Laparoscopic revisional bariatric surgery: myths and facts

Abstract

Laparoscopic revisional bariatric surgery is safe and effective. However, it should be performed only by experienced bariatric and laparoscopic surgeons.

Gastric banding: Conversion to sleeve, bypass, or DS

“…RYGB on the other hand appears to have adequate EWL, decreasing to 32 kg/m 2 from 45 kg/m 2 at 12 months in one study [17]. Furthermore, complication rates are similar to rebanding rates [11,14,17,[20][21][22]24]. When revisional surgery is performed by experienced hands, creation of an LRYGB after failed AGB can have similar complication rates as primary LRYGB surgery [8,14,17,19,21,24,25].…”

“…Nonetheless, in the setting of inadequate weight loss after band placement, RYGB appears to be a superior procedure [8,14,17,19,21,24,25]. Of four studies analyzing the results after rebanding only one reported postoperative BMI, and it was unchanged after 12 months [11,14,20,22].…”

“…such as band slippage, tubing leakage or breakage, motility problems caused by the band such as proximal pouch and esophageal dilatation, and dysmotility along with problems seen in other bariatric procedures such as inadequate weight loss and wound infection (Table 1) [11,14,17,[20][21][22]24]. Inadequate weight loss is considered \25% EWL as defined by the Reinhold criteria [1].…”

“…Studies including a total of 214 patients that had undergone RYGB or LRYGB after a failed placement of a band were found in the literature [14,17,21,24]. BMI prior to their revisional procedures was 38-45.8 kg/m 2 and dropped to 26-38 kg/m 2 after a follow-up of 12-18 months.…”

“…Complications include wound infection (2%); intestinal hemorrhage, fever, and small-bowel obstruction (SBO) requiring surgery (1%). Staple-line leaks, intra-abdominal abscesses, and pneumonia occurred in less than 1% [14,17,21,24]. Rutledge has also published on converting gastric band to mini-gastric bypass.…”