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News

Revisional surgery after failed laparoscopic adjustable gastric banding

This month's issue of Surgical Endoscopy reviews revisional surgery after failed laparoscopic adjustable gastric banding,

News image

Laparoscopic adjustable gastric banding has emerged as one of the most commonly performed bariatric procedures worldwide.

Unfortunately, revisional surgery is required in 20–30% of cases.

Dr Ahmad Elnahas and colleagues reported that the several revisional strategies have been proposed, but there is no consensus regarding the best surgical option.

This systematic review was designed to determine which revisional surgery is best suited to enhance weight loss following failed laparoscopic adjustable gastric banding due to complications or inadequate weight loss.

The research team searched EMBASE, MEDLINE, PsycINFO, and Cochrane Clinical Trials using the most comprehensive timeline for each database.

A total of 24 relevant articles were identified.

The doctors reported that 2 investigators independently extracted data, and differences were resolved by consensus.

The weighted means were calculated for weight loss measurements.

The team of doctors examined that a total of 106, 514, and 71 patients underwent conversion from laparoscopic adjustable gastric banding to laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic biliopancreatic diversion and duodenal switch, respectively.

The weighted mean body mass index was 39 kg/m2 for the laparoscopic sleeve gastrectomy
Surgical Endoscopy

Before revisional surgery, the weighted mean body mass index was 39, 43, and 41 kg/m2 for the laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and biliopancreatic diversion and duodenal switch groups, respectively.

The majority of data was reported at 12–24 months follow-up.

The researchers noted that the mean body mass index within this interval was 28 , 32, and 33 kg/m2 for the laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and biliopancreatic diversion and duodenal switch groups, respectively.

In addition, the mean excess weight loss was 22%, 58%, 47% for the laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and biliopancreatic diversion and duodenal switch groups, respectively.

The excess weight loss reached 78.% in the biliopancreatic diversion and duodenal switch group after 2-year follow-up.

Failed Laparoscopic adjustable gastric banding is best managed with conversion to another bariatric procedure.

Dr Elnahas's team commented "Stable weight loss occurs with salvage laparoscopic Roux-en-Y gastric bypass."

"Although results for revisional biliopancreatic diversion and duodenal switch appear promising, additional research, with higher methodological quality, is needed."

Surg Endoscopy 2013: 27(3): 740-745
02 April 2013

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