Redo surgery dopo gastric banding : tempo unico o intervento differito?
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Redo surgery dopo gastric banding: tempo unico o
intervento differito?Intervento differito
G. LESTIProf. Ass. Università di Chieti
Fondazione Salus
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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
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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
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Redo surgery after G.B. weight regains : 25.6
% Paz. 15 (2005-2009) poor weight loss: 33.3
% slippage:
26.6 %
13 patients: one step revision 2 patients: two steps revision
Emeka Acholonu, 2009
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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
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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
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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.
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Redo surgery after G.BRevisional 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
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Redo surgery after B.GThe 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.
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Redo surgery after G.B REDO-LRYGB : 85 Pats after LAGB
ONE STEP : 78%TWO STEPs: 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
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Redo surgery after G.BRE-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
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Redo surgery after G.BCONCLUSIONI
Weight regains ONE STEP Poor weight loss Slippage (very caution)
TWO STEPS Erosion
The procedure should be, always, registered
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