive Surgery, Bichat-Claude-Bernard University Hospital, Paris, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gero
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland.
authors.forename: Anna
authors.initials: A
authors.lastname: Dayer-Jankechova
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Allemann
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.affiliation: Department of Digestive Surgery, Bichat-Claude-Bernard University Hospital, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Marmuse
authors.affiliation: Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland. Electronic address: michelsuter@netplus.ch.
authors.forename: Michel
authors.initials: M
authors.lastname: Suter
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D015391:Gastroplasty / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complications; Gastric banding; Long-term; Revisional surgery; Roux-en-Y gastric bypass