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Surg Obes Relat Dis. 2018 Dec;14(12):1869-1875. doi: 10.1016/j.soard.2018.09.003. Epub 2018 Sep 13.

Large series examining laparoscopic adjustable gastric banding as a salvage solution for failed gastric bypass.

Author information

1
Center for Bariatric Medicine and Surgery, Hackensack University Medical Center, Hackensack, New Jersey. Electronic address: hans.schmidt@hackensackmeridian.org.
2
Department of Surgery, Stanford University School of Medicine, Stanford, California.
3
Center for Bariatric Medicine and Surgery, Hackensack University Medical Center, Hackensack, New Jersey.
4
Department of Research, Hackensack University Medical Center, Hackensack, New Jersey.
5
Department of Surgery, Baylor University Medical Center at Trophy Club, Trophy Club, Texas.

Abstract

BACKGROUND:

The Roux-en-Y gastric bypass (RYGB) has long been considered the gold standard of weight loss procedures. However, there is limited evidence on revisional options with both minimal risk and long-term weight loss results.

OBJECTIVE:

To examine percent excess weight loss, change in body mass index (BMI), and complications in patients who underwent laparoscopic adjustable gastric banding (LAGB) over prior RYGB.

SETTING:

Academic hospital.

METHODS:

Retrospective analysis of a single-center prospectively maintained database. Three thousand ninety-four LAGB placements were reviewed; 139 were placed in patients with prior RYGB.

RESULTS:

At the time of LAGB, the median BMI was 41.3. After LAGB, we observed weight loss or stabilization in 135 patients (97%). The median maximal weight loss after LAGB was 37.7% excess weight loss and -7.1 change in BMI (P < .0001). At last follow-up visit, the median weight loss was 27.5% excess weight loss and -5.3 change in BMI (P < .0001). Median follow-up was 2.48 years (.01-11.48): 68 of 132 eligible (52%) with 3-year follow-up, 12 of 26 eligible (44%) with 6-year eligible follow-up, and 3 of 3 eligible (100%) with >10-year follow-up. Eleven bands required removal, 4 for erosion, 4 for dysphagia, and 3 for nonband-related issues.

CONCLUSIONS:

LAGB over prior RYGB is a safe operation, which reduces the surgical risks and nutritional deficiencies often seen in other accepted revisional operations. Complication rates were consistent with primary LAGB. Weight loss is both reliable and lasting, and it can be considered as the initial salvage procedure in patients with failed gastric bypass surgery.

KEYWORDS:

Adjustable gastric banding; Bariatric surgery; Gastric bypass; Gastric bypass failure; Laparoscopic adjustable gastric banding; Laparoscopic gastric banding; Morbid obesity; Revision surgery; Weight loss failure

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