High secondary failure rate of rebanding after failed gastric banding
Autor: | Markus Weber, Markus K. Müller, Stephan M. Wildi, Nicolas Attigah, Pierre-Alain Clavien, Dieter Hahnloser, R. Hauser |
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Přispěvatelé: | University of Zurich, Weber, M |
Rok vydání: | 2007 |
Předmět: |
Adult
Male Reoperation medicine.medical_specialty Gastroplasty Gastric Bypass 610 Medicine & health Weight loss medicine Humans Treatment Failure Derivation Laparoscopy 10217 Clinic for Visceral and Transplantation Surgery medicine.diagnostic_test business.industry Stomach Middle Aged 2746 Surgery Endoscopy Surgery medicine.anatomical_structure Female Pouch medicine.symptom business Body mass index Abdominal surgery |
Zdroj: | Surgical Endoscopy. 22:448-453 |
ISSN: | 1432-2218 0930-2794 |
DOI: | 10.1007/s00464-007-9450-2 |
Popis: | Background: Over the last decade, more than 130,000 laparoscopic adjustable gastric bandings (LAGB) have been performed for the treatment of morbid obesity. Nowadays, longer follow-up data are available in the literature and increasing numbers of late complications and treatment failures of gastric banding have been reported. The aim of the present study was the long-term evaluation of two different rescue operations after failed LAGB: conversion to laparoscopic Roux-en-Y bypass (LRYGB) versus laparoscopic gastric rebanding. Methods: Between January 1997 and November 2002, 74 consecutive patients underwent either laparoscopic gastric rebanding (n = 44) or LRYGB (n = 30) after failed LAGB. There were 14 men and 60 women, with a median age of 42 (23-60) years. The indication for reoperation was an increasing body mass index (BMI) and band-related complications such as pouch dilatation, band slippage, and penetration after LAGB. Rebandings were done by preference during the initial period of the study and LRYGB was the treatment of choice during the latter period. The success of the rescue operation was assessed by postoperative changes in the BMI, improvements of co-morbidities, and the need for further reoperations (secondary failure). The median follow-up was 36 months (range, 24-60 months). Results: Patients who underwent LRYGB had a significantly better weight loss than patients with a rebanding operation (mean −6.1 versus +1.5 BMI points). In addition, the LRYGB patients showed a significantly better control of serum cholesterol during the long term follow-up (−0.6 versus +0.1 mmol/l). Almost half of the patients (45%) in the rebanding group needed a further operative revision, whereas only 20% underwent reoperation after rescue LRYGB. Thus, the secondary failure rate in the rebanding group was significantly higher compared to the bypass group (p = 0.028). Conclusions: The present long-term study confirms our previous finding that LRYGB is a better treatment than rebanding after failed laparoscopic gastric banding regarding weight loss and treatment of co-morbidities. During the long-term follow-up the reoperation rate due to secondary failure became significantly higher in the rebanding group. We therefore recommend that LRYGB should be preferred as rescue procedure after failed laparoscopic adjustable gastric banding |
Databáze: | OpenAIRE |
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