Reoperations After Gastric Banding: Replacement or Alternative Procedures?

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2008 Apr 30

PMID 18443872

Citations 27

Authors

Marco Bueter

Andreas Thalheimer

Alexander Wierlemann

Martin Fein

Affiliations

Soon will be listed here.

Abstract

Background: Laparoscopic gastric banding (LAGB) is the most popular surgical procedure for morbid obesity in Europe. Long-term complications like slippage of the band or pouch dilatation are well known and lead to reoperations in a substantial number of patients. In this study, results and follow-ups of patients with reoperations after gastric banding were analyzed.

Methods: Between May 1997 and June 2006, 172 patients were treated with LAGB for morbid obesity. 41 of these patients underwent one or more band-related reoperations (female symbol = 32, male symbol = 9). Causes for and type of reoperation were analyzed. Weight loss and comorbidities were compared for different types of reoperations.

Results: There were no deaths following the reoperations. Band replacement (n = 18), band repositioning (n = 7), conversion to sleeve gastrectomy (SG, n = 2) and Roux-en-Y gastric bypass (RYGBP, n = 2) or band removal without any further substitution (n = 12) were performed as first reoperation. Seven patients had a second reoperation: RYGBP (n = 3), SG (n = 1), or band removal (n = 3). Median follow-up since reoperation was 56 months (range 7-113). Excess weight loss (EBWL%) of patients was 59.4% after RYGBP (n = 5), 45.1% after re-banding (n = 18), and 33.4% after SG (n = 2). Comorbidities were further reduced or even resolved after reoperation. Patients whose band was removed without subsequent bariatric procedures lost significantly less weight (n = 13, EBWL% 23.4) than patients with band replacement (n = 18, EBWL% 46.4, p = 0.04).

Conclusion: Laparoscopic reoperation after LAGB is safe and feasible. Reoperation leads to further decrease of BMI and obesity-related comorbidities. Band replacement is a good option for patients with good weight loss after initial LAGB. Alternative procedures, preferably RYGBP, are required for cases of band failure. Overall, RYGBP appears to be the most effective option to induce further weight loss.

Citing Articles

Laparoscopic management of a left hepatic vein injury during one -step laparoscopic Roux-en-Y gastric bypass after adjustable gastric banding removal: A case report.

Lawani I, Costantino F, Imorou Souaibou Y, Morelli U, Dossou F, Keller P Int J Surg Case Rep. 2022; 94:107043.

PMID: 35658274 PMC: 9093008. DOI: 10.1016/j.ijscr.2022.107043.

Revisional Gastric Bypass After Failed Adjustable Gastric Banding-One-Stage or Two-Stage Procedure?.

Schafer A, Gehwolf P, Umlauft J, Dziodzio T, Biebl M, Perathoner A Obes Surg. 2018; 29(3):943-948.

PMID: 30484173 DOI: 10.1007/s11695-018-3614-0.

IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures.

Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J Obes Surg. 2018; 28(12):3783-3794.

PMID: 30121858 DOI: 10.1007/s11695-018-3450-2.

Management of Slipped Gastric Bands via Creation of a De Novo Tunnel and Band Replacement: a Single-Centre Experience.

Patel R, Woodburn P, Skipworth J, Smellie W Obes Surg. 2017; 28(5):1377-1384.

PMID: 29236206 DOI: 10.1007/s11695-017-3032-8.

Slippage-a Significant Problem Following Gastric Banding-a Single Centre Experience.

Szewczyk T, Janczak P, Jezierska N, Juralowicz P Obes Surg. 2017; 27(10):2637-2642.

PMID: 28439749 DOI: 10.1007/s11695-017-2683-9.

References

Spivak H, Favretti F . Avoiding postoperative complications with the LAP-BAND system. Am J Surg. 2003; 184(6B):31S-37S. DOI: 10.1016/s0002-9610(02)01177-7. View

Weber M, Muller M, Michel J, Belal R, Horber F, Hauser R . Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg. 2003; 238(6):827-33. PMC: 1356164. DOI: 10.1097/01.sla.0000098623.53293.bb. View

Steffen R, Biertho L, Ricklin T, Piec G, Horber F . Laparoscopic Swedish adjustable gastric banding: a five-year prospective study. Obes Surg. 2003; 13(3):404-11. DOI: 10.1381/096089203765887741. View

Reinhold R . Critical analysis of long term weight loss following gastric bypass. Surg Gynecol Obstet. 1982; 155(3):385-94. View

Frezza E . Laparoscopic vertical sleeve gastrectomy for morbid obesity. The future procedure of choice?. Surg Today. 2007; 37(4):275-81. DOI: 10.1007/s00595-006-3407-2. View

Dargent J . Surgical treatment of morbid obesity by adjustable gastric band: the case for a conservative strategy in the case of failure - a 9-year series. Obes Surg. 2004; 14(7):986-90. DOI: 10.1381/0960892041719545. View

Suter M . Laparoscopic band repositioning for pouch dilatation/slippage after gastric banding: disappointing results. Obes Surg. 2001; 11(4):507-12. DOI: 10.1381/096089201321209431. View

Rubin M, Spivak H . Prospective study of 250 patients undergoing laparoscopic gastric banding using the two-step technique: a technique to prevent postoperative slippage. Surg Endosc. 2003; 17(6):857-60. DOI: 10.1007/s00464-002-8804-z. View

Bueter M, Maroske J, Thalheimer A, Gasser M, Stingl T, Heimbucher J . Short- and long-term results of laparoscopic gastric banding for morbid obesity. Langenbecks Arch Surg. 2007; 393(2):199-205. DOI: 10.1007/s00423-007-0170-9. View

10.

Ceelen W, Walder J, Cardon A, Van Renterghem K, Hesse U, El Malt M . Surgical treatment of severe obesity with a low-pressure adjustable gastric band: experimental data and clinical results in 625 patients. Ann Surg. 2002; 237(1):10-6. PMC: 1513977. DOI: 10.1097/00000658-200301000-00002. View

11.

Fisher B, Schauer P . Medical and surgical options in the treatment of severe obesity. Am J Surg. 2003; 184(6B):9S-16S. DOI: 10.1016/s0002-9610(02)01173-x. View

12.

Forsell P, Hellers G . The Swedish Adjustable Gastric Banding (SAGB) for morbid obesity: 9 year experience and a 4-year follow-up of patients operated with a new adjustable band. Obes Surg. 1997; 7(4):345-51. DOI: 10.1381/096089297765555601. View

13.

Chevallier J, Zinzindohoue F, Douard R, Blanche J, Berta J, Altman J . Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years. Obes Surg. 2004; 14(3):407-14. DOI: 10.1381/096089204322917954. View

14.

Abu-Abeid S, Bar Zohar D, Sagie B, Klausner J . Treatment of intra-gastric band migration following laparoscopic banding: safety and feasibility of simultaneous laparoscopic band removal and replacement. Obes Surg. 2005; 15(6):849-52. DOI: 10.1381/0960892054222696. View

15.

van Wageningen B, Berends F, van Ramshorst B, Janssen I . Revision of failed laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. Obes Surg. 2006; 16(2):137-41. DOI: 10.1381/096089206775565212. View

16.

Sarker S, Myers J, Serot J, Shayani V . Three-year follow-up weight loss results for patients undergoing laparoscopic adjustable gastric banding at a major university medical center: does the weight loss persist?. Am J Surg. 2006; 191(3):372-6. DOI: 10.1016/j.amjsurg.2005.10.040. View

17.

Calmes J, Giusti V, Suter M . Reoperative laparoscopic Roux-en-Y gastric bypass: an experience with 49 cases. Obes Surg. 2005; 15(3):316-22. DOI: 10.1381/0960892053576785. View

18.

Suter M, Giusti V, Heraief E, Calmes J . Band erosion after laparoscopic gastric banding: occurrence and results after conversion to Roux-en-Y gastric bypass. Obes Surg. 2004; 14(3):381-6. DOI: 10.1381/096089204322917918. View

19.

Bueter M, Thalheimer A, Meyer D, Fein M . Band erosion and passage, causing small bowel obstruction. Obes Surg. 2007; 16(12):1679-82. DOI: 10.1381/096089206779319446. View

20.

Niville E, Dams A, Vlasselaers J . Lap-Band erosion: incidence and treatment. Obes Surg. 2002; 11(6):744-7. DOI: 10.1381/09608920160558704. View