• P P C Poyck, F Polat, D J Gouma, and W L E M Hesp.
• Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands. p.p.c.poyck@asz.nl
• Surg Obes Relat Dis. 2012 Jul 1; 8 (4): 393-9.

BackgroundWeight loss failure after laparoscopic gastric banding (LAGB) can occur in ≤ 25% of patients. Conversion to a malabsorptive procedure might provide more durable weight loss. The present study evaluated biliopancreatic diversion with duodenal switch (BPD/DS) after LAGB failure with a 3-year follow-up period.MethodsA total of 35 patients underwent BPD/DS after LAGB failure and were prospectively analyzed using a multidisciplinary approach. Weight indexes, co-morbidities, complications, morbidity/mortality, and nutritional status were analyzed.ResultsExcess weight decreased from 91% (134 kg, body mass index 48 kg/m(2)) to 75% (124 kg, body mass index 44 kg/m(2)) after LAGB failure and decreased further to 40% (100 kg, body mass index 35 kg/m(2)) after BPD/DS. The mean percentage of excess weight loss was 55% after LAGB and BPD/DS together and 48% after BPD/DS alone. The incidence of co-morbidities, such as diabetes, sleep apnea, hypertension, hyperlipidemia, joint problems, and chronic obstructive pulmonary disease was reduced after BPD/DS. Nutritional deficiencies were already present after LAGB failure (e.g., iron, ferritin, vitamins B(12), B(6), A, D, and E, albumin, and calcium) and either increased (folic acid, potassium, and vitamin B(12)), remained stable (iron, ferritin, vitamin A), or decreased after BPD/DS (albumin and vitamins B(6) and E).ConclusionBPD/DS provided substantial weight loss after LAGB failure and reduced the incidence of obesity-related co-morbidities during a 3-year period. Long-term nutritional follow-up is advocated for all patients after malabsorptive BPD/DS.Copyright © 2012 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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