Advertisement

Surgical Endoscopy

, Volume 27, Issue 11, pp 4087–4093 | Cite as

Revisional weight loss surgery after failed laparoscopic gastric banding: an institutional experience

  • Tung T. Tran
  • Eric Pauli
  • Jerome R. Lyn-Sue
  • Randy Haluck
  • Ann M. Rogers
Article

Abstract

Background

Increasing experience with laparoscopic adjustable gastric banding (LAGB) has demonstrated a high rate of complications and inadequate weight loss. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have been reported to be safe and effective in selected patients. The purpose of our study was to evaluate the incidence and outcomes of revisional weight loss surgery (RWLS) after laparoscopic gastric banding at our institution.

Methods

From June 2006 to February 2013, all patients who underwent LAGB and those who required revision were retrospectively analyzed. All procedures were performed by two surgeons with extensive experience in bariatric surgery. Parametric data are presented as mean ± SD; nonparametric data are presented as median and interquartile range (IQR).

Results

During the study period, 256 patients underwent LAGB. A total of 111 patients (43 %) required reoperation. Sixty-one patients (56 women, age = 43.7 ± 12 years) with a BMI of 45.4 ± 6 kg/m2 successfully underwent RWLS (53 RYGB, 8 LSG). Indications for RWLS included dysphagia (40 patients, 63 %), inadequate weight loss (17 patients, 27 %), GERD (2 patients, 3 %), gastric prolapse (2 patients, 3 %), and needle phobia (1 patient, 2 %). Two required conversion to an open RYGB due to extensive adhesions. RWLS was undertaken approximately 36.3 [25–45] months after LAGB. Removal of the gastric band and the RWLS were performed in 15 patients with an interval of 3 [1.5–7] months between procedures. Median operative time was 165 [142–184] min. Median hospital length of stay was 2 [2–3] days. Early complications occurred in 11 patients (18 %), including 4 anastomotic leaks. Twelve patients (20 %) presented with late complications requiring intervention. There was one death. At a median follow-up of 12.4 months, excess weight loss was 47.5 ± 27 %, and 48 % of patients achieved a BMI < 33.

Conclusion

LAGB is associated with a high incidence of reoperation. Reoperative weight loss surgery can be performed in selected patients with a higher rate of complications than primary surgery. Good short-term weight loss outcomes can be achieved.

Keywords

Laparoscopic adjustable gastric banding Revisional weight loss surgery Obesity Bariatric surgery Complications 

Notes

Disclosures

Dr. Eric Pauli is a lecturer for Bard (Murray Hill, NJ), and Synthes (West Chester, PA) and a consultant for Synapse Biomedical (Oberlin, OH). Drs. Randy Haluck, Jerome Lyn-Sue, Ann Rogers, and Tung Tran have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Mitka M (2003) Surgery for obesity: demand soars amid scientific, ethical questions. JAMA 289(14):1761–1762PubMedCrossRefGoogle Scholar
  2. 2.
    Tessier DJ, Eagon JC (2008) Surgical management of morbid obesity. Curr Probl Surg 45(2):68–137PubMedCrossRefGoogle Scholar
  3. 3.
    Bjorntorp P (1980) Results of conservative therapy of obesity: correlation with adipose tissue morphology. Am J Clin Nutr 33(2 Suppl):370–375PubMedGoogle Scholar
  4. 4.
    Fisher BL, Schauer P (2002) Medical and surgical options in the treatment of severe obesity. Am J Surg 184(6B):9S–16SPubMedCrossRefGoogle Scholar
  5. 5.
    Christou NV, Sampalis JS, Liberman M et al (2004) Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 240:416–423PubMedCrossRefGoogle Scholar
  6. 6.
    Buchwald H et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737PubMedCrossRefGoogle Scholar
  7. 7.
    Gustavsson S, Westling A (2002) Laparoscopic adjustable gastric banding: complications and side effects responsible for the poor long-term outcome. Semin Laparosc Surg 9:115–124PubMedCrossRefGoogle Scholar
  8. 8.
    Favretti F, Cadiere GB, Segato G et al (1997) Laparoscopic adjustable silicone gastric banding (Lap-Band): how to avoid complications. Obes Surg 7:352–358PubMedCrossRefGoogle Scholar
  9. 9.
    Morino M, Toppino M, Garrone C (1997) Disappointing long-term results of laparoscopic adjustable silicone gastric banding. Br J Surg 84:868–869PubMedCrossRefGoogle Scholar
  10. 10.
    O’Brien PE, Dixon JB (2003) Lap-band: outcomes and results. J Laparoendosc Adv Surg Tech A 13(4):265–270PubMedCrossRefGoogle Scholar
  11. 11.
    O’Brien PE, Dixon JB (2002) Weight loss and early and late complications-the international experience. Am J Surg 184(6B):42S–45SPubMedCrossRefGoogle Scholar
  12. 12.
    Doherty C, Maher JW, Heitshusen DS (2002) Long-term data indicate a progressive loss in efficacy of adjustable silicone gastric banding for the surgical treatment of morbid obesity. Surgery 132(4):724–728PubMedCrossRefGoogle Scholar
  13. 13.
    Peterli R et al (2002) Re-operations following laparoscopic adjustable gastric banding. Obes Surg 12(6):851–856PubMedCrossRefGoogle Scholar
  14. 14.
    Westling A et al (1998) Silicone-adjustable gastric banding: disappointing results. Obes Surg 8(4):467–474PubMedCrossRefGoogle Scholar
  15. 15.
    National Institutes of Health (1993) Methods for voluntary weight loss and control. Proceedings of NIH Technology Assessment Conference, Bethesda, Maryland, 30 March–1 April 1992. Ann Intern Med 119(7 Pt 2): pp 641–770Google Scholar
  16. 16.
    Weber M, Muller MK, Michel JM et al (2003) Laparoscopic Roux-en-Y gastric bypass, but not rebanding, should be proposed as rescue procedure for patients with failed laparoscopic gastric banding. Ann Surg 238:827–833 discussion 833–834PubMedCrossRefGoogle Scholar
  17. 17.
    Reinhold RB (1982) Critical analysis of long term weight loss following gastric bypass. Surg Gynecol Obstet 155:385–394PubMedGoogle Scholar
  18. 18.
    Gagner M, Gumbs AA (2007) Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc 21:1931–1935PubMedCrossRefGoogle Scholar
  19. 19.
    Schouten R, van Dielen FM, Greve JW (2006) 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 16:821–828PubMedCrossRefGoogle Scholar
  20. 20.
    Suter M, Giusti V, Heraief E, Calmes JM (2004) Band erosion after laparoscopic gastric banding: occurrence and results after conversion to Roux-en-Y gastric bypass. Obes Surg 14:381–386PubMedCrossRefGoogle Scholar
  21. 21.
    Westling A, Ohrvall M, Gustavsson S (2002) Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery. J Gastrointest Surg 6:206–211PubMedCrossRefGoogle Scholar
  22. 22.
    Bernante P, Foletto M, Busetto L, Pomerri F, Pesenti FF, Pelizzo MR, Nitti D (2006) Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg 16(10):1327–1330PubMedCrossRefGoogle Scholar
  23. 23.
    Belachew M, Legrand M, Vincent V et al (1998) Laparoscopic adjustable gastric banding. World J Surg 22:955–963PubMedCrossRefGoogle Scholar
  24. 24.
    Deitel M, Greenstein RJ (2003) Recommendations for reporting weight loss. Obes Surg 13:159–160PubMedCrossRefGoogle Scholar
  25. 25.
    Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196PubMedCrossRefGoogle Scholar
  26. 26.
    Boza C, Gamboa C et al (2011) Laparoscopic adjustable gastric banding (LAGB): surgical results and 5-year follow-up. Surg Endosc 25(1):292–297PubMedCrossRefGoogle Scholar
  27. 27.
    Van Nieuwenhove Y, Ceelen W, Stockman A et al (2011) Long-term results of a prospective study on laparoscopic adjustable gastric banding for morbid obesity. Obes Surg 21(5):582–587PubMedCrossRefGoogle Scholar
  28. 28.
    Lanthaler M, Aigner F, Kinzl J et al (2010) Long-term results and complications following adjustable gastric banding. Obes Surg 20(8):1078–1085PubMedCrossRefGoogle Scholar
  29. 29.
    Scozzari G, Farinella E, Bonnet G et al (2009) Laparoscopic adjustable silicone gastric banding vs laparoscopic vertical banded gastroplasty in morbidly obese patients: long-term results of a prospective randomized controlled clinical trial. Obes Surg 19(8):1108–1115PubMedCrossRefGoogle Scholar
  30. 30.
    Rogers AM (2010) Improvement of esophageal dysmotility after conversion from gastric banding to gastric bypass. Surg Obes Relat Dis 6(6):681–683PubMedCrossRefGoogle Scholar
  31. 31.
    Moore R, Perugini R, Czerniach D et al (2009) Early results of conversion of laparoscopic adjustable gastric band to Roux-en-Y gastric bypass. Surg Obes Relat Dis 5(4):439–443PubMedCrossRefGoogle Scholar
  32. 32.
    Mognol P, Chosidow D, Marmuse JP (2005) Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding in the super-obese: a comparative study of 290 patients. Obes Surg 15(1):76–81PubMedCrossRefGoogle Scholar
  33. 33.
    Kothari SN, DeMaria EJ, Sugerman HJ et al (2002) Lap-band failures: conversion to gastric bypass and their preliminary outcomes. Surgery 131(6):625–629PubMedCrossRefGoogle Scholar
  34. 34.
    Elnahas A, Graybiel K, Farrokhyar F et al (2013) Revisional surgery after failed laparoscopic adjustable gastric banding: a systematic review. Surg Endosc 27:740–745PubMedCrossRefGoogle Scholar
  35. 35.
    Hii MW, Lake AC, Kenfield C, Hopkins GH (2012) Laparoscopic conversion of failed gastric banding to Roux-en-Y gastric bypass. Short-term follow-up and technical considerations. Obes Surg 22:1022–1028PubMedCrossRefGoogle Scholar
  36. 36.
    Tice JA, Karliner L, Walsh J et al (2008) Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med 121(10):885–893PubMedCrossRefGoogle Scholar
  37. 37.
    Van Dessel E, Hubens G, Ruppert M et al (2008) Roux-en-Y gastric bypass as a re-do procedure for failed restrictive gastric surgery. Surg Endosc 22(4):1014–1018PubMedCrossRefGoogle Scholar
  38. 38.
    Goiten D, Feigin A, Segal-Lieberman G (2011) Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure. Surg Endosc 25:2626–2630CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Tung T. Tran
    • 1
  • Eric Pauli
    • 1
  • Jerome R. Lyn-Sue
    • 1
  • Randy Haluck
    • 1
  • Ann M. Rogers
    • 1
  1. 1.Division of Minimally Invasive/Bariatric Surgery, Department of SurgeryPenn State Milton S. Hershey Medical CenterHersheyUSA

Personalised recommendations