In most experienced bariatric centers, revisional procedures comprise 10% to 15% of the operations performed, most of which are referred from other bariatric surgeons. The need for revisional surgery has been reported in 5% to 36% of patients undergoing vertical banded gastro plasty (VBG) and from 5% to 23% of patients under going Roux-en-Y gastric bypass (RYGBP) (1, 2). This chapter discusses RYGBP as a revisional procedure for failed bariatric procedures. Although the number of revi sional procedures done laparoscopically is very small, there is a growing body of evidence that supports its safety and feasibility (3-6). Yet, it is important to remem ber that the principles of evaluating failed bariatric pro cedures and the rationale for revisional surgery are not dictated by the method of accessing the abdominal cavity but rather are governed by lessons learned from the cumulative experience of an evidence-based approach and a tertiary, bariatric practice.
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