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. 33.1 % 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 (2005-2009) 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<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

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