Laparoscopic sleeve gastrectomy (LSG)-a good bariatric option for failed laparoscopic adjustable gastric banding (LAGB): a review of 90 patients

Thierry Yazbek, Nagi Safa, Ronald Denis, Henri Atlas, Pierre Y Garneau
Obesity Surgery 2013, 23 (3): 300-5

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is one of the most frequently performed bariatric surgeries. Even with a high failure rate, revisional procedures such as re-banding or laparoscopic Roux-en-Y gastric bypass (LRYGB) were commonly performed. Recently, conversions of LAGB to laparoscopic sleeve gastrectomy (LSG) were reported. We will review our experience on this conversion.

METHODS: Between February 2007 and January 2012, 800 patients underwent LSG, with 90 as a revisional procedure for failed LAGB. A retrospective review of a prospectively collected database was performed. Data were collected through routine follow-up and weight loss data were also obtained through self-reporting via the Internet. Demographics, complications, and percentage of excess weight loss (%EWL) were determined.

RESULTS: A total of 90 patients underwent LSG as a revisional procedure, comprising of 77 women and 13 men with a mean age of 41 years (22 to 67), a mean body mass index of 42 kg/m(2) (26 to 58). Among them, 15.5 % had diabetes mellitus, 35.5 % had hypertension, 20.0 % had hyperlipidemia, and 18.8 % had obstructive sleep apnea. The mean operative time was 112 min (50 to 220) and mean hospital stay was 4.2 days (1 to 180). Operative complications included 5.5 % leak and 4.4 % hemorrhage or gastric hematoma. There was no postoperative mortality. The mean postoperative %EWL was 51.8 % (n = 82), 61.3 % (n = 60), 61.6 % (n = 45), 53.0 % (n = 30), 55.3 % (n = 20), and 54.1 % (n = 10) at 6, 12, 18, 24, 36, and 48 months, respectively.

CONCLUSIONS: LSG after LAGB yields a positive outcome with higher complication rates than for primary LSG. We advocate this procedure as a good bariatric option for failed LAGB.

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