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Conversion of Adjustable Gastric Banding to Adjustable Banded Roux-en-Y Gastric Bypass: Should We Leave the Band in Place?

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Abstract

Objective

Laparoscopic adjustable gastric banding (LAGB) is rapidly becoming a deprecated bariatric procedure due to disappointing weight loss results and a high rate of band intolerance. Conversion to Roux-en-Y gastric bypass is a common revisional procedure after failed LAGB. The aim of this study was to evaluate the feasibility, safety, and risk profile of conversion to adjustable banded Roux-en-Y gastric bypass (ABRYGB).

Methods

A retrospective patient file review of all consecutive laparoscopic conversions of LAGB to ABRYGB 2008–2017. Pre/perioperative data, weight change, and long-/short-term complications were retrieved.

Results

Study population 98 patients. Mean BMI before revision was 40,15 kg/m2. Most revisional procedures were performed for band intolerance and/or weight regain or weight loss failure. All procedures were performed laparoscopically. During follow-up, 16 bands had to be removed due to one of the following reasons: infection, anastomotic leakage, anastomotic peptic perforation, adhesions around the anastomosis, internal hernia around the tubing, adhesions to the tubing, tubing failure, and erosion of the band. Three of those bands were replaced with a non-adjustable Silastic (Minimizer) ring. In total, issues with tubing requiring an intervention were found in 20 patients after conversion to ABRYGB. Seven revisional procedures had to be performed for symptomatic internal hernias not related to the tubing and incidental internal hernias were found in another 7 procedures.

Conclusion

Although conversion of LAGB to ABRYGB is technically feasible, initially well-tolerated, and has good weight loss results, the number of additional procedures during follow-up is rather high, suggesting that leaving the band in place should not be advised.

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Authors and Affiliations

  1. Department of Surgery, Zuyderland MC, Henri Dunantstraat 5, 6419 PC, Heerlen, The Netherlands

    Frederik PDM Lecot, Evert-Jan G Boerma, Rochelle Sigterman-Nelissen, Berry Meesters, Sofie Fransen & Jan Willem Greve

  2. Bariatric and Abdominal Surgeon, Maastricht University Medical Center, Maastricht, The Netherlands

    Jan Willem Greve

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  1. Frederik PDM Lecot
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  2. Evert-Jan G Boerma
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  3. Rochelle Sigterman-Nelissen
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  4. Berry Meesters
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  5. Sofie Fransen
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  6. Jan Willem Greve
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Correspondence to Frederik PDM Lecot.

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The authors declare that they have no conflicts of interest.

Statements Regarding Ethics and Consent

This study has been approved by our hospital ethics committee. All patients have given consent preoperatively for their patient file data to be used in future research.

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Lecot, F.P., Boerma, EJ.G., Sigterman-Nelissen, R. et al. Conversion of Adjustable Gastric Banding to Adjustable Banded Roux-en-Y Gastric Bypass: Should We Leave the Band in Place?. OBES SURG 29, 3912–3918 (2019). https://doi.org/10.1007/s11695-019-04106-w

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