Jérôme Dargent1. 1. Polyclinique de Rillieux, 941, Rue Capitaine Julien, 69165 Rillieux-la-Pape Cedex, France. jerome.dargent@polyclinique-rillieux.fr
Abstract
BACKGROUND: The redo issue is a growing and debated issue in bariatric surgery. From the experience of failed vertical banded gastroplasty (VBG), we suggest that adjustable gastric band is a relevant method in many cases. METHODS: Ninety-eight patients have been operated on in a 13-year period (07/1995-07/2008). The cause of VBG failure has been staple disruption in 58% of cases and an outlet enlargement in 37% of cases. In the meantime, two gastric bypasses have been performed. Mean body mass index has been 38 (28-48) and was less than 35 in 37% of the cases. RESULTS: Postoperative complications occurred in seven cases, and the band had to be removed in five cases. Mean excess weight loss has been 52% at 8 years, yet 22% of the patients have been lost for follow-up. Slippage occurred in two patients and erosion in one. A final removal of the band has been necessary in two patients. CONCLUSIONS: VBG failures are highly common in the long run. Lap banding represents an interesting option for redo in a majority of cases, providing good long-term results and demonstrating that "restriction over restriction" can be a relevant strategy. The initial response to VBG has been a key information: if it has been successful in terms of weight loss and food tolerance, then lap banding was a valuable option. VBG has represented an interesting model because it has historical value and could be a procedure for the future if performed through endoscopic channels.
BACKGROUND: The redo issue is a growing and debated issue in bariatric surgery. From the experience of failed vertical banded gastroplasty (VBG), we suggest that adjustable gastric band is a relevant method in many cases. METHODS: Ninety-eight patients have been operated on in a 13-year period (07/1995-07/2008). The cause of VBG failure has been staple disruption in 58% of cases and an outlet enlargement in 37% of cases. In the meantime, two gastric bypasses have been performed. Mean body mass index has been 38 (28-48) and was less than 35 in 37% of the cases. RESULTS: Postoperative complications occurred in seven cases, and the band had to be removed in five cases. Mean excess weight loss has been 52% at 8 years, yet 22% of the patients have been lost for follow-up. Slippage occurred in two patients and erosion in one. A final removal of the band has been necessary in two patients. CONCLUSIONS: VBG failures are highly common in the long run. Lap banding represents an interesting option for redo in a majority of cases, providing good long-term results and demonstrating that "restriction over restriction" can be a relevant strategy. The initial response to VBG has been a key information: if it has been successful in terms of weight loss and food tolerance, then lap banding was a valuable option. VBG has represented an interesting model because it has historical value and could be a procedure for the future if performed through endoscopic channels.
Authors: Peter Vasas; Bruno Dillemans; Sebastiaan Van Cauwenberge; Marieke De Visschere; Charlotte Vercauteren Journal: Obes Surg Date: 2013-02 Impact factor: 4.129