66 Obesity Surgery, 11, 2001 © FD-Communications Inc. Obesity Surgery, 11, 66-69 Background: Revision of gastric bariatric operations is sometimes technically difficult and may fail to achieve prolonged weight reduction. The use of the adjustable silicone gastric banding (ASGB) offers a new approach for these revisions. Methods: ASGB was performed as a revisional procedure on 37 patients whose initial bariatric oper- ations were as follows: silastic ring vertical gastro- plasty (21), gastric bypass (12), horizontal gastro- plasty (3) and vertical banded gastroplasty (1). Results: The length of the procedure varied from 55 to 145 minutes (mean 83 minutes). Intraoperative complications included two fundic tears which were sutured without any postoperative sequelae. Five patients needed reoperation during the first postop- erative year due to gastric volvulus (1), tubing tear (1) and development of postoperative ventral hernia (3). BMI fell from 44.8 ± SD 8.07 to 33.4 ± 6.9 kg/m 2 for patients operated with BMI higher than 35 kg/m 2 and from 29.2 ± 3.32 to 25.4 ± 2.8 kg/m 2 for patients oper- ated with BMI lower than 35 kg/m 2 . Conclusions: ASBG can be performed with revi- sions with an acceptable complication rate and post- operative weight reduction. Keywords: Adjustable silicone gastric banding, bariatric surgery, morbid obesity, revision Introduction Regain of body weight after initial satisfactory weight reduction may occur after gastric bartiatric operations. There may be many clinical reasons responsible for this occurrence, such as staple-line disruption or pouch dilatation after silastic ring vertical gastroplasty (SRVG) or stoma and/or pouch dilatation after gastric bypass (GBP). Correction of these conditions is sometimes tech- nically difficult and may fail to achieve prolonged weight reduction. The introduction of the adjustable silicone gastric band (ASGB) offers a new more feasible operative approach. An advan- tage of this technique is that it is associated with minimal additional trauma to the stomach because no suture-lines or anastomoses are needed. In addi- tion, postoperatively a desired stomal size can be achieved. We hereby describe retrospectively our experience with the use of ASGB (Lap-Band ® , BioEnterics Corporation, Carpinteria, CA, U.S.A.) after failure of earlier gastric reduction procedures. Patients and Methods From January 1996 to May 1998, introduction of an ASBG was performed on 37 patients, who had undergone an earlier gastric bariatric procedure which failed. Their ages were 17 - 65 years (mean 38 years). The previous procedures were SRVG – 21 patients, GBP – 12 patients, horizontal gastro- plasty – 3 and vertical banded gastroplasty (VBG) – 1 patient. In three patients, the present procedure was the third bariatric gastric operation. The time elapsed since the initial bariatric operation varied from 2 - 192 months (mean 94 months). Failure of the initial procedure was evident by increased body weight after satisfactory weight reduction in 34 of the patients. The causes for this Use of Adjustable Silicone Gastric Banding for Revision of Failed Gastric Bariatric Operations S. Kyzer, MD; A. Raziel, MD; O. Landau, MD; A. Matz, MD; I. Charuzi, MD Department of Surgery “B”,Wolfson Medical Center, Holon, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Reprint requests to: S. Kyzer, MD, Department of Surgery “B”, Wolfson Medical Center, P.O.B. 5, Holon 58100, Israel. Tel: 972 3 502-8634; fax: 972 3 501-6667.