Surgery for Obesity and Related Diseases ] (2014) 00–00

Original article

A retrospective comparison of early results of conversion of failed gastric banding to sleeve gastrectomy or gastric bypass William R.J. Carr, F.R.C.S.(Edin.)*, Neil A. Jennings, F.R.C.S.(Edin.), M.D., Maureen Boyle, Kamal Mahawar, M.S., M.S.C., F.R.C.S.(Edin.), Shlokarth Balupuri, F.R.C.S.(Edin.), M.D., Peter K. Small, R.D., F.R.C.S.(Edin.), M.D. Bariatric Surgery Unit, Sunderland Royal Hospital, Sunderland, United Kingdom Received April 17, 2014; accepted July 14, 2014

Abstract

Background: Laparoscopic adjustable gastric banding (LAGB) is associated with high long-term failure rates requiring conversion to alternative procedures. Operative conversion to laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric (LRYGB) bypass is associated with higher complication rates than primary procedures. Objectives: To compare results for converting failed LAGB to LSG versus LRYGB. Setting: University Hospital, United Kingdom, National Health Service. Methods: All patients undergoing conversion of LAGB to LRYGB and LSG from July 2006 to September 2012 were included. A retrospective analysis of our prospectively maintained database was performed to identify differences in death rates, complication rates, length of hospital stay, and weight loss. Within this study LRYGB was the preferred choice for conversion and LSG was only considered in the presence of significant intraabdominal adhesions, because of patient choice, or in patients with contraindications to LRYGB. Results: Eighty-nine patients with failed LAGB underwent conversional surgery within this period. Of these, 64 patients underwent conversion to LRYGB and 25 underwent conversion to LSG. There was no statistical difference in percentage of excess weight loss at 1 or 2 years after conversional surgery to LSG or LRYGB. Conversion to LRYGB was carried out as a single procedure in 51/64 (80%) compared with 10/25 (40%) for conversion to LSG (P ¼ .003). One postoperative complication occurred requiring reoperation after conversion to LRYGB. Conclusion: There was no difference in complication rates, hospital stay, and early weight loss when converting failed LAGB to LRYGB or LSG. Both procedures are appropriate for conversion from LAGB, although a staged approach is often needed, especially for LSG. (Surg Obes Relat Dis 2014;]:00–00.) r 2014 American Society for Metabolic and Bariatric Surgery. All rights reserved.

Keywords:

Conversion; Revision; Failed gastric band; Gastric bypass; Sleeve gastrectomy; Complications

Laparoscopic adjustable gastric banding (LAGB) has been the most commonly performed bariatric operation worldwide in the last decade. Longer-term experience with LAGB has revealed potentially high failure rates requiring *

Correspondence: William Carr, Sunderland Royal Hospital, Sunderland SR4 7 TP, United Kingdom. E-mail: [email protected]

conversional surgery [1–5]. The choice of surgery for failed bands lies between band salvage procedures, which are generally associated with poor outcomes, or conversion to laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) [6,7]. We have previously published our experience with LAGB-to-LRYGB conversion, showing comparable outcomes to primary LRYGB for mortality, length of stay, morbidity, and excess

http://dx.doi.org/10.1016/j.soard.2014.07.021 1550-7289/r 2014 American Society for Metabolic and Bariatric Surgery. All rights reserved.

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W. R. J. Carr et al. / Surgery for Obesity and Related Diseases ] (2014) 00–00

weight loss [8]. These results are consistent with other published reports on LAGB-to-LRYGB conversion [9–12]. The International Sleeve Gastrectomy consensus statement advised that LRYGB should be the procedure of choice for conversion after failed LAGB rather than LSG [13]. Despite this advice, a cohort of patients with failed LAGB seek conversions but have relative contraindications to LRYGB (e.g., significant intraabdominal adhesions). Reports comparing outcomes from LAGB to LSG and LRYGB are limited; however, a systematic review of 15 LRYGB studies (588 patients) and 8 LSG studies (286 patients) found that these procedures were associated with short-term complication rates of 8.5% and 15.7%, long-term complications of 8.9% and 2.5%, and a need for reoperation of 6.5% and 3.5%, respectively [14]. As a result, LSG’s role as a conversion procedure after failed LAGB remains controversial, with little published data comparing the 2 procedures from the same unit. This study reports our experience of conversion operations for failed LAGB, comparing conversion to LSG and LRYGB for morbidity, mortality, and weight loss. Methods A prospective database has been maintained for all patients undergoing bariatric surgery from 2000 to the present. Results were compared for patients undergoing conversion operations from July 2006 to September 2012. All patients undergoing conversion operations had originally undergone their initial band placement at the same hospital. Conversion was only considered if the patient still met the criteria for primary bariatric surgery (body mass index [BMI] 435 kg/m2 with co-morbidity, BMI 440 kg/m2) at the time of band removal. Patients presenting with emergency band complications had the band deflated or removed before being discussed at the multidisciplinary team (MDT) meeting composed of surgeons, dieticians, bariatric nurse specialist, and psychologist. Failure of LAGB was classified as because of inadequate weight loss, band infection, acute band slippage or chronic pouch dilation, dysphagia, band leakage, or band erosion. Inadequate weight loss was not precisely defined, although this indication was documented in the patient’s notes at the time of MDT discussion. All these patients had a conversion BMI of 435 kg/m2 at the time of the decision to convert. Within the time frame of the study LRYGB remained the preferred choice of procedure for conversion after failed LAGB. Gastroesophageal reflux disease was regarded as a contraindication for primary LSG, and this remained true for conversions. All patients underwent upper gastrointestinal video endoscopy before conversion to assess for gastroesophageal reflux disease and exclude a band erosion. LSG was performed for patients with relative contraindications to LRYGB, including significant intraabdominal adhesions (as noted at the time of band removal), celiac

disease, preexisting hypocalcaemia, and pernicious anemia. For high-risk patients with severe co-morbidities LSG was considered if the MDT felt the shorter operative time of LSG was beneficial and the patient had a dietary history of bulk eating. Patient choice remained the final consideration in the selection of the procedure, but LSG was only considered if the patient had proven, effective weight loss with the initial restrictive procedure (LAGB). Patients without reflux who were felt to be suitable for RYGB were informed that LSG would be considered if intraoperative findings of adhesions meant that RYGB was not possible. Emergency band complications were always converted as staged procedures. Although the final decision about the elective conversions in 1 or 2 stages was made intraoperatively, chronic pouch dilation and active inflammation were regarded as strong indications for adopting a 2-staged approach. However, for patients with poor weight loss but a nondilated pouch, 1-stage conversion was recommended. Operative procedures are described in Appendix 1. Postoperative care was standardized. Patients were allowed sips of water on the day of surgery, 1 L of water on postoperative day 1, and pureed diet on postoperative day 2. Postoperative blood tests were performed on day 1 and patients discharged if clinical observations and examinations and inflammatory markers did not raise concern and the patient was tolerating a pureed diet. Postoperative outpatient follow-up was scheduled for 6 weeks, 6 months, 1 year, and 2 years in a combined surgical and dietetic bariatric clinic. The cohorts were analyzed to look for differences in weight loss (percentage excess weight loss [%EWL] and reduction in BMI), morbidity, mortality, and length of stay between conversion to LRYGB or LSG after failed LAGB. Weight loss was analyzed using the initial preband weight, the weight at the time of conversion, and postconversion surgery weights. Chi-square and independent t tests were used as appropriate to compare the groups. Results were considered to be statistically significant if the P value was o.05. Results A total of 89 patients underwent LAGB conversion; 64 were converted to LRYGB and 25 to LSG. All procedures were performed laparoscopically. Poor weight loss (51.7%) and chronic pouch dilation (19.1%) were the main indications for conversion (Table 1). Conversion from LAGB to LSG was performed in 1 stage in 40% (10/25), compared with 80% (51/64) for LRYGB. This difference was statistically significant (P ¼ .03). All 6 patients presenting with acute slippage had emergency band removal followed by interval conversion surgery after 3 months. Eighty-nine percent (41/46) of patients whose band was removed for poor weight loss underwent a single-stage removal and conversion, which was more often a conversion to LRYGB

Conversion of LAGB to LSG or LRYGB Achieves Comparable Outcomes / Surgery for Obesity and Related Diseases ] (2014) 00–00 Table 1 Classification of LAGB failures Reason for LAGB Number of Failure Patients Converted to LSG One Stage Poor weight loss Acute band slippage Pouch dilation Vomiting/ dysphagia Leaking band Infection Band erosion Total

Two Stage

Number of Patients Converted to LRYGB

Percentage of Failed LAGB

One Stage

(%)

Two Stage

3 0

2 4

38 0

3 2

51.7 6.7

1 4

6 0

6 5

4 3

19.1 13.5

0 2 0 10

0 2 1 15

2 0 0 51

0 1 0 13

2.2 5.6 1.1

LAGB ¼ laparoscopic adjustable gastric band; LRYGB ¼ laparoscopic Roux-en-Y gastric bypass; LSG ¼ laparoscopic sleeve gastrectomy.

than to LSG (93% versus 60%; P ¼ .03). Two-stage conversion to LSG was preferred in pouch dilation, although this decision was made intraoperatively based the condition of the pouch after band removal (Table 1). At initial referral the mean age was 48.3 ⫾ 10.17 years (range 26–70), mean excess weight was 71.3 ⫾ 24.10 kg, and mean BMI was 50.4 ⫾ 8.58 kg/m2. There were no statistical differences in any of these parameters between patients undergoing conversion LSG or LRYGB (Table 2). LSG was performed for 48% (12/25) because of intraabdominal adhesions preventing LRYGB. Patient choice accounted for 24% (6/25), severity of co-morbidities 16% (4/25), and celiac disease, hypocalcemia, and pernicious anemia the remaining 3 cases. There were no deaths in either group at 30 days. The median postoperative length of stay after conversion was 2 days. The first patient within the band-to-LSG conversion group underwent a postoperative swallow on day 7 before commencing oral intake. One further patient stayed for 5 Table 2 Comparison of demographic data between conversion to LSG or LRYGB using prebanding weights (⫾ standard deviation) All Patients

Conversion to LSG

Conversion to LRYGB

P value

Male 21 8 13 .27 Female 68 17 51 Age 48.3 (⫾10.17) 49.8 (⫾10.65) 47.7 (⫾10.01) .39 Ideal 70.2 (⫾9.15) 70.7 (⫾8.20) 70.1 (⫾9.48) .77 weight (kg) Weight (kg) 141.4 (⫾28.04) 149.2 (⫾36.86) 138.3 (⫾23.37) .10 Excess 71.3 (⫾24.10) 78.5 (⫾33.88) 68.4 (⫾18.57) .08 weight (kg) BMI (kg/m2) 50.4 (⫾8.58) 52.7 (⫾12.11) 49.5 (⫾6.62) .11 BMI ¼ body mass index (kg/m2); LRYGB ¼ laparoscopic Roux-enY gastric bypass; LSG ¼ laparoscopic sleeve gastrectomy.

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postoperative days for close observation after a 2-stage conversion for band erosion. One patient, after a singlestage conversion of gastric band to LRYGB, had been discharged at 2 days postoperatively but was readmitted 20 days later with abdominal pain, requiring a laparotomy. An anastomotic leak at the jejuno-jejunal anastomosis was found and revised. The patient was discharged 7 days later. This was the only complication in either group leading to readmission, reoperation, or reintervention. Of the 89 patients, 83 attended for 1-year follow-up (93%). At 1 year postoperatively, %EWL from the initial referral weight was 60.6% ⫾ 21.69% after conversion to LRYGB and 58.9% ⫾ 24.04% with conversion to LSG (Table 3). BMI decreased by 14.7 ⫾ 5.53 kg/m2 with LRYGB and 16.5 ⫾ 9.25 kg/m2 with LSG. These differences did not reach statistical significance. When taking weight at the time of conversion, LRYGB resulted in a %EWL of 52.1% ⫾ 23.77% compared with 44.1% ⫾ 32.74% for LSG or a reduction in BMI of 10.1 ⫾ 5.17 kg/m2 versus 8.4 ⫾ 5.46 kg/m2. At 2 years, 43 of 89 patients attended for follow-up (48%). No statistical difference was found when comparing excess weight loss, reduction in BMI, or mean weight loss between conversions to LSG of LRYGB at this point. Mean weights and BMI are shown in Figs. 1 and 2. There was no statistical difference in EWL, BMI, or mean weight loss between 1 and 2 years for LSG or LRYGB. Discussion We have previously reported our long-term experience with LAGB in which an overall failure rate of 14.6% was noted (85 out of 575 patients) with 24 band repositions, 20 band removals, and 41 conversions to LRYGB. Other studies with longer follow-up failure rates of up to 50% have been reported [15]. Although LAGB is no longer as commonly performed, it still constitutes 17.8% of all bariatric procedures worldwide [16]. Although advocates of gastric banding believe improvements to band design will reduce failure rates, this remains unsubstantiated. Dealing with band complications and converting failed bands to other procedures will therefore continue to be a persistent challenge to bariatric surgeons. A recent systematic review found higher complication rates after conversion to LSG or LRYGP than primary procedures, with short-term complications of 8.5% versus 15.7%, longterm complications of 8.9% versus 2.5%, and need for reoperation of 6.5% and 3.5% for LSG and LRYGB, respectively [14]. We have previously published our experience of conversion to LRYGB with no major complications [8]. Within this extended study period there was 1 major complication requiring reoperation after an LRYGB. The complication rates for conversions observed in this study are lower than previously reported in the literature for LSG. A systematic review by Schouten et al. looked at 12 studies from 2002 to 2009, including 438 conversions to

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Table 3 Comparison of weight loss after conversion to LSG or LRYGB at 1 and 2 years after revisional surgery (⫾ standard deviation)

Follow-up at 1 yr Weight at time of conversional surgery (⫾ standard deviation) Weight at initial (pre band) presentation (⫾ standard deviation)

n ¼ (%) %EWL Reduction in BMI Mean weight loss (kg) %EWL Reduction in BMI Mean weight loss (kg)

Conversion to LRYGB (n ¼ 64)

Conversion to LSG (n ¼ 25)

61/64 52.1 10.1 28.2 60.6 14.72 41.1

22/25 44.1 8.4 24.7 58.9 16.5 47.3

(73%) (⫾23.77) (⫾5.17) (⫾15.58) (⫾21.69) (⫾5.53) (⫾16.87)

Conversion to LRYGB Follow-up at 2 yr Weight at time of conversional surgery (⫾ standard deviation) Weight at initial (pre band) presentation (⫾ standard deviation)

n ¼ (%) %EWL Reduction in BMI Mean weight loss (kg) %EWL Reduction in BMI Mean weight loss (kg)

35/64 47.9 9.8 27.35 58.4 14.2 39.6

(55%) (⫾29.79) (⫾6.72) (⫾20.27) (⫾26.40) (⫾6.80) (⫾19.83)

(88%) (⫾32.74) (⫾5.46) (⫾16.93) (⫾24.04) (⫾9.25) (⫾27.08)

Conversion to LSG 8/25 42.0 8.3 26.1 59.9 15.6 46.3

(35%) (⫾29.67) (⫾6.60) (⫾22.90) (⫾25.31) (⫾5.53) (⫾21.41)

P value

Overall

0.23 0.21 0.38 0.77 0.30 0.22

49.9 9.7 27.2 60.1 15.2 42.78

p value

Overall

0.61 0.57 0.89 0.88 0.60 0.40

46.8 9.56 27.0 58.7 14.45 40.8

(⫾26.65) (⫾5.27) (⫾15.93) (⫾22.20) (⫾6.72) (⫾20.12)

(⫾29.51) (⫾6.64) (⫾20.50 (⫾25.31) (⫾6.55) (⫾20.05)

BMI ¼ body mass index (kg/m2); %EWL ¼ percentage excess weight loss; LRYGB ¼ laparoscopic Roux-en-Y gastric bypass; LSG ¼ laparoscopic sleeve gastrectomy.

LRYGB patients, with an average follow-up of 14 months [17]. They reported no deaths, with an early complication rate of 0–36%, a late complication rate of 2–23%, and a reoperation rate of 0–20%. The same review reported on 91 patients who underwent conversion to LSG, reporting no deaths and early and late complication rates of 0–13.8% and 0–10.3%, respectively. Several studies have reported deaths after conversion to LSG, and others have reported high complication rates [18–20]. Berende reported a series of 51 band-to-LSG conversions with 7 bleeds and 7 leaks, giving an overall major complication rate of 27% [19]. In the largest series of 90 conversions to LSG there was a 5.5% leak rate and a 4.4% hematoma rate but no deaths [21]. These outcomes have been the basis for avoiding LSG as a conversion procedure after failed LAGB.

We note that within our series a higher number of patients underwent conversion to LSG as a staged procedure compared with LRYGB. We believe this is a reflection of the different indications for band removal, which included a greater number of emergency band complications or cases where the gastric pouch was dilated or inflamed at the time of band removal. Nevertheless the literature suggests band to LSG is more often undertaken as a staged procedure than band to LRYGB. However, this study reports one of the highest 2-stage rates (78%), compared with most other studies at 13–50% [18,20,22], but also the lowest complication rate. This interval allows the stomach to recover after band removal and may lead to improved staple line integrity and easier hemostasis. Poor weight loss remained the most common indication for conversion, and LRYGB was the procedure of choice,

Fig. 1. A comparison of mean weights (⫾ standard error) (kg) at band insertion, conversion, 1 year postoperatively, and 2 years postoperatively between patients converted to laparoscopic Roux en-Y gastric bypass and laparoscopic sleeve gastrectomy.

Fig. 2. A comparison of mean body mass index (⫾ standard error) (kg/m2) at band insertion, conversion, 1 year postoperatively, and 2 years postoperatively between patients converted to laparoscopic Roux en-Y gastric bypass and laparoscopic sleeve gastrectomy.

Conversion of LAGB to LSG or LRYGB Achieves Comparable Outcomes / Surgery for Obesity and Related Diseases ] (2014) 00–00

which was possible as a 1-stage procedure in 93% (38/41). Clearly a 2-stage revision requires a second procedure and hence results in longer overall hospital stay. Nevertheless we believe this is necessary to reduce the possibility of postoperative complications when 1-stage band removal and conversion is not straightforward. Within this study, 89 band conversion procedures were performed without a death and with only 1 serious complication. We believe this reflects our cautious approach to conversions from LAGB to either LSG or LRYGB, which we only embarked on after gaining significant experience from primary procedures. Over the period of the study we have performed 41300 RYGBs and 400 LSGs. Perhaps the most challenging band complication to consider with conversion is band erosion. One patient in this cohort had band erosion and presented as an emergency. The patient presented with epigastric pain and an infected port site. At endoscopy a 30% circumferentially eroded band was noted and the buckle was not visible. This was removed laparoscopically, followed by a 12-month delay before proceeding with conversion to LSG, which was only agreed to after that patient experienced significant weight gain without the band. We believe a cautious approach to patient and procedure selection is essential to minimizing complication rates. The complication rates from this study compare favorably with those recently published for a randomized controlled trial comparing primary LRYGB and LSG [23]. Planning conversion is dependent on a number of different factors. Our unit policy is to advise patients against LSG in the presence of significant reflux disease, and this remains an important consideration in the decision-making process [24]. Intraabdominal adhesions, often encountered intraoperatively, meant preoperative plans to perform a LRYGB were not possible. As a result, it is worth noting that with the 25 revisional LSG patients, 3 complained of significant de novo reflux symptoms at 1 year after conversion and 1 patient has now been listed for conversion to LRYGB. Mechanical gastric obstruction has also been reported after band-to-sleeve conversion by several authors [18,20,22], but this was not found in our series. In this study, overall weight loss outcomes were similar for both procedures, with mean overall weight loss 2 years after conversional surgery of 60.1%. This finding has been reported elsewhere but with less overall weight loss for LSG versus LRYGB [25]. This weight loss is o 70% EWL, as was reported in a recent randomized controlled trial comparing primary LSG with LRYG [23]. This is may be explained by the high number of patients (53%) who were converted with poor weight loss as the indication, who may represent a cohort of patients who are less adaptive to the dietary and lifestyle choices required for long-term success after any bariatric procedure. The follow-up rate at 1 year after conversion was high (93%) but tailed off significantly at 2 years (48%).

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Nevertheless our findings are in keeping with other published results that the maximal weight loss occurs over the first year [26]. When converting to LRYGB, the authors create the pouch below the site of the previous band, avoiding the capsule within the pouch staple line. Nevertheless this does not greatly increase the size of the pouch. With conversion to LSG, care is taken to stay lateral to the band capsule, ensuring staples are placed on normal stomach with the intention of minimizing staple line disruption. The authors expected that this would result in a larger sleeve being created, resulting in less weight loss. This was not shown to be correct. We hypothesize that the band capsule may act as a restrictive band around the sleeve and potentially augment early weight loss. Conclusion This study has found that conversion to LRYGB or LSG can be undertaken for failed LAGB with comparable postoperative outcomes. We have previously published data demonstrating similar weight loss and complication rates between conversion from LAGB to LRYGB and primary LRYGB [8]. Within this study period LRYGB was our conversional procedure of choice for failed LAGB, in keeping with the International Sleeve Consensus status [13]. Despite this, LRYGB is not possible for many patients and some patients do not want a LRYGB. This paper reported that conversion to LSG is well tolerated, can be undertaken with no increase in morbidity or deaths, and achieves equivalent outcomes compared with conversion to LRYGB, although it often requires a 2-stage procedure. Acknowledgments The authors wish to acknowledge the work of Dr. Norbert Schroeder, Consultant Bariatric Surgeon, for his clinical input as well as all other members of the bariatric team. Appendix Supplementary data Supplementary data associated with this article can be found in the online version at http://dx.doi.org/10.1016/j. soard.2014.07.021.

References [1] Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am J Surg 2002;184:9S–16S. [2] Chapman AE, Kiroff G, Game P, et al. Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Surgery 2004;135:326–51.

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W. R. J. Carr et al. / Surgery for Obesity and Related Diseases ] (2014) 00–00

[3] Rogers AM. Improvement of esophageal dysmotility after conversion from gastric banding to gastric bypass. Surg Obes Relat Dis 2010;6: 681–3. [4] Van Gemert WG, van Wersch MM, Greve JW, Soeters PB. Revisional surgery after failed vertical banded gastroplasty: restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg 1998;8:21–8. [5] Alhamdani A, Wilson M, Jones T, et al. Laparoscopic adjustable gastric banding: a 10-year single-centre experience of 575 cases with weight loss following surgery. Obes Surg 2012;22:1029–38. [6] Müller MK, Attigah N, Wildi S, et al. High secondary failure rate of rebanding after failed gastric banding. Surg Endosc 2008;22:448–53. [7] Bueter M, Thalheimer A, Wierlemann A, Fein M. Reoperations after gastric banding: replacement or alternative procedures? Surg Endosc 2009;23:334–40. [8] Jennings NA, Boyle M, Mahawar K, Balupuri S, Small PK. Revisional laparoscopic Roux-en-Y gastric bypass following failed laparoscopic adjustable gastric banding. Obes Surg 2013;23:947–52. [9] Mognol P, Chosidow D, Marmuse J-P. Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg 2004;14:1349–53. [10] Ardestani A, Lautz DB, Tavakkolizadeh A. Band revision versus Roux-en-Y gastric bypass conversion as salvage operation after laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2011;7: 33–7. [11] Calmes JM, Giusti V, Suter M. Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg 2005;15: 316–22. [12] Lanthaler M, Mittermair R, Erne B, Weiss H, Aigner F, Nehoda H. Laparoscopic gastric re-banding versus laparoscopic gastric bypass as a rescue operation for patients with pouch dilatation. Obes Surg 2006;16:484–7. [13] Rosenthal RJ, Diaz AA, Arvidsson D, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of 412,000 cases. Surg Obes Relat Dis 2012;8:8–19. [14] Coblijn UK, Verveld CJ, van Wagensveld BA, Lagarde SM. Laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy as revisional procedure after adjustable gastric band—a systematic review. Obes Surg 2013;23:1899–914.

[15] Victorzon M, Tolonen P. Mean fourteen-year 100% follow-up of laparoscopic adjustable gastric banding for morbid obesity. Surg Obes Realt Dis 2013;9:753–7. [16] Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013;23:427–36. [17] Schouten R, Japink D, Meesters B, Nelemans PJ, Greve JWM. Systematic literature review of reoperations after gastric banding: is a stepwise approach justified? Surg Obes Relat Dis 2011;7:99–109. [18] Foletto M, Prevedello L, Bernante P, et al. Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty. Surg Obes Relat Dis 2010;6:146–51. [19] Berende CAS, de Zoete J-P, Smulders JF, Nienhuijs SW. Laparoscopic sleeve gastrectomy feasible for bariatric revision surgery. Obes Surg 2012;22:330–4. [20] Utech M, Shaheen H, Halter J, et al. Sleeve gastrectomy as a revision procedure for Failed Gastric Banding. Zentralbl Chir 2014;139: 79–82. [21] Yazbek T, Safa N, Denis R, Atlas H, Garneau PY. Laparoscopic sleeve gastrectomy (LSG)-a good bariatric option for failed laparoscopic adjustable gastric banding (LAGB): a review of 90 patients. Obes Surg 2013;23:300–5. [22] Acholonu E, McBean E, Court I, Bellorin O, Szomstein S, Rosenthal RJ. Safety and short-term outcomes of laparoscopic sleeve gastrectomy as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity. Obes Surg 2009;19:1612–6. [23] Peterli R, Borbély Y, Kern B, et al. Early results of the Swiss Multicentre Bypass or Sleeve Study (SM-BOSS): a prospective randomized trial comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass. Ann Surg 2013;258:690–5. [24] Mahawar KK, Jennings N, Balupuri S, Small PK. Sleeve gastrectomy and gastro-oesophageal reflux disease: a complex relationship. Obes Surg 2013;23:987–91. [25] Khoursheed M, Al-Bader I, Mouzannar A, et al. Sleeve gastrectomy or gastric bypass as revisional bariatric procedures: retrospective evaluation of outcomes. Surg Endosc 2013;27:4277–83. [26] Jacobs M, Gomez E, Romero R, Jorge I, Fogel R, Celaya C. Failed restrictive surgery: is sleeve gastrectomy a good revisional procedure? Obes Surg 2011;21:157–60