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

Overview

Journal Obes Surg

Date 2017 Dec 14

PMID 29236206

Authors

Roshani Vijaykumar Patel

Patrick Woodburn

James R A Skipworth

William James Buchanan Smellie

Affiliations

Soon will be listed here.

Abstract

Background: A lack of clarity remains over the optimal strategy for the management of laparoscopic adjustable gastric band (LAGB) slippage, which, although rare (around 3% in our experience), can when acute result in obstruction, gastric erosion or ischaemia. Typically, slipped bands are removed acutely. The aim of this study was to explore outcomes following immediate or delayed resiting of slipped LAGBs in a single centre, comparing simple repositioning with retunnelling and replacement.

Methods: A retrospective analysis of computerised records, notes and prospectively maintained bariatric databases was undertaken to identify all patients with a slipped LAGB in a single centre.

Results: Thirty-two patients required operative intervention following a diagnosis of slipped LAGB (median time from initial LAGB insertion to slippage 2.9 years). Two (6%) patients underwent band removal and 30 (94%), band revision surgery (25 immediately and five at a planned but expedited procedure).Twenty-four (77%) patients underwent insertion of a new LAGB via a de novo retrogastric tunnel, five (21%) of which required further future operative intervention; whereas, six (23%) patients underwent repositioning of the existing LAGB within the same tunnel, five (83%) of which underwent further operative intervention (log-rank test p = 0.0001). Following LAGB revision, there was no significant further change in BMI (median + 1 kg/m; range - 13 to + 10 kg/m).

Conclusion: Resiting of slipped LAGBs is safe and maintains weight loss. Although a significant risk of future operative intervention remains, this can be reduced via the creation of a de novo retrogastric tunnel for band resiting.

References

Weinstein A, Marascalchi B, Spiegel M, Saunders J, Fagerlin A, Parikh M . Patient preferences and bariatric surgery procedure selection; the need for shared decision-making. Obes Surg. 2014; 24(11):1933-9. DOI: 10.1007/s11695-014-1270-6. View

Major P, Wysocki M, Pedziwiatr M, Pisarska M, Dworak J, Malczak P . Risk factors for complications of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Int J Surg. 2016; 37:71-78. DOI: 10.1016/j.ijsu.2016.12.012. View

Beitner M, Ren-Fielding C, Kurian M, Schwack B, Skandarajah A, Thomson B . Sustained weight loss after gastric banding revision for pouch-related problems. Ann Surg. 2014; 260(1):81-6. DOI: 10.1097/SLA.0000000000000327. View

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

Aarts E, Dogan K, Koehestanie P, Janssen I, Berends F . What happens after gastric band removal without additional bariatric surgery?. Surg Obes Relat Dis. 2014; 10(6):1092-6. DOI: 10.1016/j.soard.2013.10.014. View

Lee Y, Veerman J, Barendregt J . The cost-effectiveness of laparoscopic adjustable gastric banding in the morbidly obese adult population of Australia. PLoS One. 2013; 8(5):e64965. PMC: 3661518. DOI: 10.1371/journal.pone.0064965. View

Schouten R, van Dielen F, Greve J . Re-operation after laparoscopic adjustable gastric banding leads to a further decrease in BMI and obesity-related co-morbidities: results in 33 patients. Obes Surg. 2006; 16(7):821-8. DOI: 10.1381/096089206777822386. View

Keidar A, Szold A, Carmon E, Blanc A, Abu-Abeid S . Band slippage after laparoscopic adjustable gastric banding: etiology and treatment. Surg Endosc. 2004; 19(2):262-7. DOI: 10.1007/s00464-003-8261-3. View

Egan R, Monkhouse S, Meredith H, Bates S, Morgan J, Norton S . The reporting of gastric band slip and related complications; a review of the literature. Obes Surg. 2010; 21(8):1280-8. DOI: 10.1007/s11695-010-0344-3. View

10.

Biertho L, Steffen R, Branson R, Potoczna N, Ricklin T, Piec G . Management of failed adjustable gastric banding. Surgery. 2004; 137(1):33-41. DOI: 10.1016/j.surg.2004.06.007. View

11.

Bueter M, Thalheimer A, Wierlemann A, Fein M . Reoperations after gastric banding: replacement or alternative procedures?. Surg Endosc. 2008; 23(2):334-40. DOI: 10.1007/s00464-008-9926-8. View

12.

Owers C, Ackroyd R . A study examining the complications associated with gastric banding. Obes Surg. 2012; 23(1):56-9. DOI: 10.1007/s11695-012-0760-7. View

13.

Endevelt R, Ben-Assuli O, Klain E, Zelber-Sagi S . The role of dietician follow-up in the success of bariatric surgery. Surg Obes Relat Dis. 2013; 9(6):963-8. DOI: 10.1016/j.soard.2013.01.006. View

14.

Lewin J, Campbell B, Sanghvi K, Skinner C, Hopkins G . Laparoscopic adjustable gastric band revisional surgery: a single surgeon series. ANZ J Surg. 2015; 87(4):296-299. DOI: 10.1111/ans.13359. View

15.

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C . Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014; 384(9945):766-81. PMC: 4624264. DOI: 10.1016/S0140-6736(14)60460-8. View

16.

Bardsley S, Hopkins G . Laparoscopic revision of gastric band surgery. ANZ J Surg. 2010; 80(5):350-3. DOI: 10.1111/j.1445-2197.2009.05088.x. View

17.

Mittermair R, Obermuller S, Perathoner A, Sieb M, Aigner F, Margreiter R . Results and complications after Swedish adjustable gastric banding-10 years experience. Obes Surg. 2009; 19(12):1636-41. DOI: 10.1007/s11695-009-9967-7. View

18.

Allen J . Laparoscopic gastric band complications. Med Clin North Am. 2007; 91(3):485-97, xii. DOI: 10.1016/j.mcna.2007.01.009. View

19.

Thornton C, Rozen W, So D, Kaplan E, Wilkinson S . Reducing band slippage in laparoscopic adjustable gastric banding: the mesh plication pars flaccida technique. Obes Surg. 2008; 19(12):1702-6. DOI: 10.1007/s11695-008-9672-y. View

20.

Te Riele W, van Santvoort H, Boerma D, van Westreenen H, Wiezer M, van Ramshorst B . Rebanding for slippage after gastric banding: should we do it?. Obes Surg. 2013; 24(4):588-93. DOI: 10.1007/s11695-013-1119-4. View