BOB RESEARCH

I found these on google scholar. If you have access to online journals you can find the references on these and go further.

 

1. Surg Obes Relat Dis. 2010 Jan-Feb;6(1):31-5. Epub 2009 Oct 9.

Adjustable gastric banding as revisional bariatric procedure after failed gastric
bypass--intermediate results.

Bessler M, Daud A, DiGiorgi MF, Inabnet WB, Schrope B, Olivero-Rivera L, Davis D.

Center for Obesity Surgery, Columbia University, New York-Presbyterian Hospital
and Lawrence Hospital, New York, NY 10032, USA. [email protected]

BACKGROUND: Although gastric bypass is the most common bariatric procedure in the
United States, it is has been associated with a failure rate of 15% (range
5-40%). The addition of an adjustable gastric band to Roux-en-Y gastric bypass
has been reported to be a useful revision strategy in a small series of patients
with inadequate weight loss after proximal gastric bypass. METHODS: We report on
22 patients who presented with inadequate weight loss or significant weight
regain after proximal gastric bypass. All patients underwent revision with the
placement of an adjustable silicone gastric band around the proximal gastric
pouch. The bands were adjusted at 6 weeks postoperatively and beyond, as needed.
Complications and weight loss at the most recent follow-up visit were evaluated.
RESULTS: The mean age and body mass index at revision was 41.27 years (range
25-58) and 44.8 +/- 6.34 kg/m(2), respectively. Patients had experienced a loss
of 19%, 27%, 47.3%, 42.3%, 43%, and 47% of their excess weight at 6, 12, 24, 36,
48, and 60 months after the revisional procedure, respectively. Three major
complications occurred requiring reoperation. No band erosions have been
documented. CONCLUSION: The results from this larger series of patients have also
indicated that the addition of the adjustable silicone gastric band causes
significant weight loss in patients with poor weight loss outcomes after gastric
bypass. That no anastomosis or change in absorption is required makes this an
attractive revisional strategy. As with all revisional procedures, the
complication rates appear to be increased compared with a similar primary
operation. 2010 American Society for Metabolic and Bariatric Surgery. Published
by Elsevier Inc. All rights reserved.

PMID: 19914147 [PubMed - indexed for MEDLINE]

1. Surg Obes Relat Dis. 2009 Jan-Feb;5(1):38-42. Epub 2008 Aug 22.

Adjustable gastric band placed around gastric bypass pouch as revision operation
for failed gastric bypass.

Chin PL, Ali M, Francis K, LePort PC.

Smart Dimensions and Lite Dimensions Surgical Weight Loss, Fountain Valley,
California, USA. [email protected]

BACKGROUND: The failure rate after gastric bypass surgery for weight loss has
been reported at 10-20%. To date, no reliably safe and effective salvage
operation is available. This pilot study was conducted to determine whether
restriction of the Roux-en-Y gastric bypass (RYGB) pouch using the adjustable
gastric band (AGB) is an effective revision operation. METHODS: A prospectively
accrued group of patients who underwent revisional surgery using the AGB placed
around the RYGB pouch by our bariatric surgical group from October 2004 to
October 2006 was analyzed. RESULTS: Of the 10 patients accrued during this
period, 2 were lost to follow-up, leaving 8 patients for analysis. Of the 8
patients, 1 was a man and 7 were women. The mean prerevision weight was 135.75 kg
(range 105-165), and the body mass index was 48.42 kg/m(2) (range 38.92-55). The
mean weight loss at 1 year of follow-up was 17.03 kg (range 0.2-42), with a mean
percentage of excess weight loss of 24.29% (range 0.2-49.2%). The mean weight
loss of the 5 patients with 2 years of follow-up was 36.4 kg (range 20-58), with
a mean percentage of excess weight loss of 48.7% (range 21.8-98.1%). One patient
with 3 years of follow-up had a weight loss of 56 kg and a percentage of excess
weight loss of 66.2%. Three minor complications developed: 2 AGB port-related
complications requiring port revision and 1 postoperative wound hematoma
requiring evacuation. No band erosions or band slippages occurred, and no major
complications developed. CONCLUSION: In our study, an AGB placed around the RYGB
pouch was a safe and effective revision operation for a failed RYGB operation.

PMID: 18996754 [PubMed - indexed for MEDLINE]


1. Obes Surg. 2009 Oct;19(10):1439-41. Epub 2008 Dec 13.

Laparoscopic insertion of a gastric band for weight gain following laparoscopic
Roux-en-Y Gastric bypass: description of the technique.

Heath D, Leff D, Sufi P.

North London Obesity Surgery Service, The Whittington Hospital, Magdala Avenue,
London, N19 5NF, UK. [email protected]

BACKGROUND: A recently published prospective series has demonstrated that weight
loss ceases 18 to 24 months following Laparoscopic Roux-en-Y gastric bypass
(RYGB) and that, by 48 months, there is significant weight regain in 50% of
patients. METHODS: We report the case of a 38-year-old male patient who developed
significant weight regain 42 months following laparoscopic (RYGB) and underwent
laparoscopic placement of a Swedish ajustable gastric band (SAGB) around the
gastric pouch. RESULTS: In previous reports, the gastric band was placed around
the upper part of the stomach. This paper provides the first report of the
placement of a gastric band around the lower gastric pouch, just above the
gastrojejunal anastomosis, in the management of weight regain following
laparoscopic RYGB. Prior to revision surgery, the patient's weight was 95 kg
[body mass index (BMI) 31 kg/m(2), excess weight loss 65%]. CONCLUSION: Four
months following the procedure this had reduced to 82.1 kg (BMI 26 kg/m(2),
excess weight loss 90%).

PMID: 19083072 [PubMed - indexed for MEDLINE]

1. Obes Surg. 2009 May;19(5):650-4. Epub 2009 Mar 5.

Laparoscopic placement of non-adjustable silicone ring for weight regain after
Roux-en-Y gastric bypass.

Dapri G, Cadière GB, Himpens J.

Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery,
Saint-Pierre University Hospital, 322 rue Haute, 1000, Brussels, Belgium.
[email protected]

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) is presently one of the most popular
surgical procedures for obesity. One of the possible long-term problems is weight
regain, usually after a period of successful weight loss. Weight regain after
RYGBP can be due to new eating habits, like sweet-eating or grazing, or volume
eating because of impaired restriction. This paper reports our experience in
patients who presented weight regain after laparoscopic RYGBP, because of new
appearance of volume eating or hyperphagia, treated by the laparoscopic placement
of a non-adjustable silicone ring around the gastric pouch. METHODS: From July
2004 to November 2007, six patients affected by weight regain due to hyperphagic
behavior, benefited from revision of RYGBP consisting of the placement of a
non-adjustable silicone ring loosely encircling the stomach part. Mean weight and
body mass index (BMI) at the time of RYGBP were 105.0 kg +/- 12.3 and 36.3 +/-
3.0 kg/m(2), respectively, and all patients suffered from obesity-related
co-morbidities. After a mean time from RYGBP of 26.0 +/- 14.2 months, patients
presented a weight regain of 4.7 +/- 3.4 kg compared with their minimal weight,
with a final mean weight, BMI, and percentage of excess weight loss (%EWL) at the
time of the silicone ring of 86.0 +/- 13.1 kg, 29.5 +/- 3.9 kg/m(2), and 47.0 +/-
24.7%, respectively. Preoperative evaluation for each patient included history
and physical examination, nutritional and psychiatric evaluation, laboratory
tests, and barium swallow check. Outcome measures included evaluation of the
Roux-en-Y construction, operative time, postoperative morbidity and mortality,
and weight loss in terms of absolute weight loss, BMI, and %EWL. RESULTS: Any
modification of the digestive circuit was evidenced. Mean operative time was 82.5
+/- 18.3 min. No operative mortality and no conversion to open surgery were
achieved. No postoperative complications were achieved. Mean hospital stay was
2.6 +/- 1.5 days. After a mean follow-up of 14.0 +/- 9.2 months, the six patients
presented a mean weight loss of 9.1 +/- 2.4 kg, with a final mean weight, BMI,
and %EWL of 76.8 +/- 13.7 kg, 26.4 +/- 4.2 kg/m(2), and 70.4 +/- 30.4%,
respectively. Difference in term of %EWL before and after revision (23.4 +/- 5.7)
is statistically significant (p < 0.05). There have been no erosions or slippage
of the ring during this follow-up. CONCLUSION: One of the possible causes of
weight regain after RYGBP is the new eating behavior of the patient, one of which
is hyperphagia. Treatment of this condition can be the placement of a
non-adjustable silicone ring loosely fitted around the gastric pouch which
contributes to improved weight loss.

PMID: 19263180 [PubMed - indexed for MEDLINE]


1. Surg Endosc. 2008 Apr;22(4):1019-22. Epub 2007 Oct 18.

Gastric banding as a salvage procedure for patients with weight loss failure
after Roux-en-Y gastric bypass.

Gobble RM, Parikh MS, Greives MR, Ren CJ, Fielding GA.

Department of Surgery, New York University School of Medicine, New Bellevue 15
North 1, 550 First Avenue, New York, New York, 10016, USA [email protected]

BACKGROUND: This study reviews outcomes after laparoscopic adjustable gastric
band (LAGB) placement in patients with weight loss failure after Roux-en-Y
gastric bypass (RYGBP). METHODS: All data was prospectively collected and entered
into an electronic registry. Characteristics evaluated for this study included
pre-operative age and body mass index (BMI), gender, conversion rate, operative
(OR) time, length of stay (LOS), percentage excess weight loss (EWL), and
postoperative complications. RESULTS: 11 patients (seven females, four males)
were referred to our program for weight loss failure after RYGBP (six open, five
laparoscopic). Mean age and BMI pre-RYGBP were 39.5 years (24-58 years) and 53.2
kg/m(2) (41.2-71 kg/m(2)), respectively. Mean EWL after RYGBP was 38% (19-49%).
All patients were referred to us for persistent morbid obesity due to weight loss
failure or weight regain. The average time between RYGBP and LAGB was 5.5 years
(1.8-20 years). Mean age and BMI pre-LAGB were 46.1 years (29-61 years) and 43.4
kg/m(2) (36-57 kg/m(2)), respectively. Vanguard (VG) bands were placed
laparoscopically in most patients. There was one conversion to open. Mean OR time
and LOS were 76 minutes and 29 hours, respectively. The 30-day complication rate
was 0% and mortality was 0%. There were no band slips or erosions; however, one
patient required reoperation for a flipped port. The average follow-up after LAGB
was 13 months (2-32 months) with a mean BMI of 37.1 kg/m(2 )(22.7-54.5 kg/m(2))
and an overall mean EWL of 59% (7-96%). Patients undergoing LAGB after failed
RYGBP lost an additional 20.8% EWL (6-58%). CONCLUSION: Our experience shows that
LAGB is a safe and effective solution to failed RYGBP.

PMID: 17943353 [PubMed - indexed for MEDLINE]

1. Obes Surg. 2000 Dec;10(6):557-63.

Revisional surgery for morbid obesity--conversion to the Lap-Band system.

O'Brien P, Brown W, Dixon J.

Monash University Department of Surgery, Alfred Hospital, Melbourne, Australia.
[email protected]

BACKGROUND: The safety and effectiveness of conversion to the Lap-Band system, of
patients who had failure of adequate weight loss and/or severe symptoms from
prior bariatric procedures has been measured by prospective evaluation of a
consecutive group of 50 patients. METHODS: The patients were drawn as a subgroup
of 713 patients who had placement of the Lap-Band system between July 1994 and
May 2000. The preceding procedures were gastroplasty (35 patients),
non-adjustable gastric banding (11), gastric bypass (2) and jejuno-ileal bypass
(2). All operations were by open laparotomy. Initial reversal of the initial
procedure was performed in 28 patients. M:F ratio was 6%/94%. Inadequate weight
was the primary problem in 69%, and symptoms of obstruction were present in 31%.
RESULTS: Significant perioperative complications occurred more frequently than
after primary placement (17% vs 1.1%). However, late complications were less
frequent (2% vs 18%). In particular, there have been no occurrences of prolapse
(slippage) of the stomach through the band or erosion of the band into the
stomach in this group to date. Weight loss of 47% of excess weight had occurred
at 3-year follow-up. This is not significantly different from the 53% EWL in the
primary Lap-Band group. All symptoms of obstruction were relieved by the
revision, and a number of comorbidities are seen to be markedly improved.
CONCLUSIONS: We observe that, when compared to primary Lap-Band placement,
revision of failed bariatric procedures to Lap-Band is associated with more
perioperative adverse events but fewer late complications. Weight loss is
equivalent and is associated with marked improvement in comorbidities and quality
of life. The outcomes are better than have been achieved by revision to another
form of gastric stapling and should be considered in those patients who have had
an unsatisfactory outcome from other bariatric procedures.

PMID: 11175966 [PubMed - indexed for MEDLINE]