Laparoscopic Insertion of a Gastric Band for Weight Gain Following Laparoscopic Roux-en-Y Gastric Bypass: Description of
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MODERN SURGERY: TECHNICAL INNOVATION
Laparoscopic Insertion of a Gastric Band for Weight Gain Following Laparoscopic Roux-en-Y Gastric Bypass: Description of the Technique Dugal Heath & Danile Leff & Pratik Sufi
Received: 1 September 2008 / Accepted: 20 November 2008 / Published online: 13 December 2008 # Springer Science + Business Media, LLC 2008
Abstract Background A recently published prospective series has demonstrated that weight loss ceases 18 to 24 months following Laparoscopic Roux-en-Y gastric bypass (RYGB) and that, by 48 months, there is significant weight regain in 50% of patients. Methods We report the case of a 38-year-old male patient who developed significant weight regain 42 months following laparoscopic (RYGB) and underwent laparoscopic placement of a Swedish ajustable gastric band (SAGB) around the gastric pouch. Results In previous reports, the gastric band was placed around the upper part of the stomach. This paper provides the first report of the placement of a gastric band around the lower gastric pouch, just above the gastrojejunal anastomosis, in the management of weight regain following laparoscopic RYGB. Prior to revision surgery, the patient’s weight was 95 kg [body mass index (BMI) 31 kg/m2, excess weight loss 65%]. Conclusion Four months following the procedure this had reduced to 82.1 kg (BMI 26 kg/m2, excess weight loss 90%). Keywords Roux-en-Y gastric bypass . Bariatric surgery . Morbid obesity . Adjustable gastric banding . Revision surgery . Post-bariatric surgery weight loss
D. Heath (*) : D. Leff : P. Sufi North London Obesity Surgery Service (NLOSS), The Whittington Hospital, Magdala Avenue, London N19 5NF, UK e-mail: [email protected]
Introduction A recently published prospective series has demonstrated that significant weight loss ceases 18 to 24 months following Roux-en-Y laparoscopic gastric bypass (RYGB) and that, by 48 months, there is significant weight regain in 50% of patients [1]. We report the case of a 38-year-old male patient who developed significant weight regain 42 months following laparoscopic (RYGB) bypass and underwent laparoscopic placement of a Swedish ajustable gastric band (SAGB; Ethicon EndoSurgery) around the gastric pouch. In previous reports, the gastric band was placed around the upper part of the stomach [2–5]. This paper provides the first report of the placement of a gastric band around the lower gastric pouch, just above the gastrojejunal anastomosis, in the management of weight regain following laparoscopic RYGB.
Case Report A 35-year-old man weighing 129 kg [body mass index (BMI), 42.1 kg/m2; ideal body weight, 77 kg, assuming a BMI of 25 kg/m2] underwent laparoscopic RYGB in October 2004. The gastric pouch was formed over a 32-French gauge bougie, the stomach being divided between the second and third vessels below the gastroesophogeal junction on the lesser curve side. Care was taken to include the posterior gastric wall and to remain close to the esophagus when forming the upper part of the gastric pouch in order to ensure
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