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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 Sep-Oct; 3(5):521-5.SO

Abstract

BACKGROUND

Of patients who have undergone gastric banding, 11-25% will require a major reoperation with band removal and conversion to another bariatric procedure after they have failed to lose sufficient weight or have developed dysphagia or reflux. The aim of this study was to evaluate the respective benefits of Roux-en-Y gastric band (RYGB) or biliopancreatic diversion with duodenal switch (BPD-DS) after failed gastric banding and whether 1 of the 2 procedures might be a better procedure for such cases.

METHODS

RYGB or BPD-DS was performed according to the institutional protocols with synchronous band removal, irrespective of the reason for failure.

RESULTS

Of the 53 patients, 32 underwent laparoscopic RYGB for a body mass index (BMI) of 43.1 +/- 6.4 kg/m(2) (BMI 45.8 +/- 6.4 kg/m(2) before laparoscopic adjustable gastric banding) and 21 underwent BPD-DS for a BMI of 46.0 +/- 5.5 kg/m(2) (BMI 49.6 +/- 5.2 kg/m(2) before laparoscopic adjustable gastric banding). BPD-DS required significantly longer operative times (239.7 +/- 55.8 versus 135 +/- 26.7 minutes) and resulted in more complications (62% versus 12.5%; P <.002). No patients died postoperatively. The 2 groups of patients had a similar BMI at 12 and 18 months after revision (BMI 33.4 +/- 5.6 kg/m(2) and 31.4 +/- 3.5 kg/m(2)). The weight loss was greater after BPD-DS than after RYGB compared with the prerevision weight loss (66.2% versus 58.8% excess weight loss) or initial weight (73% versus 61.8%), although this was not significant.

CONCLUSION

Despite an excessive rate of complications that were, in part, related to the learning curve in this series, BPD-DS resulted in greater weight loss compared with RYGB. However, both procedures were successful after failed gastric banding. A more accurate definition of failure could help to determine the respective indications for revisional surgery.

Authors+Show Affiliations

Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France. philippetopart@wanadoo.frNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

17903771

Citation

Topart, Philippe, et al. "Biliopancreatic Diversion With Duodenal Switch or Gastric Bypass for Failed Gastric Banding: Retrospective Study From Two Institutions With Preliminary Results." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 3, no. 5, 2007, pp. 521-5.
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.
Topart, P., Becouarn, G., & Ritz, P. (2007). Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 3(5), 521-5.
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 Sep-Oct;3(5):521-5. PubMed PMID: 17903771.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: retrospective study from two institutions with preliminary results. AU - Topart,Philippe, AU - Becouarn,Guillaume, AU - Ritz,Patrick, PY - 2007/05/07/received PY - 2007/06/11/revised PY - 2007/07/12/accepted PY - 2007/10/2/pubmed PY - 2008/1/9/medline PY - 2007/10/2/entrez SP - 521 EP - 5 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 3 IS - 5 N2 - BACKGROUND: Of patients who have undergone gastric banding, 11-25% will require a major reoperation with band removal and conversion to another bariatric procedure after they have failed to lose sufficient weight or have developed dysphagia or reflux. The aim of this study was to evaluate the respective benefits of Roux-en-Y gastric band (RYGB) or biliopancreatic diversion with duodenal switch (BPD-DS) after failed gastric banding and whether 1 of the 2 procedures might be a better procedure for such cases. METHODS: RYGB or BPD-DS was performed according to the institutional protocols with synchronous band removal, irrespective of the reason for failure. RESULTS: Of the 53 patients, 32 underwent laparoscopic RYGB for a body mass index (BMI) of 43.1 +/- 6.4 kg/m(2) (BMI 45.8 +/- 6.4 kg/m(2) before laparoscopic adjustable gastric banding) and 21 underwent BPD-DS for a BMI of 46.0 +/- 5.5 kg/m(2) (BMI 49.6 +/- 5.2 kg/m(2) before laparoscopic adjustable gastric banding). BPD-DS required significantly longer operative times (239.7 +/- 55.8 versus 135 +/- 26.7 minutes) and resulted in more complications (62% versus 12.5%; P <.002). No patients died postoperatively. The 2 groups of patients had a similar BMI at 12 and 18 months after revision (BMI 33.4 +/- 5.6 kg/m(2) and 31.4 +/- 3.5 kg/m(2)). The weight loss was greater after BPD-DS than after RYGB compared with the prerevision weight loss (66.2% versus 58.8% excess weight loss) or initial weight (73% versus 61.8%), although this was not significant. CONCLUSION: Despite an excessive rate of complications that were, in part, related to the learning curve in this series, BPD-DS resulted in greater weight loss compared with RYGB. However, both procedures were successful after failed gastric banding. A more accurate definition of failure could help to determine the respective indications for revisional surgery. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/17903771/Biliopancreatic_diversion_with_duodenal_switch_or_gastric_bypass_for_failed_gastric_banding:_retrospective_study_from_two_institutions_with_preliminary_results_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(07)00564-3 DB - PRIME DP - Unbound Medicine ER -