Pierre Fournier1, Daniel Gero2, Anna Dayer-Jankechova3, Pierre Allemann1, Nicolas Demartines1, Jean-Pierre Marmuse2, Michel Suter4. 1. Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. 2. Department of Digestive Surgery, Bichat-Claude-Bernard University Hospital, Paris, France. 3. Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland. 4. Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Department of Surgery, Riviera-Chablais Hospital, Aigle-Monthey, Switzerland. Electronic address: michelsuter@netplus.ch.
Abstract
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a well-tolerated procedure but has high long-term complication and failure rates. Laparoscopic conversion to Roux-en-Y gastric bypass (LRYGB) is one of the rescue strategies. OBJECTIVES: To analyze short- and long-term results of reoperative LRYGB after failed LAGB. SETTING: Three European expert bariatric center (2 university hospitals and 1 regional hospital). METHODS: A retrospective review of prospectively collected data, including all consecutive patients submitted to revisional LRYGB for failed LAGB between 1999 and 2013, was performed. Complications were classified according to the Dindo-Clavien system. Long-term results in terms of weight loss were analyzed in a subgroup of patients. RESULTS: A total of 642 patients (569 women and 73 men) were included. Mean±standard deviation operating time was 188±43 minutes. There was no mortality and an overall complication rate of 9.7%, including 3.6% major complications, with no difference between the 1- or 2-step approaches. Follow-up rate was 88% at 10 years for the Swiss patient cohort. The mean excess body mass index loss was between 65% and 70% throughout the study period, and the mean total weight loss was between 28% and 30% based on the maximum weight. The mean body mass index decreased from 44.7 kg/m(2) before LAGB to 31.6, 32.2, and 32.5 kg/m(2) at 1, 5, and 10 years after revision. CONCLUSIONS: Revisional LRYGB is well tolerated and feasible after failed LAGB. A 1-step approach, in cases without erosion, does not increase operative morbidity. Results up to 10 years after revision are comparable to those reported after primary LRYGB.
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is a well-tolerated procedure but has high long-term complication and failure rates. Laparoscopic conversion to Roux-en-Y gastric bypass (LRYGB) is one of the rescue strategies. OBJECTIVES: To analyze short- and long-term results of reoperative LRYGB after failed LAGB. SETTING: Three European expert bariatric center (2 university hospitals and 1 regional hospital). METHODS: A retrospective review of prospectively collected data, including all consecutive patients submitted to revisional LRYGB for failed LAGB between 1999 and 2013, was performed. Complications were classified according to the Dindo-Clavien system. Long-term results in terms of weight loss were analyzed in a subgroup of patients. RESULTS: A total of 642 patients (569 women and 73 men) were included. Mean±standard deviation operating time was 188±43 minutes. There was no mortality and an overall complication rate of 9.7%, including 3.6% major complications, with no difference between the 1- or 2-step approaches. Follow-up rate was 88% at 10 years for the Swiss patient cohort. The mean excess body mass index loss was between 65% and 70% throughout the study period, and the mean total weight loss was between 28% and 30% based on the maximum weight. The mean body mass index decreased from 44.7 kg/m(2) before LAGB to 31.6, 32.2, and 32.5 kg/m(2) at 1, 5, and 10 years after revision. CONCLUSIONS: Revisional LRYGB is well tolerated and feasible after failed LAGB. A 1-step approach, in cases without erosion, does not increase operative morbidity. Results up to 10 years after revision are comparable to those reported after primary LRYGB.
Authors: Mauricio Gonzalez-Urquijo; David E Hinojosa-Gonzalez; Ale Gibran Alam Gidi; Sofia Hurtado Arellano; Eduardo Flores-Villalba; Javier Rojas-Mendez Journal: Surg Endosc Date: 2021-10-27 Impact factor: 3.453