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Intervento differito G. LESTI Prof. Ass. Università di Chieti Fondazione Salus Fondazione Salus.

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Presentation on theme: "Intervento differito G. LESTI Prof. Ass. Università di Chieti Fondazione Salus Fondazione Salus."— Presentation transcript:

1 Intervento differito G. LESTI Prof. Ass. Università di Chieti Fondazione Salus Fondazione Salus

2 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

3 Redo surgery after G.B. Paz.317 BMI 43.5 Compl. Tot % erosione 9.5% dilat/slipp. 6.5% cath./port 7.6% M.Suter 2006

4 Redo surgery after G.B. weight regains : 25.6 % Paz. 15 ( ) poor weight loss: 33.3 % slippage: 26.6 % 13 patients: one step revision 2 patients: two steps revision Emeka Acholonu, 2009

5 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

6 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

7 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.

8 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

9 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.

10 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

11 Redo surgery after G.B RE-LRYGBP tot: 107 pats (21 VBG, 86 GB) Major compl. : 11% (more frequent after VBG p

12 Redo surgery after G.B CONCLUSIONI Weight regains ONE STEP Poor weight loss Slippage (very caution) TWO STEPS Erosion The procedure should be, always, registered

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