Study on Band to Sleeve Revisions
I too had a 34F, and wonder if a Band to Sleeve, used to restriction, needs a much smaller bougie... at least a 32F but maybe even a 30F. I was also 7 years out... so I wonder if Sleeve to Band revisions done earlier are more successful.
To me, 40% EWL makes it a questionable revision procedure.... not a successful one. Mean BMI after 2 years was 39!
http://www.ncbi.nlm.nih.gov/pubmed/19889585?itool=Email.EmailReport.Pubmed_ReportSelector.Pubmed_RVDocSum&ordinalpos=1
Surg Obes Relat Dis. 2009 Sep 15. [Epub ahead of print]
Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty.
Foletto M, Prevedello L, Bernante P, Luca B, Vettor R, Francini-Pesenti F, Scarda A, Brocadello F, Motter M, Famengo S, Nitti D.
Bariatric Unit, Azienda Ospedaliera Universita' di Padova, Padova, Italy.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is considered an effective multipurpose operation for morbid obesity, although long-term results are still lacking. Also, the best procedure to be offered in the case of failed restrictive procedures is still debated. We here reported our results of LSG as a revisional procedure for inadequate weight loss and/or complications after adjustable gastric banding or gastroplasty. METHODS: Since April 2005, 57 patients (20 men and 37 women), with a mean age of 49.9 +/- 11.9 years, underwent revisional LSG, 52 after laparoscopic adjustable gastric banding/adjustable gastric banding and 5 after vertical banded gastroplasty at our institution. The mean interval from the primary procedure to LSG was 7.54 +/- 4.8 years. The LSG was created using a 34F bougie with an endostapler, after removing the laparoscopic adjustable gastric band or the anterior portion of the band in those who had undergone vertical banded gastroplasty. An upper gastrointestinal contrast study was performed within 3 days after surgery and, if the findings were negative, a soft diet was promptly started. RESULTS: A total of 41 patients had undergone concurrent band removal and LSG and 16 had undergone band removal followed by an interval LSG. Three cases required conversion to open surgery because of a large incisional hernia. The mean operative time was 120 minutes (range 90-180). One patient died of multiple organ failure from septic shock. Three patients (5.7%) developed a perigastric hematoma, 3 (5.7%) had leaks, and 1 had mid-gastric short stenosis. The median hospital stay was 5 days. The mean body mass index at revisional LSG was 45.7 +/- 10.8 kg/m(2) and had decreased to 39 +/- 8.5 kg/m(2) after 2 years, with a mean percentage of the estimated excess body mass index lost of 41.6% +/- 24.4%. Two patients required a duodenal switch for insufficient weight loss. CONCLUSION: LSG seems to be effective as revisional procedure for failed LAGB/vertical banded gastroplasty, although with greater complication rates than the primary procedures. Larger series and longer follow-up are needed to confirm these promising results.
PMID: 19889585 [PubMed - as supplied by publisher]
Lap-Band June 14, 2001. Dr. Rumbaut, Monterrey, Mexico.
Lap-Band removed after 7 years and converted to Sleeve Gastrectomy on July 7, 2008 by Dr. Roslin. I've had three happy healthy Lap-Band babies.... and one VSG baby. 5 years out from revision to VSG. Gained 55 pounds in past 5 months, now considering DS. :(
Obes Surg. 2009 Sep;19(9):1216-20. Epub 2009 Jun 27.
Laparoscopic sleeve gastrectomy as revisional procedure for failed gastric banding and vertical banded gastroplasty.
Iannelli A, Schneck AS, Ragot E, Liagre A, Anduze Y, Msika S, Gugenheim J.
Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint Antoine de Ginestiere, BP 3079, 06202 Nice, France. [email protected]
BACKGROUND: The problem of revision of failed gastric banding (GB) and vertical banded gastroplasty (VBG) procedures has become a common situation in bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) has been recently used to revise failed restrictive procedures. The objective of this study is to evaluate the results of LSG as revisional procedure for failed GB and VBG. METHODS: A prospective held database was questioned regarding patients' demographic, indication for revision, conversion to open surgery, morbidity, percentage of excess weight loss (%EWL), evolution of comorbidities, and need for a second procedure after LSG. RESULTS: Forty-one patients, 34 women and seven men with a mean age of 42 years (range 19 to 63 years) and a mean body mass index at 49.9 kg/m(2) (range 35.9-63 kg/m(2)), underwent laparoscopic conversion of GB (36 patients) and VBG (five patients) into LSG. Indication for revisional surgery was insufficient weight loss in all the cases. All procedures were completed laparoscopically. There was no mortality and five patients (12.2%) developed complications (high leak, one patient; intra-abdominal abscess, three patients; and complicated incisional hernia, one patient). At a mean follow-up of 13.4 months, %EWL is on average 42.7% (range 4-76.1%). Six patients had a second procedure (four had laparoscopic duodenal switch, one had laparoscopic Roux-en-Y gastric bypass, and one had laparoscopic biliopancreatic diversion). CONCLUSION: Conversion of GB and VBG into LSG is feasible and safe. LSG is effective in the short term with a mean %EWL of 42.7% at 13.4 months. Long-term results of LSG as revisional procedure are awaited to establi****s efficacy in the long term.
PMID: 19562420 [PubMed - in process]
Lap-Band June 14, 2001. Dr. Rumbaut, Monterrey, Mexico.
Lap-Band removed after 7 years and converted to Sleeve Gastrectomy on July 7, 2008 by Dr. Roslin. I've had three happy healthy Lap-Band babies.... and one VSG baby. 5 years out from revision to VSG. Gained 55 pounds in past 5 months, now considering DS. :(
My honest feeling is that most Band revisions should go for something with malabsorption. General feeling is that if you weren't successful with a Band, you won't be successful with another restriction-only procedure. I thought I'd be O.K. because I did well with my Band until I had fill issues... but the thing is, with a sleeve, you can eat much more than with a Band... and that only increases over time. I should have gone for the DS... or gotten approval for a two-part DS, so I could at least fall back on the DS if I needed it.
Oh well, hindsight is 20/20. :)
Lap-Band June 14, 2001. Dr. Rumbaut, Monterrey, Mexico.
Lap-Band removed after 7 years and converted to Sleeve Gastrectomy on July 7, 2008 by Dr. Roslin. I've had three happy healthy Lap-Band babies.... and one VSG baby. 5 years out from revision to VSG. Gained 55 pounds in past 5 months, now considering DS. :(
I too had a 34F, and wonder if a Band to Sleeve, used to restriction, needs a much smaller bougie... at least a 32F but maybe even a 30F. I was also 7 years out... so I wonder if Sleeve to Band revisions done earlier are more successful.
To me, 40% EWL makes it a questionable revision procedure.... not a successful one. Mean BMI after 2 years was 39!
http://www.ncbi.nlm.nih.gov/pubmed/19889585?itool=Email.EmailReport.Pubmed_ReportSelector.Pubmed_RVDocSum&ordinalpos=1
Surg Obes Relat Dis. 2009 Sep 15. [Epub ahead of print]
Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty.
Foletto M, Prevedello L, Bernante P, Luca B, Vettor R, Francini-Pesenti F, Scarda A, Brocadello F, Motter M, Famengo S, Nitti D.
Bariatric Unit, Azienda Ospedaliera Universita' di Padova, Padova, Italy.
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is considered an effective multipurpose operation for morbid obesity, although long-term results are still lacking. Also, the best procedure to be offered in the case of failed restrictive procedures is still debated. We here reported our results of LSG as a revisional procedure for inadequate weight loss and/or complications after adjustable gastric banding or gastroplasty. METHODS: Since April 2005, 57 patients (20 men and 37 women), with a mean age of 49.9 +/- 11.9 years, underwent revisional LSG, 52 after laparoscopic adjustable gastric banding/adjustable gastric banding and 5 after vertical banded gastroplasty at our institution. The mean interval from the primary procedure to LSG was 7.54 +/- 4.8 years. The LSG was created using a 34F bougie with an endostapler, after removing the laparoscopic adjustable gastric band or the anterior portion of the band in those who had undergone vertical banded gastroplasty. An upper gastrointestinal contrast study was performed within 3 days after surgery and, if the findings were negative, a soft diet was promptly started. RESULTS: A total of 41 patients had undergone concurrent band removal and LSG and 16 had undergone band removal followed by an interval LSG. Three cases required conversion to open surgery because of a large incisional hernia. The mean operative time was 120 minutes (range 90-180). One patient died of multiple organ failure from septic shock. Three patients (5.7%) developed a perigastric hematoma, 3 (5.7%) had leaks, and 1 had mid-gastric short stenosis. The median hospital stay was 5 days. The mean body mass index at revisional LSG was 45.7 +/- 10.8 kg/m(2) and had decreased to 39 +/- 8.5 kg/m(2) after 2 years, with a mean percentage of the estimated excess body mass index lost of 41.6% +/- 24.4%. Two patients required a duodenal switch for insufficient weight loss. CONCLUSION: LSG seems to be effective as revisional procedure for failed LAGB/vertical banded gastroplasty, although with greater complication rates than the primary procedures. Larger series and longer follow-up are needed to confirm these promising results.
PMID: 19889585 [PubMed - as supplied by publisher]
I guess I am one of the lucky ones in that I didn't need to lose at the time of my revision, I was already at goal. My challenge was gaining after the post op diet.
I think there are some that just plain need malabsorption. I think most do. I don't know, maybe (since obesity is a disease) some just have a worse case than others?
I totally agree that if someone did not do well with banding they won't do well with a sleeve. If one restrictive procedure doesn't do the trick, another isn't going to work any better. But there is also the concept of overhauling your diet. I honestly have. I never had a mega sugar thing going, mine has always been flour. Anything with flour and really, those foods are pretty easy to avoid. Maybe that is the difference? If I don't eat it I don't crave it. If I eat it I'm doing the 5DPT to get off white carbs.
I'm almost 18 months post op from a revision and I maintain easily within 5#. 20-20.8 BMI. If I ever get to a point where I don't maintain well with VSG, I think I'm done with WLS. I HATE taking the MVIs and Ca I take now. I would never be compliant with what is needed for bypass or DS and I know that. So, I continue to weigh daily and if I go beyond my 5# that I give myself, I'm all over it like stink on pooh.
But, what works for me doesn't work for everyone. It's hard finding what works. :o/
