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Gianfranco Silecchia, MD, PhD; Nicola Perrotta, MD; Cristian Boru, MD; Alessandro Pecchia, MD; Mario Rizzello, MD; Francesco Greco, MD; Alfredo Genco, MD; Vincenzo Bacci, MD; Nicola Basso, MD

Arch Surg. 2004;139:1225-1230.

Hypothesis  Complications after laparoscopic adjustable gastric banding as treatment for morbid obesity may require a major reintervention. A minimally invasive approach represents an attractive management alternative for such complications.

Design  Prospective case series.

Setting  Major academic medical and surgical center.

Patients  From January 1996 to July 2003, 47 patients who had undergone laparoscopic adjustable gastric banding were operated on again. Considering the causes for reoperation, the patients were divided into 4 groups: group A had major complications (n = 26); group B, minor complications (n = 11); group C, psychological problems (n = 6); and group D, insufficient weight loss (n = 4).

Interventions  Forty-three procedures, 38 using general anesthesia (groups A, C, and D) and 5 using local anesthesia (group B), were performed.

Main Outcome Measures  Feasibility, safety, and effectiveness of a minimally invasive approach in the treatment of laparoscopic adjustable gastric banding complications.

Results  In group A, 9 of 10 patients with irreversible gastric pouch dilatation and 15 of 16 with intragastric band migrations were treated laparoscopically. In group B, 5 ports were substituted and 2 reconnections of the catheter-port system were performed. In group C, 6 laparoscopic band removals were carried out. In group D, 4 laparoscopic revision procedures for insufficient weight loss were performed. The operative mortality was nil. The most frequent cause of reoperation was intragastric migration (37.2%). A minimally invasive approach was adopted in 94.7% of cases.

Conclusion  Laparoscopy is safe and effective, even as a second operative procedure.

Author Affiliations: Departments of Surgery "Paride Stefanini" (Drs Silecchia, Perrotta, Boru, Pecchia, Rizzello, Greco, Genco, and Basso) and Clinical and Applied Medical Therapy (Dr Bacci), Policlinico Umberto I, Università "La Sapienza" Roma, Rome, Italy.

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