One-year weight loss after primary or revisional Roux-en-Y gastric bypass for failed adjustable gastric banding.

BACKGROUND: Adjustable gastric banding has been widely used in Europe, but recently gastric bypass (Roux-en-Y gastric bypass [RYGB]) has become the procedure of choice. With a gastric banding failure rate of nearly 40% at 5 years, the need for revisional surgery is increasing. The effect of a failed previous bariatric surgery on the weight loss curve after RYGB is still a controversial issue.

METHODS: A total of 259 patients underwent RYGB from 2003 to 2007, 58 after failed gastric banding and 201 as primary surgery. All the procedures were laparoscopically performed by the same surgeon at a single institution. The postoperative course and the percentage of excess weight loss were compared between the 2 groups.

RESULTS: The 2 groups were similar in age and initial body mass index (46.3 +/- 7.2 kg/m(2) for revision versus 47.7 +/- 6.7 kg/m(2) for primary RYGB). In contrast, the prerevision body mass index was 43.2 +/- 7.0 kg/m(2). Revisional RYGB required a significantly longer operative time (128.3 +/- 25.9 minutes versus 89.0 +/- 14.7 minutes, P <.0001) and the morbidity was greater (8.6% versus 5.5%), but no patient died in the postoperative period after revision. As determined from the initial body mass index, the 1-year percentage of excess weight loss was comparable between the 2 groups (66.1% +/- 26.8% and 70.4% +/- 18.9%).

CONCLUSION: When RYGB is performed after an adjustable gastric band failure to restore weight loss or because of a complication, the weight loss curve is similar to that after primary RYGB. Therefore, the strategy of adjustable gastric banding first is an option that does not seem to preclude satisfactory weight loss after revision to RYGB.