Bypass Gastric Banding Research Articles

Insufficient weight loss after banded vs. non-banded primary gastric bypass surgery: insights from an observational 5year follow-up study.

While Roux-en-Y gastric bypass (RYGB) is effective in achieving weight loss and improving obesity-related co-morbidities, insufficient weight loss in the long-term can occur. The goal was to assess whether banded vs. non-banded RYGB reduces the risk of insufficient weight loss at 5-year follow-up. This is a retrospective single-center cohort study from Switzerland. We assessed the 5-year metabolic trajectories in terms of body weight, body mass index, glucose control, lipid profile and blood pressure of two surgical cohorts undergoing identical RYGB procedures with or without banding using a uniform 6.5cm silastic Fobi band. Insufficient weight loss was defined as < 50% excess weight loss (EWL) at 5years. A total of 55 patients receiving banded (Fobi) and 55 patients receiving non-banded (non-Fobi) RYGB were included in the analysis. 5-year follow-up was 91% for both groups. Percentage of EWL at 5years was 78.11 ± 26.1% and 73.5 ± 27%.3 for the Fobi vs. non-Fobi group (p = 0.368), respectively. Insufficient weight loss (defined as < 50%EWL) at 5years or last follow-up was significantly higher in the non-Fobi group compared to the Fobi group (19/55 vs. 9/55, respectively, OR = 2.639 (95% CI 1.066, 6.531), p = 0.036). Surrogate markers for cardiometabolic outcomes consistently improved over time, without differences between the groups. During the follow-up period, Fobi-removal was necessary in nine patients (16.3%). Banded-RYGB lowered the odds of insufficient weight loss at 5years follow-up by approximately 62%. Further research is needed to explore the effect of restriction on eating behaviour and neuroendocrine responses after RYGB.

Impact of Laparoscopic Banded Gastric Bypass on Weight Loss Surgery Outcomes: 5 Years' Experience.

Evaluate 5-year outcomes of banded gastric bypass (BRYGB) as a primary and conversion bariatric procedure. Retrospective review of BRYGB between January 2011and March 2013. Outcomes included percentage of total weight loss (%TWL), weight loss maintenance, and band-related complications. One hundred forty-two patients underwent BRYGB, 106 primary and 36 conversions. Indications for conversion to BRYGB were complications of the primary procedure (n = 19), insufficient weight loss (n = 5), and weight regain (n = 12). In the primary group, mean preoperative BMI was 44.8 kg/m2 (± 6.9 kg/m2). Compared with preoperative weight, mean %TWL was 33.9% (n = 95), 34.1% (n = 82), 34.0% (n = 70), 33.9% (n = 62), and 31.8% (n = 75) after 1, 2, 3, 4, and 5 years, respectively. In conversions secondary to failed primary procedure (insufficient WL and weight regain), mean preoperative BMI was 40.8 kg/m2 (± 6.01 kg/m2). Despite one patient gaining weight, mean %TWL was 25.7% (n = 13), 28% (n = 11), 23.9% (n = 8), 18.3% (n = 8), and 15.1% (n = 12) after 1, 2, 3, 4, and 5 years, respectively. In conversions secondary to primary procedure complications (n = 19), mean preoperative BMI was 28.4 kg/m2 (± 3.5 kg/m2). After 1, 2, 3, 4, and 5 years, mean BMI was 28.1 (n = 15), 29 (n = 10), 29.8 (n = 9), 30.6 (n = 10), and 30.9 (n = 12) kg/m2, respectively. Band-related complications after 5 years: three erosion and five patients complained of persistent dysphagia. One band needed reposition. Perioperative surgical complications: two bleeding, one leakage, one port-site hernia, and one food impaction. Banded gastric bypass has good results in terms of weight loss and weight loss maintenance in both primary and conversional bariatric procedures with acceptable incidence of band-related complications.

Endoscopic Closure of Gastro-gastric Fistula After Gastric Bypass: a Technically Feasible Procedure but Associated with Low Success Rate.

Gastro-gastric fistulas (GGF) are reported to be as high as 12% after gastric bypass for treatment of morbid obesity. While different endoscopic methods are described, the management traditionally consists of surgical revision with high associated morbidity. The aim of the study was to assess feasibility, safety and success rate of endoscopic closure using an endoscopic suturing device. From January 2016 to March 2018, we reviewed the electronic records of all patients undergoing endoscopic closure of a GGF with the Apollo Overstitch system (Apollo Endosurgery, Austin, Texas, USA). Demographic details, procedure details, and outcome variables were recorded. A total of six patients (M:F = 5:1) underwent endoscopic fistula closure. Five patients (83.3%) had a prior banded gastric bypass (with subsequent band removal). The median number of prior abdominal surgeries was 3, the mean time from bypass to endoscopic fistula closure was 5years (range 1.1-10.4). While immediate complete endoscopic fistula closure was possible in 10 of 12 attempts in those six patients (83%), all patients had recurrent (persistent) fistulas at follow-up. After a mean follow-up time of 12months, 83.3% had further laparoscopic converted to open (n = 2) or laparoscopic (n = 3) revisions with complete fistula closure. One patient is refusing further intervention. Endoscopic gastro-gastric fistula closure with an endoscopic suturing device is feasible and safe. Unfortunately, due to the nature of gastro-gastric fistulas, permanent successful closure is rare. Therefore, the approach should be reserved for patients in whom a laparoscopic or open surgical attempt is impossible due to prior abdominal revisions.

Endoscopic management of erosion after banded bariatric procedures

BackgroundProsthetic materials wrapped around a portion of the stomach have been used to provide gastric restriction in bariatric surgery for many years. Intraluminal erosion of adjustable and nonadjustable gastric bands typically occurs many years after placement and results in various symptoms. Endoscopic management of gastric band erosion has been described and allows for optimal patient outcomes. ObjectivesWe will describe our methods and experience with endoscopic management of intraluminal gastric band erosions after bariatric procedures. SettingUniversity hospital in the United States. MethodsA retrospective review of our bariatric surgery database identified patients undergoing removal of gastric bands. A chart review was then undertaken to confirm erosion of prosthetic material into the gastrointestinal tract. Baseline characteristics, operative reports, and follow-up data were analyzed. ResultsSixteen patients were identified with an eroded gastric band: 11 after banded gastric bypass, 3 after laparoscopic adjustable gastric band (LAGB), and 2 after vertical banded gastroplasty. All patients were successfully treated with endoscopic removal of the prosthetic materials using either endoscopic scissors or ligation of the banding material with off-label use of a mechanical lithotripter device. Complications included a postoperative gastrointestinal bleed requiring repeat endoscopy, 1 patient with asymptomatic pneumoperitoneum requiring observation, and 1 with seroma at the site of LAGB port removal. ConclusionsEndoscopic management of intraluminal prosthetic erosion after gastric banded bariatric procedures can be safe and effective and should be considered when treating this complication. Erosion of the prosthetic materials inside the gastric lumen allows for potential endoscopic removal without free intraabdominal perforation. Endoscopic devices designed for dividing eroded LAGBs may help standardize and increase utilization of this approach.

Endoscopic Management of Eroded Bands Following Banded-Gastric Bypass (with Video).

Banded-gastric bypass is a highly effective bariatric procedure, yet the possibility of band erosion remains a significant drawback. Surgical removal of eroded bands may be associated with significant morbidity. In this study, we assess the efficacy and safety of a solely peroral endoscopic approach for the management of eroded bands in patients with a banded-gastric bypass. Starting January 2012, all patients with banded-gastric bypass and an eroded band were subjected to an attempt at peroral endoscopic removal using endoscopic scissors and/or argon plasma coagulation (APC), regardless of the circumference of band eroding inside the lumen. Sixteen patients presented with eroded bands, 2 were deemed not amenable to endoscopic removal as only part of the thickness was eroded. Of the 14 patients where endoscopic attempts were performed, 12 (86%) were completely removed successfully, while 2 (14%) were cut but could not be extracted and only the intraluminal portion was trimmed. Complete resolution of symptoms occurred in 13 (93%) while in 1 patient (7%) there was partial improvement. Only one endoscopic session was performed per patient with a median time of 37.5min per session (22-55min). No complications were encountered. Endoscopic removal of eroded gastric bands in patients with banded-gastric bypass is effective and safe in the majority of patients. When bands are adherent to the gastric wall, removal of the intraluminal portion of the band may lead to full or partial improvement of symptoms. Endoscopic band removal can be attempted even when a small part of band circumference has eroded.

Banded Gastric Bypass: Better Long-Term Results? A Cohort Study with Minimum 5-Year Follow-Up

BackgroundWhile gastric bypass has been the treatment of choice for morbid obesity, insufficient weight loss and even weight regain has been observed in a sub-group of patients. Dilatation of the pouch, pouch outlet, and proximal alimentary limb have been suggested to cause weight regain on the long term. The banded gastric bypass surgery has been introduced to overcome this problem.MethodsFour hundred thirty-two patients (n = 254, non-banded/n = 178, banded-GaBP Ring™) were followed-up for 5 years. Patients were evaluated for weight loss, % excess weight loss (%EWL), weight regain and BMI.ResultsNo significant differences between groups in the first year following surgery were observed in terms of weight loss and %EWL. %EWL at 5 years was as follows: non-banded 65.2 ± 20.0 %; banded 74.0 ± 15.1 %. At 5 years, the banded group showed more weight loss (non-banded 35.4 ± 12.5; banded 43.9 ± 11.9 kg, P < 0.0001); weight regain was significantly higher in the non-banded group (P < 0.0001). Only minor complications were reported; no signs of ring migration or slippage were reported.ConclusionAlthough, following the first year after surgery, no differences in treatment groups were observed in terms of weight loss, 5 years following surgery, patients who received banded surgery maintained better weight loss and had less weight regain compared to the non-banded group. These results suggest that laparoscopic banded gastric bypass using a silastic ring was effective in maintaining weight loss on the long term, while the complication rate was low. The banded gastric bypass is regarded by us as the new gold standard.

Endoscopic treatment of food intolerance after a banded gastric bypass: inducing band erosion for removal using a plastic stent.

Ring complications after a banded Roux-en-Y gastric bypass (RYGB) are usually managed surgically. The aim of this study was to analyze the safety and effectiveness of endoscopic removal of noneroded rings after banded-RYGB, by inducing intragastric erosion of the ring using a self-expandable plastic stent (SEPS). A total of 41 patients with banded RYGB who had noneroded rings and food intolerance were prospectively enrolled. Patients were treated with endoscopic SEPS placement and ring removal. Data from time of stenting, resolution of symptoms, need for endoscopic dilation, and complications were recorded. Successful ring removal was possible in all patients. In 21 cases, the SEPS induced complete erosion, and in 17 cases the ring was removed a month later because of incomplete erosion at the time of SEPS removal. Nine patients (22.0 %) needed endoscopic dilation after stent removal in order to treat fibrotic strictures. Food tolerance was observed in 32 patients (78.0 %) after the procedure. No patient needed surgery and there were no deaths. Endoscopic removal of the ring using SEPS appeared to be safe and effective after a banded RYGB.

A Comparative, Prospective and Randomized Evaluation of Roux-en-Y Gastric Bypass With and Without the Silastic Ring: A 2-Year Follow Up Preliminary Report on Weight Loss and Quality of Life.

Currently, Roux-en-Y gastric bypass (RYGB) is one of the most widely used bariatric surgeries. Banding the pouch forms a banded gastric bypass operation, an accepted and frequently used variant. Placing a silastic ring around the pouch to band the gastric bypass operation increases the restriction mechanism. However, the ubiquitous use of the banded gastric bypass remains controversial. One of the controversies is the effect of the silastic ring on patients' perception of their well being after surgery because of the frequency of vomiting. A prospective, blindly randomized, comparative trial was undertaken to resolve this controversy. Four hundred subjects scheduled for gastric bypass surgery were randomized into two arms of the trial, 200 with a silastic ring (WR) and 200 without (NR). After 2-year follow-up, the variables associated with the scores of Bariatric Analysis and Reporting Outcome System (BAROS) were analyzed. The initial median weight (125 kg), BMI (47), and age (36 years) were the same in both the NR and WR groups. The median excess weight loss, weight regain, and incidence of vomiting were 71, 10.5, and 7.75%, respectively, in the NR group vs. 75.4 and 1.1, and 24.4% in the WR group. The mean QOL score was 79% in the NR group vs. 80% in the WR group. After 2-year follow-up, silastic ring placement in the RYGB resulted in greater weight loss and weight stability and a threefold greater incidence of vomiting. There was no difference in the scores in the quality of life analysis.

Long-Term Results of Primary Vertical Banded Gastroplasty.

The vertical banded gastroplasty (VBG) used to be a common restrictive bariatric procedure but has been abandoned by many due to a high failure rate, a high incidence of long-term complications, and the newer adjustable gastric band (AGB) and sleeve. However, potential favorable long-term results and the upcoming banded gastric bypass, with a similar mechanical outlet restriction and control of the pouch size, renewed our interest in the VBG. Therefore, we investigated the long-term outcome of primary VBG at the Catharina Hospital in the Netherlands. Patients that underwent a primary VBG between 1998 and 2008 were included. Patients' characteristics, operative details, evolution on weight and comorbidities, complications, and outcome of revisions were reviewed. A total of 392 patients (80 % female) were reviewed with a mean age of 40 ± 9 years and body mass index of 44 ± 5 kg/m(2). Mean follow-up after VBG was 66 ± 50 months and showed a mean excess weight loss (EWL) of 53 ± 27 % and comorbidity reduction of 54 %. One hundred fifty-two patients (39 %) out of 227 patients (58 %) with long-term complaints underwent revisional surgery. Main reasons for revision were weight regain and vomiting/food intolerance. Analysis before revision showed an outlet dilatation (17 %), pouch dilatation (16 %), and outlet stenosis (10 %). After revision, an additional EWL of 23 % and 33 % further reduction in comorbidities was seen. Primary VBG has an acceptable EWL of 53 % and 55 % of comorbidities were improved. However, the high complication rate, often necessitating revision, underlines the limits of this procedure.

Banded gastric bypass - four years follow up in a prospective multicenter analysis.

BackgroundThe gastric bypass is the gold standard of bariatric surgery. Nevertheless some patients show insufficient weight loss or weight regain. Dilation of the pouch or the pouch outlet may be the cause. The banded gastric bypass tries to overcome dilation by placing an implant around the pouch or pouch outlet. In this study we describe our results using the GaBP™ ring system in banded gastric bypass operations in 3 bariatric centers.Methods183 patients in 3 bariatric reference centers received a banded gastric bypass operation using the GaBP™ ring system. Up to 4 years follow up was evaluated including weight loss and complications.ResultsMean EWL after 6 Months was 60% with a mean BMI of 30.1 kg/m2. After one year mean EWL reached 75.3% with a mean BMI of 27 kg/m2 (110 patients). After two and three years the EWL was 78.8% (n = 49) and 79.9% (n = 35). There was a mean EWL of 85% after 4 years. Thirteen patients finished a 4 year follow up period and mean BMI after 4 years was 25.2 kg/m2. In the perioperative and early postoperative period there was a low complication rate (4.3%). Stenosis or dysphagia was observed in only one patient. There was only one ring related complication.ConclusionBanded gastric bypass using the GaBP™ ring system allows good weight loss with no regain of weight in a four year follow up. The complication rate is low. A randomized controlled trial is currently underway to compare banded and conventional gastric bypass.

An unusual cause of gastric pouch outlet obstruction as a late complication of banded gastric bypass

Although still relatively uncommon, an increasing number of revisional bariatric surgical procedures are being carried out for weight regain or technical failure of the primary operation [1]. A range of revisional procedures has been developed, but one such option is the use of an adjustable gastric band positioned around a dilated gastric pouch after the index procedure of Roux-en-Y gastric bypass (RYGB), which has been previously been described as salvage gastric banding [2]. It is widely acknowledged that revisional bariatric surgery is associated with increased rates of morbidity and mortality [3], but most studies are concerned with problems encountered in the immediate postoperative period.

Bypass anillado ¿cuál es su real utilidad?: Estudio comparativo a diez años

Banded gastric bypass. A ten years evaluation Background: Placing a ring around the gastric reservoir could improve the weight lowering effects of gastric bypass. Previous studies have shown positive results of banded gastric bypass. Aim: To evaluate the long-term outcome of patients subjected to banded gastric bypass (GB) and non-banded GB procedures. Material and Methods: Ten years follow up of 260 non randomized obese patients who underwent banded GB and 218 patients in whom the ring was not placed. Excess weight loss (EWL), quality of life (QOL), food tolerance (FT), and correction of comorbidities were assessed. Results: The percentage EWL at ten years of follow up was 82 and 63% among patients subjected to banded and non-banded gastric bypass, respectively (p < 0.01). In three patients with banded GB, there was a migration of the ring to the interior of the stomach. Stenosis of the gastro-jejuno anastomosis occurred in 4 and 0.4% of patients subjected to banded and non- banded GB Perception of quality of life was similar in both groups. The outcome in terms of comorbidities was not conclusive. Conclusions: There is a clear advantage in terms of EWL among patients subjected to banded GB. No differences in quality of life were found in both groups.

Ten Years Experience of Banded Gastric Bypass: Does It Make a Difference?

Many surgeons support some sort of restriction of the gastric pouch outlet by placing a ring around the gastric reservoir. Previous studies have shown positive results of banded gastric bypass (BGBP); however, there are not many comparative long-term studies to assess the real advantage of placing a ring during gastric bypass (GBP) surgery. This study aims to evaluate the long-term outcome of patients subjected to BGBP and nonbanded GBP procedures. We studied 260 retrospective, nonrandomized obese patients who underwent BGBP and 218 patients without the ring (i.e., GBP). They were followed up for 10years, and the following parameters were evaluated: excess weight loss (EWL), quality of life (QOL), food tolerance, and correction of comorbidities. The study was approved by the Committee on Ethics, and all the patients gave their informed consent. There is a significant difference in %EWL from the third year until the tenth year of observation, with the proportion being 82% in BGBP versus 63% in nonbanded GBP patients at the end of the study. Although there was some increased intolerance to food intake in the BGBP patients, this was not felt to reduce the QOL. The outcome in terms of comorbidities was not conclusive. There is a clear advantage in terms of %EWL in the BGBP patients. No differences in QOL were found in both groups. Further, selecting the right type of material and the right size of the ring is important to improve results and avoid complications.

P-119: Is the effect of gastric bypass on type 2 diabetes permanent?

Banded Gastric Bypass (BGB) is known to control type 2 diabetes mellitus (T2DM). The question has often been raised as to whether the effect is temporal or a cure. This study on the long term effect of BGB on T2DM was undertaken to answer the question.

P-127: Initial report of prospective evaluation of banded gastric bypass vs. standard gastric bypass

P-127: Initial report of prospective evaluation of banded gastric bypass vs. standard gastric bypass

Conversion from Sleeve Gastrectomy to Roux-en-Y Gastric Bypass—Indications and Outcome

Due to excellent weight loss success in the short-time follow-up, sleeve gastrectomy (SG) has gained popularity as sole and definitive bariatric procedure. In the long-term follow-up, weight loss failure and intractable severe reflux can necessitate further surgical intervention. A retrospective analysis of laparoscopic conversions from SG to Roux-en-Y gastric bypass (RYGB) was performed to assess the efficacy for reflux relief and weight loss success. A total of eight out of 73 patients (11%) underwent conversion to RYGB for severe reflux (n=3) or weight regain (n=5) after a median interval of 33 months following laparoscopic sleeve gastrectomy. In one of the patients, a banded gastric bypass was performed. In both groups, conversion to RYGB was successful, as proton pump inhibitor medication could be discontinued in all patients presenting with severe reflux, and a significant weight loss could be achieved in the patients with weight regain within a median follow-up of 33 months. Postoperative complications were observed in only one patient as leakage at the gastrojejunostomy was successfully treated by temporary stent placement. Conversion to RYGB is an effective treatment for weight regain or intractable reflux symptoms following SG. Thus, SG can be performed, intended as sole and definitive bariatric intervention, with conversion from SG to RYGB as an exit strategy for these complications.

The laparoscopic banded gastric bypass &amp;#8211; operation technique

The banded Roux-en-Y gastric bypass can be used as a primary or revisionary bariatric procedure. This article describes the operation technique including materials, size and placement of the banding and gives an overview con cerning evolution and indications of the operation. A video of a primary banded Roux-en-Y gastric bypass is presented.

Obese Patients with Type 2 Diabetes Submitted to Banded Gastric Bypass: Greater Incidence of Dumping Syndrome

Dumping syndrome is one of ten most common complications in morbidly obese patients operated. Recent studies in relation to type 2 diabetes mellitus (DM2) in patients submitted to gastric bypass led us to examine the different outcomes in this group of patients. Our objective was to determine the difference in the prevalence of dumping syndrome in patients with DM2 submitted to gastric bypass. In this retrospective study, 49 diabetic and 54 non-diabetic morbidly obese patients were submitted to gastric bypass and followed up at 3, 6, and 12 months after surgery. The occurrence of dumping was determined by the patient's medical chart, where it was considered positive if recorded in at least one of three evaluations. The 103 patients evaluated had a mean BMI of 49.5 +/- 9.3 kg/m(2) and mean age of 38 +/- 9.7 years, with 75.7% being women. The prevalence of dumping syndrome in this population was 24.3%. The prevalence of dumping was greater in patients with DM2 (44.9%) when compared to the control group (5.6%; p < 0.001). Multivariate logistic regression analysis indicated the diagnosis of DM2 as the only variable associated with dumping syndrome. Dumping syndrome is a common postoperative complication in gastric bypass. Patients with DM2 show a greater postoperative prevalence of dumping.

Gastric bypass: increased restriction for poor weight loss

Gastric bypass, the most common bariatric procedure performed in the United States, is becoming increasingly popular worldwide. Currently, gastric bypass is most often performed laparoscopically, and anecdotal experience has helped to evolve this operation, minimizing complications and optimizing long-term weight management. With better visualization and video documentation, we can compare outcomes based on anatomic differences between centers. As we debate the nuances concerning the optimal size and configuration of the gastric pouch and the amount of intestine that can or should be bypassed, it is clear that we are only on the verge of understanding the mechanism by which this procedure produces weight loss. Anatomic manipulation is important only if it produces a physiologic response. Whether one subscribes to the theory of a mediated incretin or a purely mechanical mechanism for sustained weight loss, it is agreed that there almost certainly is a metabolic effect associated with the gastric bypass as opposed to the adjustable gastric band or the vertical-banded gastroplasty. Creation of a standard ‘‘gastric reservoir’’ and ‘‘stoma’’ independent of the initial size, energy requirements, gender, or age of the patient is standard for most surgeons. Yet, patients respond with a predictable percentage of excess weight loss. This should be sufficient evidence to refute a purely mechanical mechanism of action for the gastric bypass. In addition, MacLean [3] has shown stoma dilation after gastric bypass to be a consistent finding not necessarily corresponding to inadequate weight loss or weight recidivism. In separate studies, Fobi et al. [2] and Capella and Capella [1] have achieved greater weight loss and maintenance with the banded approach, stabilizing at least one aspect of the anatomy: pouch diameter. Despite long-term data, few surgeons have adopted the banded gastric bypass as a primary operation compared with the majority who have embraced the laparoscopic approach. Debate continues as to the risks and benefits of a reinforced stoma, or more correctly, a stabilized gastric pouch, but most agree that initial, if not, permanent restriction is at least one important aspect of the gastric bypass. More controversial is whether increased restriction is appropriate for patients with inadequate initial weight loss or weight recidivism. Evaluation of patients with inadequate weight loss or recidivism after gastric bypass begins with defining the current anatomy in the context of the potential for optimization. Horizontal pouches will dilate along with the stoma due to the inclusion of the gastric fundus. Surgeons differ concerning the actual size and consistency of the anatomy. Therefore, both upper gastrointestinal and flexible endoscopies are useful and complementary studies. If the current anatomy appears optimal, then other options such as conversion to a duodenal switch or alteration of the intestinal limb lengths should be considered. However, increasing malabsorption with maintenance of restriction may impart a higher risk of protein–calorie malnutrition [4]. Presented at the annual meeting of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in Las Vegas, NV, 20 April 2007

Laparoscopic Re-operations for Band Removal after Open Banded Gastric Bypass

Roux-en-Y gastric bypass (RYGBP) has been demonstrated to be an effective treatment for weight loss in the morbidly obese. Numerous variations of the RYGBP have been performed, including placing a ring proximal to the gastric outlet. This ring in RYGBP is intended to decrease pouch dilation and limit weight regain. We reviewed our experience in laparoscopic re-operation after open banded RYGBP. All charts of patients who underwent laparoscopic revisional bariatric surgery were reviewed. Patients who had laparoscopic removal of the band following the open banded RYGBP were reviewed in this study. There were 4 patients who had laparoscopic removal of the band. The indication in all patients was dysphagia and emesis. The ring removed was a silicone band (1) and a large braided non-absorbable suture (3). After the laparoscopic reoperation, there was immediate relief. There has been an average of 5.8 kg weight regain at average follow-up of 30 months. This complication after open banded RYGBP may require operative intervention. Laparoscopic removal of a band is feasible and safe.