The adjustable gastric band (GB) can produce 40 - 50% excess weight loss (EWL) in morbidly obese patients, however certain populations fail to achieve adequate results. GB failure etiologies are multifactorial, however, in these cases corrective surgical options include removal / repositioning of the band, conversion to a Roux-en-Y gastric bypass with or without leaving the band in place, or conversion to a biliopancreatic diversion with duodenal switch (BPD with DS). We demonstrate our technique for laparoscopic LapBand removal and conversion to a BPD with DS.

This is a 43 yo female with morbid obesity (BMI = 53 m/kg²) associated with hypertension, depression, sleep apnea, and osteoporosis who underwent a GB two years ago. At one year her BMI had only decreased to 46 m/kg² and then began to increase over the next 6 months to 51 m/kg². A contrast study showed a dilated pouch and anterior slippage. After an extensive discussion of the various options, the patient elected for the laparoscopic conversion to a BPD with DS. Laparoscopically, the band was removed and a BPD with DS was constructed. The duodenoileostomy was hand-sewn and the enteroenterostomy was performed using a combined linear staple and hand-sewn technique. The patient was discharged on postoperative day 3 after an uneventful recovery and her BMI one month later has decreased to 48 m/kg².

Some patients fail to achieve adequate weight loss and reversal of co-morbidities following lap bands. In these cases, laparoscopic conversion to a malabsorptive procedure (BPDDS) is a feasible alternative that can benefit the patient with maximum %EWL and minimal risk.