Revisional surgery after failed adjustable gastric banding: institutional experience with 90 consecutive cases

Keng-Hao Liu, Michele Diana, Michel Vix, Didier Mutter, Hurng-Sheng Wu, Jacques Marescaux
Surgical Endoscopy 2013, 27 (11): 4044-8

BACKGROUND: Revisional surgery may be required in a high percentage of patients (up to 30 %) after laparoscopic adjustable gastric banding (LAGB). We report our institutional experience with revisional surgery.

METHODS: From January 1996 to November 2011, 90 patients underwent revisional surgery after failed LAGB. Both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) were proposed. In the presence of gastroesophageal reflux disease, esophageal dysmotility, hiatal hernia, or diabetes, RYGB was preferentially proposed.

RESULTS: In two cases, revisional surgery was aborted due to local severe adhesions. Eighty-eight patients (74 females; mean age 42.79 ± 10.03 years; mean BMI 44.73 ± 6.19 kg/m(2)) successfully underwent revisional SG (n = 48) or RYGB (n = 40). One-stage surgery was performed in 29 cases. Follow-up rate was 78.2 % (n = 61) and 40.9 % (n = 36) at 12 and 24 months respectively. One major complication after SG (staple-line leakage) was observed. Overall postoperative excess weight loss (%EWL) was 31.24, 40.92, 52.41, and 51.68 % at 3, 6, 12, and 24 months of follow-up respectively. There was a statistically significant higher %EWL at 1 year in patients <50 years old (55.9 vs. 41.5 % in patients >50 years old; p = 0.01), of female gender (55.22 vs. 40.73 % in male; p = 0.04), and in patients in which the AGB was in place for <5 years (57.09 vs. 47.43 % if >5 years p = 0.02).

CONCLUSIONS: Revisional surgery is safe and effective. Patients <50 years, of female gender, and with the AGB in place for <5 years had better %EWL after revisional surgery.

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