INTRODUCTION O BESITY IS BECOMING INCREASINGLY PREVALENT in the United States and can lead to multiple life-threatening comorbidities, including hypertension and diabetes as well as sleep apnea and obesity–hy- poventilation syndromes. 1 Only surgical therapies have been shown to produce sustained weight loss and improve or resolve associated comorbidities. 2 It has been estimated that 10 million obese Americans qual- ify for bariatric surgery. 3 Surgical weight loss can be achieved by procedures leading to gastric restriction, intestinal malabsorption, or both. Malabsorptive pro- cedures can produce superior weight loss results but at the expense of potential metabolic and nutritional de- ficiencies. 4 The Lap-Band ® Adjustable Gastric Banding System, manufactured by BioEnterics Corporation (Carpinteria, CA), received Food and Drug Administration (FDA) ap- proval on June 5, 2001. Laparoscopic adjustable silicone gastric banding (LASGB) is a minimally invasive, re- strictive procedure that is intended to produce adequate weight loss in the morbidly obese patient. 5 However, in a multicenter Lap-Band ® trial, the FDA found an aver- age excess-weight loss of only 36% at 3 years after de- vice implantation. 6 It is anticipated that many LASGB patients will require revision in the next few years be- cause of inadequate weight loss. The procedure of choice for such a revision is unknown. Two patients with less than satisfactory weight loss are presented. They underwent a laparoscopic gastric band removal with conversion to a biliopancreatic diversion JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 12, Number 4, 2002 © Mary Ann Liebert, Inc. Conversion to a Laparoscopic Biliopancreatic Diversion with a Duodenal Switch for Failed Laparoscopic Adjustable Silicone Gastric Banding JOHN de CSEPEL, M.D., THERESA QUINN, M.D., ALFONS POMP, M.D., and MICHEL GAGNER, M.D. ABSTRACT Background: Initial data indicate that long-term weight loss for patients who have undergone lap- aroscopic adjustable silicone gastric banding (LASGB) may be inadequate. It is anticipated that many of these patients will require revision in the next few years. The procedure of choice for such a revision is unknown. Patients and Methods: Two LASGB patients, who underwent a laparoscopic gastric band removal with a conversion to a biliopancreatic diversion with a duodenal switch (BPD/DS), are presented. Results: Their procedures were completed without intraoperative complications. Significant weight loss over 12 and 13 months was achieved. Conclusion: The BPD/DS, as opposed to the Roux-en-Y gastric bypass (RGB), is well suited for LASGB revision, as its proximal anastomosis is at the duodenum, away from the gastric band scar tissue. Our experience performing laparoscopic BPD/DS has yielded satisfactory weight loss results without the need for revision. Division of Laparoscopic Surgery, Mount Sinai School of Medicine, New York, New York. 237