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Reoperations after gastric banding: replacement or alternative procedures?

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Abstract

Background

Laparoscopic gastric banding (LAGB) is the most popular surgical procedure for morbid obesity in Europe. Long-term complications like slippage of the band or pouch dilatation are well known and lead to reoperations in a substantial number of patients. In this study, results and follow-ups of patients with reoperations after gastric banding were analyzed.

Methods

Between May 1997 and June 2006, 172 patients were treated with LAGB for morbid obesity. 41 of these patients underwent one or more band-related reoperations (♀ = 32, ♂ = 9). Causes for and type of reoperation were analyzed. Weight loss and comorbidities were compared for different types of reoperations.

Results

There were no deaths following the reoperations. Band replacement (n = 18), band repositioning (n = 7), conversion to sleeve gastrectomy (SG, n = 2) and Roux-en-Y gastric bypass (RYGBP, n = 2) or band removal without any further substitution (n = 12) were performed as first reoperation. Seven patients had a second reoperation: RYGBP (n = 3), SG (n = 1), or band removal (n = 3). Median follow-up since reoperation was 56 months (range 7–113). Excess weight loss (EBWL%) of patients was 59.4% after RYGBP (n = 5), 45.1% after re-banding (n = 18), and 33.4% after SG (n = 2). Comorbidities were further reduced or even resolved after reoperation. Patients whose band was removed without subsequent bariatric procedures lost significantly less weight (n = 13, EBWL% 23.4) than patients with band replacement (n = 18, EBWL% 46.4, p = 0.04).

Conclusion

Laparoscopic reoperation after LAGB is safe and feasible. Reoperation leads to further decrease of BMI and obesity-related comorbidities. Band replacement is a good option for patients with good weight loss after initial LAGB. Alternative procedures, preferably RYGBP, are required for cases of band failure. Overall, RYGBP appears to be the most effective option to induce further weight loss.

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Acknowledgements

The authors acknowledge Mrs. Kathrin Hohl, who devotedly manages and organizes our Obesity Center. We also thank Mrs. Caroline Lager for the psychological evaluation and support of the patients and her extraordinary engagement during the whole process. Finally, we thank Mrs. Lorraine Stevenson-Knebel for the assistance in the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Surgery I, Julius-Maximilians-University of Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany

    Marco Bueter, Andreas Thalheimer, Alexander Wierlemann & Martin Fein

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  1. Marco Bueter
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  2. Andreas Thalheimer
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  3. Alexander Wierlemann
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  4. Martin Fein
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Correspondence to Marco Bueter.

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Bueter, M., Thalheimer, A., Wierlemann, A. et al. Reoperations after gastric banding: replacement or alternative procedures?. Surg Endosc 23, 334–340 (2009). https://doi.org/10.1007/s00464-008-9926-8

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  • DOI: https://doi.org/10.1007/s00464-008-9926-8

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