Intervento differito
G. LESTI
Prof. Ass. Università di Chieti
Fondazione Salus
Redo surgery after G.B.
 after 7 years, adjustable gastric
banding should not longer be
considered as the procedure of choice
for morbid obesity; other long lasting
procedure should be used
M Suter 2006
Redo surgery after G.B.
 Paz.317
 BMI 43.5
 Compl. Tot. 33.1 % erosione
9.5%
dilat/slipp. 6.5%
cath./port 7.6%
M.Suter 2006
Redo surgery after G.B.
 Paz. 15 (2005-2009)


13 patients:
2 patients:
weight regains : 25.6 %
poor weight loss: 33.3 %
slippage:
26.6 %
one step revision
two steps revision
Emeka Acholonu, 2009
Redo surgery after G.B.
L.S.G. could provide short-term weight loss
after previously failed L.A.G.B. , but prone to
more complications compared to an initial L.S.G.
without a prior bariatric procedure
E. Acholonu, 2009
Redo surgery after G.B.
 Paz. : 41 redo : per 36 G.B.
per 5 V.B.G.
 Complicazioni: 5 (12.2 % ) 1 fistola alta
3 ascessi addominali
1 ernia incisionale
 6 pazienti : secondo intervento
A. Iannelli, 2009
Redo surgery after G.B.
Conversion of G.B. or V.B.G. into L.S.G. is
feasible and safe. L.S.G. is effective in the short-term
with a mean % EWL of 42% at 13 months. Long –term
results of L.S.G. as revisional procedure are aweited to establish
its efficacy in the long-term.
A Iannelli,2009.
Redo surgery after G.B
Revisional L.S.G.
tot:
90
Complications :
hemorrhage 4.4%
leak
5.5%
LSG after LAGB yields a positive outcome with higher
complication rates than for primary LSG.
We advocate this procedure as a good bariatric option for failed
LAGB.
T. Yazbek, 2013
Redo surgery after B.G
 The increasing popularity of the LAGB has led to a
considerable number of revisions of the device. Our
early experience has shown that converting patients
from LAGB to laparoscopic Roux-en-Y gastric bypass is
feasible and safe and can offer patients substantial
additional weight loss.
Redo surgery after G.B
 REDO-LRYGB : 85 Pats after LAGB
 ONE STEP :
 TWO STEPs:
78%
22%
 MAJOR COMPLICATIONS :
13.4%
This is a challenging procedure, but can usually be performed in a single stage
with acceptable morbidity and mortality. These patients should be treated in
high-volume, subspecialty bariatric units.
MW Hii, Royal Hospital Herston; Australia 2013
Redo surgery after G.B
RE-LRYGBP
tot: 107 pats (21 VBG, 86 GB)
 Major compl. : 11% (more frequent after VBG p<o,o5)
 RE-LRYGBP single step : 59%
 RE-LRYGBP two steps :
41%
Outcomes are worse after VBG, the procedure can be
performed safely as one step after GB removal
J.A.Apers Surg Endosc, 2013
Redo surgery after G.B
CONCLUSIONI
ONE STEP
Weight regains
Poor weight loss
Slippage (very caution)
TWO STEPS
Erosion
The procedure should be, always, registered