Is Laparoscopic Gastric Bypass a Reliable Procedure After an Adjustable Gastric Band?

Diego Barros, MD, Jose Salinas, MD, Ricardo Funke, MD, Alejandro Raddatz, MD, Luis Ibanez, MD, Gustavo Perez, MD, Fernando Pimentel, MD, Camilo Boza, MD

Pontificia Universidad Catolica de Chile

Introduction: Laparoscopic adjustable gastric band (LAGB) is one of the most frequently performed bariatric procedures due to a low morbidity published and good short-term results. Unsatisfactory long-term outcomes reported have motivated different surgeons to perform others procedures instead. In some patients, the lack of satisfactory results in term of weight loss, determine its conversion to a different procedure. The objective of this study is to evaluate the experience in our institution of patients who underwent a revisional laparoscopic gastric bypass after removal of an adjustable gastric band.

Methods: Retrospective study of patients with an adjustable gastric band installed who underwent a gastric bypass as revisional surgery. Demographic data, comorbidities, surgical interval, surgical indication and outcomes were studied.

Results: A total of 37 revisional gastric bypasses were performed in patients with an adjustable gastric band from January 2000 until July 2011. Ten patients had the gastric band installed in our institution (27 %) accounting a 4.9 % of revisional bypass of the 202 LAGB performed in our institution. Gastric band was removed in one stage on 21 patients (56.8%), the median time of band removal was 3 (0-60) months. The most frequent indication for revisional surgery was low weight loss in 29 patients (78.4%). Ten patients reported a poor quality of life (27%), 3 gastro esophageal reflux disease (8.1%), 1 patient presented frequent vomiting (2.7%) and 1 band migration (2.7%). Median preoperative BMI was 37.1 kg/m2 for LAGB and 37.8 kg/m2 for LRYGB. Median operative time for LRYGB was 135 minutes, 75.7% of LRYGB were performed laparoscopically, no conversion to open surgery in this series. There were 2 postoperative early complications (5.4%), an upper GI bleeding and an anastomotic leak, and 8 late complications (21.6%) corresponding to 3 gastrojejunal stenosis (8.1%), 3 mechanical ileus (8.1%), 2 GERD (5.4%) and 1 dumping syndrome (2.7%). Median BMI at 1 postoperative year was 29.0 kg/m2.

Conclusion: Revisional gastric bypass subsequent a LAGB is a procedure that can be performed by laparoscopic approach satisfactorily with significant weight loss at one year, however, it´s associated with a higher incidence of complications compared to non revisional surgery.

Session: Poster Presentation

Program Number: P448

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