Obesity Surgery

, Volume 19, Issue 12, pp 1612–1616 | Cite as

Safety and Short-Term Outcomes of Laparoscopic Sleeve Gastrectomy as a Revisional Approach for Failed Laparoscopic Adjustable Gastric Banding in the Treatment of Morbid Obesity

  • Emeka Acholonu
  • Etwar McBean
  • Ismael Court
  • Omar Bellorin
  • Samuel Szomstein
  • Raul J. RosenthalEmail author
Clinical Report


Laparoscopic sleeve gastrectomy (LSG) has been used as a first step of a two-stage approach in bariatric surgery for high-risk patients. Recently, LSG is being utilized as a primary and final procedure for morbid obesity with acceptable short-term results. The aim of this study is to investigate the effectiveness of LSG as a revisional procedure for patients with unsatisfactory outcomes after laparoscopic adjustable gastric band (LAGB). A retrospective review of a prospectively maintained database was performed. Data were reviewed for all patients undergoing revision from LAGB to LSG during the period May 2005 and May 2009. Data collected included demographics, indication for revision, operative time, length of stay, postoperative complications, and degree of weight reduction. Fifteen patients (three males and 12 females) had revisional surgery converting a LAGB to a LSG. The indication in four patients (26.66%) was weight regains and in five patients (33.33%) was poor weight loss; four patients (26.66%) had a band slippage and symptoms of gastroesophageal reflux, and one patient (6.66%) had poor weight loss, band slippage, and reflux. In one patient (6.66%), the indication was slippage and duodenal fistula. One-step revision procedure was done in 13 patients (86.66%), while two-step procedure was done in two patients (13.33%). Mean preoperative weight and BMI were 233.02 (181.4–300) lb and 38.66 (29.7–49.3) kg/m2, respectively. Mean weight loss at 2, 6, 12, 18, and 24 months postoperatively was 20.7, 48.3, 57.2, 60.1, and 13.5 lb, respectively. Mean % excess BMI loss was 28.9%, 64.2%, 65.3%, 65.7%, and 22.25% at 2, 6, 12, 18, and 24 months, respectively. There was one major complication (staple line leak) and one postoperative acute gastric outlet obstruction. We had no mortality. Thirteen patients were followed up postoperatively. The number decreased as follow-up time progressed. LSG could provide short-term weight loss after previously failed LABG, but prone to more complications compared to an initial LSG without a prior bariatric procedure.


Laparoscopic Sleeve gastrectomy Adjustable gastric banding 


  1. 1.
    Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery. 2004;135(3):326–51.CrossRefGoogle Scholar
  2. 2.
    Weiner R, Blanco-Engert R, Weiner S, et al. Outcome after laparoscopic adjustable gastric banding—8 years experience. Obes Surg. 2003;13(3):427–34.CrossRefGoogle Scholar
  3. 3.
    O’Brien PE, Dixon JB. Lap-Band: outcomes and results. J Laparoendosc Adv Surg Tech Part A. 2003;13(4):265–70.CrossRefGoogle Scholar
  4. 4.
    Biertho L, Steffen R, Branson R, et al. Management of failed adjustable gastric banding. Surgery. 2005;137(1):33–41.CrossRefGoogle Scholar
  5. 5.
    Suter M, Calmes JM, Paroz A, et al. A 10 year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates. Obes Surg. 2006;16(7):829–35.CrossRefGoogle Scholar
  6. 6.
    Baltasar A, Serra C, Perez N, et al. Laparoscopic sleeve gastrectomy: a multipurpose bariatric operation. Obes Surg. 2005;15:1124–8.CrossRefGoogle Scholar
  7. 7.
    Hess DS, Hess DW. Biliopancreatic diversion with duodenal switch. Obes Surg. 1998;8:267–82.CrossRefGoogle Scholar
  8. 8.
    Ren CJ, Patterson E, Gagner M. Early results of laparoscopic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg. 2000;10:514–23.CrossRefGoogle Scholar
  9. 9.
    Roa PE, Kaider-Person O, Rosenthal RJ, et al. Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obes Surg. 2006;16:1323–6.CrossRefGoogle Scholar
  10. 10.
    Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17:962–9.CrossRefGoogle Scholar
  11. 11.
    Cottam D, Qureshi FG, Schauer P. Laparoscopic sleeve gastrectomy as an initial weight-loss procedure for high-risk patients with morbid obesity. Surg Endosc. 2006;20:859–63.CrossRefGoogle Scholar
  12. 12.
    Bernante P, Foletto M, Busetto L. Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg. 2006;16:1327–30.CrossRefGoogle Scholar
  13. 13.
    Gagner M, Rogula T. Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg. 2003;13:649–54.CrossRefGoogle Scholar
  14. 14.
    De Waele B, Lauwers M, Delvaux G, et al. Outpatient laparoscopic gastric banding: initial experience. Obes Surg. 2004;14:1108–10.CrossRefGoogle Scholar
  15. 15.
    Vella M, Galloway DJ. Laparoscopic adjustable gastric banding for severe obesity. Obes Surg. 2003;13:642–8.CrossRefGoogle Scholar
  16. 16.
    Dargent J. Surgical treatment of morbid obesity by adjustable gastric band: the case for a conservative strategy in the case of failure—a 9 year series. Obes Surg. 2004;14(7):986–90.CrossRefGoogle Scholar
  17. 17.
    Schouten R, van Dielen FM, Greve JW. Re-operation after laparoscopic adjustable gastric banding leads to a further decrease in BMI and obesity-related co-morbidities: results in 33 patients. Obes Surg. 2006;16(7):821–8.CrossRefGoogle Scholar
  18. 18.
    Spivak H, Beltran OR, Wilson EB, et al. Laparoscopic revision from LAP-BAND to gastric bypass. Surg Endosc. 2007;21(8):1388–92.CrossRefGoogle Scholar
  19. 19.
    van Wageningen B, Berends FJ, Janssen IF. Revision of failed laparoscopic adjustable gastric banding to roux-en-y gastric bypass. Obes Surg. 2006;16(2):137–41.CrossRefGoogle Scholar
  20. 20.
    Topart P, Becouarn G, Ritz P. Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. Surg Obes Relat Dis. 2007;3(5):521–5.CrossRefGoogle Scholar
  21. 21.
    Di Betta E, Mittempergher F, Di Fabio F, et al. Duodenal switch without gastric resection after failed gastric restrictive surgery for morbid obesity. Obes Surg. 2006;16:258–61.CrossRefGoogle Scholar
  22. 22.
    Mognol P, Chosidow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: initial results in 10 patients. Obes Surg. 2005;15:1030–3.CrossRefGoogle Scholar
  23. 23.
    Krawczykowski DR, Lecko M, Nore O. Preliminary results with laparoscopic sleeve gastrectomy. Chir Gastroenterol. 2005;21(Suppl 1):1–5.Google Scholar
  24. 24.
    Dapri G, Cadière GB, Himpens J. Feasibility and technique of laparoscopic conversion of adjustable gastric banding to sleeve gastrectomy. Surgery for Obesity and Related Diseases. 2009;5:72–6.CrossRefGoogle Scholar
  25. 25.
    Frezza EE, Jaramillo-de la Torre EJ, Enriquez CC, et al. Laparoscopic sleeve gastrectomy after gastric banding removal: a feasibility study. Surgical Innovation. 2009;16:68–72.CrossRefGoogle Scholar
  26. 26.
    Deitel M, Crosby R, Gagner M. The first international consensus summit for sleeve gastrectomy. Obes Surg. 2008;18:487–96.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Emeka Acholonu
    • 1
  • Etwar McBean
    • 1
  • Ismael Court
    • 1
  • Omar Bellorin
    • 1
  • Samuel Szomstein
    • 1
  • Raul J. Rosenthal
    • 1
    Email author
  1. 1.The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General & Vascular SurgeryCleveland Clinic FloridaWestonUSA

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