Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass.

BACKGROUND: The most common bariatric surgical operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported to have a high incidence of long-term complications. Also, insufficient weight loss is reported. We investigated whether revision to Roux-en-Y gastric bypass (RYGBP) is a safe and effective therapy for failed LAGB and for further weight loss.

METHODS: From Jan 1999 to May 2004, 613 patients underwent LAGB. Of these, 47 underwent later revisional Roux-en-Y gastric bypass (RYGBP). Using a prospectively collected database, we analyzed these revisions. All procedures were done by two surgeons with extensive experience in bariatric surgery.

RESULTS: All patients were treated with laparoscopic (n=26) or open (n=21) RYGBP after failed LAGB. Total follow-up after LAGB was 5.5+/-2.0 years. For the RYGBP, mean operating time was 161+/-53 minutes, estimated blood loss was 219+/-329 ml, and hospital stay was 6.7+/-4.5 days. There has been no mortality. Early complications occurred in 17%. There was only one late complication (2%)--a ventral hernia. The mean BMI prior to any form of bariatric surgery was 49.2+/-9.3 kg/m2, and decreased to 45.8+/-8.9 kg/m2 after LAGB and was again reduced to 37.7+/-8.7 kg/m2 after RYGBP within our follow-up period.

CONCLUSION: Conversion of LAGB to RYGBP is effective to treat complications of LAGB and to further reduce the weight to healthier levels in morbidly obese patients.