title: Laparoscopic sleeve gastrectomy after failed gastric banding: is it really effective? Six years of follow-up.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) has become a valuable surgical option to rescue laparoscopic adjustable gastric banding (LAGB) failures.
  
  
  OBJECTIVE
  The aim of this study was to determine whether conversion to LSG after failed LAGB (CLSG) is a well-tolerated and effective rescue procedure compared with primary LSG (PLSG) in the long term.
  
  
  METHODS
  University hospital, France.
  
  
  METHODS
  A retrospective review of data concerning consecutive patients receiving a LSG between February 2008 and December 2014 was conducted. Mortality, postoperative complications, and weight loss outcomes were analyzed.
  
  
  RESULTS
  Of 701 LSG, 601 (85.7%) were PLSG and 100 (14.3%) were CLSG. The mortality rate was 0%. Overall morbidity was comparable between the primary and conversion group (10% versus 6%, P = .27). The mean percentage of excess weight loss at 3, 36, and 72 months was 34.9%, 72.1%, and 57.2% after PLSG and 22.6%, 51.2% and 29.8% after CLSG (P<.05). The failure rate (mean percentage of excess weight loss<50%) was higher in the CLSG group during the first 5 postoperative years (P < .001) with more than two thirds of the CLSG considered as having failed at 60 months. Patients who underwent band ablation as a result of insufficient weight loss or weight regain presented the worst results after conversion to LSG.
  
  
  CONCLUSIONS
  In this study, the conversion of failed LAGB to LSG in 2 steps indicated a safety profile comparable to that of primary LSG but was significantly less effective from the early postoperative course (3 mo) up to 6 years postoperatively. CLSG may not be the best option because a third operation may be needed as a result of insufficient weight loss.
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital. Centre Intégré Nord Francilien de la Prise en Charge de l'Obésité (CINFO). Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, Bobigny, France; Department of General and Bariatric Surgery, Clinique Bouchard, Marseille, France. Electronic address: sergio.carandina@aphp.fr.
authors.forename: Sergio
authors.initials: S
authors.lastname: Carandina
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Hepato-Pancreato-Biliary Surgery, Liver Transplantation, Pitié-Salpêtrière University Hospital, Pierre & Marie Curie University, Paris, France. Electronic address: laurent.genser@aphp.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Genser
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital. Centre Intégré Nord Francilien de la Prise en Charge de l'Obésité (CINFO). Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, Bobigny, France.
authors.forename: Manuela
authors.initials: M
authors.lastname: Bossi
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital. Centre Intégré Nord Francilien de la Prise en Charge de l'Obésité (CINFO). Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, Bobigny, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Polliand
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital. Centre Intégré Nord Francilien de la Prise en Charge de l'Obésité (CINFO). Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, Bobigny, France.
authors.forename: Malek
authors.initials: M
authors.lastname: Tabbara
authors.affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital. Centre Intégré Nord Francilien de la Prise en Charge de l'Obésité (CINFO). Université Paris XIII-UFR SMBH "Léonard de Vinci", AP-HP, Bobigny, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Barrat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D015331:Cohort Studies; D020878:Device Removal; D005743:Gastrectomy / Q000379:methods*; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult
keywords: 2-step procedure; Gastric banding failure; Long-term results; Rescue procedure; Sleeve gastrectomy