title: Laparoscopic Adjustable Gastric Banding Revisions in Singapore: a 10-Year Experience.
abstract: BACKGROUND
  Bariatric surgery is increasingly being carried out and revisional procedures have also risen in concert. A review of the complications and revisions might elucidate technical and patient factors that influence the outcomes of bariatric surgeries in Asian patients. The objective of this study is to review the safety and efficacy of revisional bariatric surgery in a single center in Singapore over a 10-year period.
  
  
  METHODS
  The setting of this study is a single public hospital with a multidisciplinary bariatric service including a weight management center, specialized endocrinology services, and bariatric surgical team. Participants were selected for surgery based on body mass index (BMI) and comorbidities. All patients underwent primary laparoscopic adjustable gastric banding (LAGB). Patients were then analyzed according to the types of revisional surgeries. The primary outcome was the type of complications and revisional surgeries. Secondary outcomes include short-term excess weight loss and further complications.
  
  
  RESULTS
  A total of 365 patients were analyzed. 9.6% had a secondary procedure. In particular, two groups of complications required revisional surgery: failure of sustained weight loss and complications related to the LAGB insertion and use. Revisional surgeries had equivalent major complication rates (5.7%) compared to primary bariatric surgeries (6.8%). Revisional surgeries such as revisional LAGB (4.9 ± 9.8 kg), laparoscopic sleeve gastrectomy (LSG; 6.9 ± 21.0 kg), Roux-en-Y gastric bypass (RYGB; 4.6 ± 13.0 kg), and bilio-pancreatic diversion (BPD; 3.5 ± 6.3 kg) had modest weight loss compared to primary weight loss (12.7 ± 9.5 kg). Primary LAGB had a greater percentage excess weight loss in the first and second years post-surgery compared to revisional surgeries. There was one mortality post-primary surgery and no post-revisional surgical mortalities.
  
  
  CONCLUSIONS
  Revisional bariatric surgery for complications related to the primary surgery is safe but had reduced excess weight loss compared to the initial surgery.
authors: Division of Surgery, University Surgical Cluster, National University Hospital Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 8, 119228, Singapore City, Singapore. kee_yuan_ngiam@nuhs.edu.sg.
authors: Kee Yuan
authors: KY
authors: Ngiam
authors: Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, 117597, Singapore City, Singapore.
authors: Valerie Yu Hui
authors: VY
authors: Khoo
authors: Department of Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore City, Singapore.
authors: Lucy
authors: L
authors: Kong
authors: Department of Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore City, Singapore.
authors: Anton Kui Sing
authors: AK
authors: Cheng
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000601:surgery; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology
keywords: Bariatric surgery; Bilio-pancreatic diversion; Complications; Laparoscopic adjustable gastric banding; Medium-term outcomes; Revisional surgery; Roux-en-Y gastric bypass; Sleeve gastrectomy