Adjustable gastric banding is increasing in the US, with an estimated 35,000 bands implanted last year. Selected US and European centers have, however, reported a 30% primary failure rate and poor overall results with the Band. Therefore, the need for conversion from band to bypass seems to be increasing in parallel. We present our technique for the laparoscopic conversion of an adjustable band to a Roux-En-Y gastric bypass.

The patient is a 60 year old female who weighed 318 pounds, had a body mass index (BMI) of 50 and underwent laparoscopic adjustable gastric banding in June 2007. At 6 post-operative months she lost 38 pounds but failed to loose weight over the next 8 months despite multiple clinic visits and band adjustments. She was converted laparoscopically to a Roux-En-Y gastric bypass 14 months after her original procedure.

The video details the important technical aspects of the laparoscopic conversion. The patient was discharged on post-op day 2 without complication. Six months after the procedure the patient has lost an additional 67 pounds weighing 210 pounds with a BMI of 33.

Adjustable gastric banding is appealing to patients and technically easier to perform for surgeons and will likely remain a popular bariatric procedure. However, failure of adequate weight loss or primary failure rate seems high in the US and Laparoscopic conversion of Gastric Band to RY Gastric Bypass is becoming a commonly requested procedure. The procedure is technically demanding, but it can be accomplished safely when technical steps are followed.