title: Laparoscopic Adjustable Gastric Band: Complications, Removal and Revision in a Portuguese Highly Differentiated Obesity Treatment Center.
abstract: BACKGROUND
  Our objective is to determine which complications lead to reoperation, and the outcomes of reoperation using laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy at Centro Hospitalar de São João.
  
  
  METHODS
  Observational study. Patients included were aged 18 to 65 years at first gastric banding, underwent removal from March 21st 2007 to January 23rd 2014 and were subsequently converted to gastric banding, gastric bypass or sleeve gastrectomy. Women who got pregnant during the initial gastric banding follow-up and patients that performed more than one conversion were excluded.
  
  
  RESULTS
  A total of 103 patients were included. Fifteen underwent revision to gastric banding, 71 to gastric bypass and 17 to sleeve gastrectomy. Respectively, percentage of excess weight loss at 1 month were 1.9 ± 12.2% in 6 patients, 36.9 ± 18.2% in 49 patients and 27.1% (13.3 - 68.6) in 11 patients (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p < 0.001, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0.002 and laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0.474). At 3 months there were 12.8% (5.7 - 84.8) in 6 patients, 44.8 ± 19.7% in 24 patients and 48 ± 20.1% in 8 patients (laparoscopic adjustable-gastric banding-laparoscopic Roux-en-Y gastric bypass p = 0.017, laparoscopic adjustable-gastric banding-laparoscopic sleeve gastrectomy p = 0.039 and laparoscopic Roux-en-Y gastric bypass-laparoscopic sleeve gastrectomy p = 0.691).
  
  
  CONCLUSIONS
  At revision, ages and body mass indices are higher than other studies. Gastric bypass is the preferred revision surgery, because combines restriction and malabsorption, surgeons have more experience and long term outcomes are better described.
  
  
  CONCLUSIONS
  The main indications for reoperation were inadequate weight loss (37.4%) and band slippage (30%). At short term, in our patients, gastric banding as a revision surgery was not effective, as opposed to gastric bypass and sleeve gastrectomy.
authors: Center for Research in Health Technology and Services Research (CINTESIS). Porto. Portugal. Faculty of Medicine. University of Porto. Porto. Portugal.
authors: Alfredo
authors: A
authors: Mendes-Castro
authors: Faculty of Medicine. University of Porto. Porto. Portugal.
authors: Joana
authors: J
authors: Montenegro
authors: Faculty of Medicine. University of Porto. Porto. Portugal.
authors: Jorge Félix
authors: JF
authors: Cardoso
authors: Faculty of Medicine. University of Porto. Porto. Portugal.
authors: Gisela
authors: G
authors: Simões
authors: Faculty of Medicine. University of Porto. Porto. Portugal.
authors: Catarina
authors: C
authors: Ferreira
authors: Faculty of Medicine. University of Porto. Porto. Portugal. Surgery Department. Centro Hospitalar de São João. Porto. Portugal.
authors: John
authors: J
authors: Preto
authors: Faculty of Medicine. University of Porto. Porto. Portugal. Surgery Department. Centro Hospitalar de São João. Porto. Portugal.
authors: Silvestre
authors: S
authors: Carneiro
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult