Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass

Background: The most common bariatric surgical operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported to have a high incidence of long-term complications. Also, insufficient weight loss is reported. We investigated whether revision to Roux-en-Y gastric bypass (RYGBP) is a safe and effective therapy for failed LAGB and for further weight loss. Methods: From Jan 1999 to May 2004, 613 patients underwent LAGB. Of these, 47 underwent later revisional Roux-en-Y gastric bypass (RYGBP). Using a prospectively collected database, we analyzed these revisions. All procedures were done by two surgeons with extensive experience in bariatric surgery. Results: All patients were treated with laparoscopic (n=26) or open (n=21) RYGBP after failed LAGB. Total follow-up after LAGB was 5.5 +/- 2.0 years. For the RYGBP, mean operating time was 161 +/- 53 minutes, estimated blood loss was 219 +/- 329 ml, and hospital stay was 6.7 +/- 4.5 days. There has been no mortality. Early complications occurred in 17%. There was only one late complication (2%) - a ventral hernia. The mean BMI prior to any form of bariatric surgery was 49.2 +/- 9.3 kg/m(2), and decreased to 45.8 +/- 8.9 kg/m(2) after LAGB and was again reduced to 37.7 +/- 8.7 kg/m(2) after RYGBP within our follow-up period. Conclusion: Conversion of LAGB to RYGBP is effective to treat complications of LAGB and to further reduce the weight to healthier levels in morbidly obese patients.