Abstract
Laparoscopic adjustable gastric banding (LAGB) is the first bariatric procedure in Europe and is becoming more and more popular in North America. However, the failure rate at 5 years can reach 50%. Although there is still no consensus on revisional surgery, the trend seems to be in favor of conversion to gastric bypass (GBP) with encouraging results. The aim of this study was to assess the results, the risks of conversion into GBP after failure of gastric banding. From January 2003 to July 2010, 85 patients had a revisional GBP after failure of LAGB, performed by two experienced surgeons. Post-operative morbidity, functional results, and weight loss were analyzed. The conversion rate was 2.3%. The mean operative time was 166 min. The mean length of stay was 5.2 days. The early morbidity rate was 7% and the mortality rate was nil. The mean body mass index (BMI) at the time of LAGB was 47.2 kg/m2 with the lowest BMI reached at 35. The mean BMI at conversion into GBP was 42.9 and the final BMI after a mean follow-up of 22 months was 34.8. Of the patients, 57.7% had a final BMI inferior to 35 and 15.3% had a final BMI superior to 40 and these were super obese and older patients. Super-obesity and advanced age appear to be factors of failure of LAGB and revisional GBP. However, conversion into GBP currently remains the choice procedure in case of gastric banding failure with satisfactory results and acceptable morbidity.
References
Suter M, Calmes JM, Paroz A, et al. A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg. 2006;16:829–35.
Topart P, Becouarn G, Ritz P. One-year weight loss after primary or revisional Roux-en-Y gastric bypass for failed adjustable gastric banding. Surg Obes Relat Dis. 2009;5(4):459–62.
DeMaria EJ, Sugerman HJ, Meador JG, et al. High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity. Ann Surg. 2001;233:809–18.
te Riele WW, Sze YK, Wiezer MJ, et al. Conversion of failed laparoscopic gastric banding to gastric bypass as safe and effective as primary gastric bypass in morbidly obese patients. Surg Obes Relat Dis. 2008;4:735–9.
Bueter M, Thalheimer A, Wierlemann A, et al. Reoperations after gastric banding: replacement or alternative procedures? Surg Endosc. 2009;23:334–40.
Weiss HG, Kirchmayr W, Klaus A, et al. Surgical revision after failure of laparoscopic adjustable gastric banding. Br J Surg. 2004;91:235–41.
Mognol P, Chosidow D, Marmuse JP. Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg. 2004;14:1349–53.
Favretti F, Cadiere GB, Segato G, et al. Laparoscopic adjustable silicone gastric banding (Lap-Band): how to avoid complications. Obes Surg. 1997;7:352–8.
Morino M, Toppino M, Garrone C. Disappointing long-term results of laparoscopic adjustable silicone gastric banding. Br J Surg. 1997;84:868–9.
Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc. 2007;21(11):1931–5.
Lonroth H, Dalenback J, Haglind E, et al. Laparoscopic gastric bypass. Another option in bariatric surgery. Surg Endosc. 1996;10:636–8.
Calmes JM, Giusti V, Suter M. Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg. 2005;15:316–22.
Suter M, Giusti V, Heraief E, et al. Laparoscopic gastric banding. Surg Endosc. 2003;17:1418–25.
van Wageningen B, Berends FJ, Van Ramshorst B, et al. Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg. 2006;16:137–41.
Weber M, Muller MK, Michel JM, et al. Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg. 2003;238:827–33. discussion 833–4.
Cohen R, Pinheiro JS, Correa JL, et al. Laparoscopic revisional bariatric surgery: myths and facts. Surg Endosc. 2005;19:822–5.
Westling A, Ohrvall M, Gustavsson S. Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery. J Gastrointest Surg. 2002;6:206–11.
Suter M, Giusti V, Heraief E, et al. Band erosion after laparoscopic gastric banding: occurrence and results after conversion to Roux-en-Y gastric bypass. Obes Surg. 2004;14:381–6.
Samuel I, Mason EE, Renquist KE, et al. Bariatric surgery trends: an 18-year report from the international bariatric surgery registry. Am J Surg. 2006;192:657–62.
Schouten R, van Dielen FM, Greve JW. Re-operation after laparoscopic adjustable gastric banding leads to a further decrease in BMI and obesity-related co-morbidities: results in 33 patients. Obes Surg. 2006;16:821–8.
Merrouche M, Sabate JM, Jouet P, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg. 2007;17:894–900.
Gamagaris Z, Patterson C, Schaye V, et al. Lap-band impact on the function of the esophagus. Obes Surg. 2008;18:1268–72.
Cruiziat C, Roman S, Robert M et al. High resolution esophageal manometry in symptomatic patients after gastric banding for morbid obesity. Dig Liver Dis. 2010;43:116–20.
Rubino F, Gagner M, Gentileschi P, et al. The early effect of the ROUX-en-Y gastric bypass on hormones involved in body weight regulation and glucose metabolism. Ann Surg. 2004;240:236–42.
Nesset EM, Kendrick ML, Houghton SG, et al. A two-decade spectrum of revisional bariatric surgery at a tertiary referral center. Surg Obes Relat Dis. 2007;3:25–30. discussion 30.
Roller JE, Provost DA. Revision of failed gastric restrictive operations to Roux-en-Y gastric bypass: impact of multiple prior bariatric operations on outcome. Obes Surg. 2006;16:865–9.
Branson R, Potoczna N, Kral JG, et al. Binge eating as a major phenotype of melanocortin 4 receptor gene mutations. N Engl J Med. 2003;348:1096–103.
Branson R, Potoczna N, Brunotte R, et al. Impact of age, sex and body mass index on outcomes at four years after gastric banding. Obes Surg. 2005;15:834–42.
Potoczna N, Branson R, Kral JG, et al. Gene variants and binge eating as predictors of comorbidity and outcome of treatment in severe obesity. J Gastrointest Surg. 2004;8:971–81.
Weber M, Muller MK, Bucher T, et al. Laparoscopic gastric bypass is superior to laparoscopic gastric banding for treatment of morbid obesity. Ann Surg. 2004;240:975–82.
Colquitt JL, Picot J, Loveman E, et al. Surgery for obesity. Cochrane Database Syst Rev. 2009;2:CD003641.
Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg. 2005;15:1030–3.
Peterli R, Wolnerhanssen BK, Peters T, et al. Prospective study of a two-stage operative concept in the treatment of morbid obesity: primary lap-band followed if needed by sleeve gastrectomy with duodenal switch. Obes Surg. 2007;17:334–40.
Keshishian A, Zahriya K, Hartoonian T, et al. Duodenal switch is a safe operation for patients who have failed other bariatric operations. Obes Surg. 2004;14:1187–92.
Gagner M, Matteotti R. Laparoscopic biliopancreatic diversion with duodenal switch. Surg Clin North Am. 2005;85:141–9.
Gagner M, Boza C. Laparoscopic duodenal switch for morbid obesity. Expert Rev Med Devices. 2006;3:105–12.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors certify having no commercial interest in the subject of study.
Rights and permissions
About this article
Cite this article
Robert, M., Poncet, G., Boulez, J. et al. Laparoscopic Gastric Bypass for Failure of Adjustable Gastric Banding: A Review of 85 Cases. OBES SURG 21, 1513–1519 (2011). https://doi.org/10.1007/s11695-011-0391-4
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-011-0391-4