Revisional Bariatric Surgery: Two-Stage Laparoscopic Sleeve Gastrectomy (LSG) as Revision After Laparosopic Adjustable Gastric Banding (LAGB) Failure

LSG has been recently proposed as a revisional procedure after LAGB removal for insufficient weight loss/regain or major complications. The safety, effectiveness of LSG and the timing of the procedure are still controversial. The aim of this paper was to evaluate the safety and efficacy of two-stage LSG, as a revisional surgery. Methods 42 patients have been evaluated. All procedures were completely laparoscopically : & first stage, band removal ; & second stage, LSG (intent as definitive surgery). The patients were divided in two groups: 1) 25 patients with insufficient weight loss (EWL <25 %) or long term weight regain (BMI>35) and/or food intolerance with intact anatomy (failure group); 2) 17 patients with acute or chronic band complications requiring band removal (complications group). Results The mean interval between implant and removal of the band was 63.2 months for group 1and 36 months for group 2. LSG was performed after a mean interval of 5.1 months (range 1-21 months) in the group1 and after 29.2 months (range 2-72 months) in the group 2. No conversion to open surgery was required, no intraoperative bleeding or postoperative leaks occurred for both groups. After 12 months the mean EWL was 60.3 % and 63.5 % in group 1 and group 2 respectively. Improvement of co-morbidities was observed in12 of 19 patients in group 1 and 9 of 14 in group 2. Conclusion LSG could be an effective alternative to LRYGB which has been proposed as “first choice” revisional procedure after a band removal