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Feasibility and technique of laparoscopic conversion of adjustable gastric banding to sleeve gastrectomy.
Surg Obes Relat Dis. 2009 Jan-Feb; 5(1):72-6.SO

Abstract

BACKGROUND

To evaluate the feasibility, safety, and short-term efficacy of the conversion of laparoscopic adjustable gastric banding (LAGB) to laparoscopic sleeve gastrectomy (LSG) because of inadequate weight loss.

METHODS

The inclusion criteria were an inadequate percentage of excess weight loss (%EWL), defined as <30% at > or =1 year after LAGB. From August 2002 to October 2007, 27 patients (17 women and 10 men) had undergone removal of their LAGB and conversion to LSG. The average age at LSG was 43.6 +/- 11.4 years (range 25-66). Before LAGB, the mean weight and body mass index was 129.8 +/- 21.9 kg (range 95-178) and 45 +/- 8.1 kg/m(2) (range 35-64), respectively. The average interval between LAGB and LSG was 51.2 +/- 30.1 months (range 22-132). Before conversion, the mean weight, body mass index, and %EWL was 117.9 +/- 27.3 kg (range 63-170), 39 +/- 9.6 kg/m2 (range 24-61), and 18.1% +/- 18.3%, respectively. Of the 27 patients, 12 had 19 obesity-related co-morbidities, including arterial hypertension in 7, type 2 diabetes mellitus in 2, degenerative joint disease in 7, and sleep apnea in 3.

RESULTS

The mean operative time was 120.6 +/- 32.4 minutes (range 65-195). No conversion to open surgery was required, and no patient died. The postoperative complications included a subphrenic hematoma that required laparoscopic drainage; no postoperative leaks developed. The mean hospital stay was 3.2 +/- 1.4 days (range 2-8). After a mean follow-up of 18.6 +/- 14.8 months (range 1-59) for 23 patients (4 patients were lost to follow-up), the mean weight, body mass index, and weight loss was 100.7 +/- 23.5 kg (range 61-152), 34.6 +/- 8.7 kg/m2 (range 21-50.4), and 23 +/- 12.4 kg (range 2-55), respectively. The patients had had an additional 16.7% EWL after LSG for a total average %EWL of 34.8% +/- 21.8% (P <.05). Of the 12 patients with obesity-related co-morbidities, 5 had had resolution, including arterial hypertension in 1, type 2 diabetes mellitus in 1, degenerative joint disease in 2, and sleep apnea in 2.

CONCLUSION

The results of this study support the safety of LSG in the case of an inadequate %EWL after LAGB. However, the degree of weight loss and co-morbidity resolution is of concern.

Authors+Show Affiliations

Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium. giovanni@dapri.netNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19161936

Citation

Dapri, Giovanni, et al. "Feasibility and Technique of Laparoscopic Conversion of Adjustable Gastric Banding to Sleeve Gastrectomy." Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, vol. 5, no. 1, 2009, pp. 72-6.
Dapri G, Cadière GB, Himpens J. Feasibility and technique of laparoscopic conversion of adjustable gastric banding to sleeve gastrectomy. Surg Obes Relat Dis. 2009;5(1):72-6.
Dapri, G., Cadière, G. B., & Himpens, J. (2009). Feasibility and technique of laparoscopic conversion of adjustable gastric banding to sleeve gastrectomy. Surgery for Obesity and Related Diseases : Official Journal of the American Society for Bariatric Surgery, 5(1), 72-6. https://doi.org/10.1016/j.soard.2008.11.008
Dapri G, Cadière GB, Himpens J. Feasibility and Technique of Laparoscopic Conversion of Adjustable Gastric Banding to Sleeve Gastrectomy. Surg Obes Relat Dis. 2009;5(1):72-6. PubMed PMID: 19161936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Feasibility and technique of laparoscopic conversion of adjustable gastric banding to sleeve gastrectomy. AU - Dapri,Giovanni, AU - Cadière,Guy Bernard, AU - Himpens,Jacques, Y1 - 2008/11/27/ PY - 2008/04/08/received PY - 2008/11/17/revised PY - 2008/11/18/accepted PY - 2009/1/24/entrez PY - 2009/1/24/pubmed PY - 2009/4/17/medline SP - 72 EP - 6 JF - Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery JO - Surg Obes Relat Dis VL - 5 IS - 1 N2 - BACKGROUND: To evaluate the feasibility, safety, and short-term efficacy of the conversion of laparoscopic adjustable gastric banding (LAGB) to laparoscopic sleeve gastrectomy (LSG) because of inadequate weight loss. METHODS: The inclusion criteria were an inadequate percentage of excess weight loss (%EWL), defined as <30% at > or =1 year after LAGB. From August 2002 to October 2007, 27 patients (17 women and 10 men) had undergone removal of their LAGB and conversion to LSG. The average age at LSG was 43.6 +/- 11.4 years (range 25-66). Before LAGB, the mean weight and body mass index was 129.8 +/- 21.9 kg (range 95-178) and 45 +/- 8.1 kg/m(2) (range 35-64), respectively. The average interval between LAGB and LSG was 51.2 +/- 30.1 months (range 22-132). Before conversion, the mean weight, body mass index, and %EWL was 117.9 +/- 27.3 kg (range 63-170), 39 +/- 9.6 kg/m2 (range 24-61), and 18.1% +/- 18.3%, respectively. Of the 27 patients, 12 had 19 obesity-related co-morbidities, including arterial hypertension in 7, type 2 diabetes mellitus in 2, degenerative joint disease in 7, and sleep apnea in 3. RESULTS: The mean operative time was 120.6 +/- 32.4 minutes (range 65-195). No conversion to open surgery was required, and no patient died. The postoperative complications included a subphrenic hematoma that required laparoscopic drainage; no postoperative leaks developed. The mean hospital stay was 3.2 +/- 1.4 days (range 2-8). After a mean follow-up of 18.6 +/- 14.8 months (range 1-59) for 23 patients (4 patients were lost to follow-up), the mean weight, body mass index, and weight loss was 100.7 +/- 23.5 kg (range 61-152), 34.6 +/- 8.7 kg/m2 (range 21-50.4), and 23 +/- 12.4 kg (range 2-55), respectively. The patients had had an additional 16.7% EWL after LSG for a total average %EWL of 34.8% +/- 21.8% (P <.05). Of the 12 patients with obesity-related co-morbidities, 5 had had resolution, including arterial hypertension in 1, type 2 diabetes mellitus in 1, degenerative joint disease in 2, and sleep apnea in 2. CONCLUSION: The results of this study support the safety of LSG in the case of an inadequate %EWL after LAGB. However, the degree of weight loss and co-morbidity resolution is of concern. SN - 1550-7289 UR - https://www.unboundmedicine.com/medline/citation/19161936/Feasibility_and_technique_of_laparoscopic_conversion_of_adjustable_gastric_banding_to_sleeve_gastrectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1550-7289(08)00830-7 DB - PRIME DP - Unbound Medicine ER -