30-day morbidity and mortality of revisional bariatric surgery - An international multi-centre collaborative (BROAD) study.

INTRODUCTION: Revisional bariatric surgery (RBS) for insufficient weight loss/weight regain or metabolic relapse is increasing worldwide. There is currently no large multinational, prospective data on 30-day morbidity and mortality of RBS. In this study, we aimed to evaluate the 30-day morbidity and mortality of RBS at participating centres. METHODS: An international steering group was formed to oversee the study. The steering group members invited bariatric surgeons worldwide to participate in this study. Ethical approval was obtained at the lead centre. Data were collected prospectively on all consecutive RBS patients operated between 15th May 2021 to 31st December 2021. Revisions for complications were excluded. RESULTS: A total of 65 global centres submitted data on 750 patients. Sleeve gastrectomy (n = 369, 49.2 %) was the most common primary surgery for which revision was performed. Revisional procedures performed included Roux-en-Y gastric bypass (RYGB) in 41.1 % (n = 308) patients, One anastomosis gastric bypass (OAGB) in 19.3 % (n = 145), Sleeve Gastrectomy (SG) in 16.7 % (n = 125) and other procedures in 22.9 % (n = 172) patients. Indications for revision included weight regain in 615(81.8 %) patients, inadequate weight loss in 127(16.9 %), inadequate diabetes control in 47(6.3 %) and diabetes relapse in 27(3.6 %). 30-day complications were seen in 80(10.7 %) patients. Forty-nine (6.5 %) complications were Clavien Dindo grade 3 or higher. Two patients (0.3 %) died within 30 days of RBS. CONCLUSION: RBS for insufficient weight loss/weight regain or metabolic relapse is associated with 10.7 % morbidity and 0.3 % mortality. Sleeve gastrectomy is the most common primary procedure to undergo revisional bariatric surgery, while Roux-en-Y gastric bypass is the most commonly performed revision.

Experience with Lap-band System up to 7 years.

BACKGROUND: Morbid obesity occurs in 2-5% of the population of Western countries. Laparoscopic adjustable silicone gastric banding was designed to be a minimally invasive, adjustable and reversible procedure for the treatment of morbid obesity. MATERIAL AND METHODS: The Lap-band System was evaluated retrospectively in a series of 543 patients. Data on preoperative aspects and postoperative outcome and weight loss patterns at up to 7 years follow-up (median follow-up 36 months) are presented. RESULTS: The most important late complication was total and irreversible food intolerance due to proximal pouch dilatation, which occurred in 24 patients (4.6%). 20 of these patients (3.8%) had had a proximal pouch calibration with 25 cc; 4 patients were calibrated with 15 cc. The mean BMI had fallen from 44 kg/m2 to 33.2 kg/m2 and was stable after a follow-up of up to 86 months (median 36 months). CONCLUSION: The Lap-band System is an effective procedure for achieving appreciable and stable weight loss at up to 7 years of follow-up (median 36 months). The minimally invasive approach was associated with a short hospital stay and a low rate of complications. Preoperative patient selection, detailed information and availability of the multidisciplinary team permitted us to achieve good longstanding results.

Repositioning the Lap-Band for proximal pouch dilatation.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) procedures have proved their efficiency and reproducibility in several studies. The most frequent late complication is proximal pouch dilatation, with possible progression to total food intolerance. MATERIALS AND METHODS: In a series of 727 laparoscopic bandings using the Lap-Band System, 54 patients presented proximal pouch dilatation and required laparoscopic reposition of the band. 2 patients who had had LAGB placed in another hospital received the same treatment. RESULTS: No particular intra- or postoperative complications occurred during laparoscopic repositioning of the band. 2 conversions were necessary in the beginning of the experience to safely unlock the band. After a median follow-up of 74 months, there has been no recurrence of proximal dilatation. CONCLUSIONS: Laparoscopic repositioning of the Lap-Band System for proximal pouch dilatation is a safe and reproducible procedure which can be proposed as an interesting alternative to its replacement by a new one. An initial perigastric placement of the band allows, during the redo, safe dissection in a virgin pars flaccida tunnel. The calibration of the tiny proximal pouch, the presence of postoperative adhesions, and maintainance of strict control of dietary behavior are probably the reasons for the absence of recurrence of pouch dilatation.