Laparoscopic Removal of Poor Outcome Gastric Banding with Concomitant Sleeve Gastrectomy
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Laparoscopic adjustable gastric banding (LAGB) has a significant incidence of long-term failure, which may require an alternative revisional bariatric procedure to remediate. Unfortunately, there is few data pinpointing which specific revisional procedure most effectively addresses failed gastric banding. Recently, it has been observed that laparoscopic sleeve gastrectomy (LSG) is a promising primary bariatric procedure; however, its use as a revisional procedure has been limited. This study aims to evaluate the safety and efficacy of LSG performed concomitantly with removal of a poor-outcome LAGB.
A retrospective review was performed on patients who underwent LAGB removal with concomitant LSG at King Saud University in Saudi Arabia between September 2007 and April 2012. Patient body mass index (BMI), percentage of excess weight loss (%EWL), duration of operation, length of hospital stay, complications after LSG, and indications for revisional surgery were all reviewed and compared to those of patients who underwent LSG as a primary procedure.
Fifty-six patients (70 % female) underwent conversion of LAGB to LSG concomitantly, and 128 (66 % female) patients underwent primary LSG surgery. The revisional and primary LSG patients had similar preoperative ages (mean age 33.5 ± 10.7 vs. 33.6 ± 9.0 years, respectively; p = 0.43). However, revisional patients had a significantly lower BMI at the time of surgery (44.4 ± 7.0 kg/m2 vs. 47.9 ± 8.2; p < 0.01). Absolute BMI postoperative reduction at 24 months was 14.33 points in the revision group and 18.98 points in the primary LSG group; similar %EWL was achieved by both groups at 24 months postoperatively (80.1 vs. 84.6 %). Complications appeared in two (5.5 %) revisional patients and in nine (7.0 %) primary LSG patients. No mortalities occurred in either group.
Conversion of LAGB by means of concomitant LSG is a safe and efficient procedure and achieves similar outcomes as primary LSG surgery alone.
KeywordsGastric Banding Revision Concomitant Sleeve Gastrectomy Obesity Bariatric
The authors extend their appreciation to the Deanship of Scientific Research at King Saud University for funding this work through research group no RGP-VPP-186. The authors also acknowledge the contribution from the Shaikh Ali Alshehri Obesity Chair and Chair team members Ms. Nesma Mustafa, Layla Alfarra, Mounira AlSaleh, and Manal Medhat. They also thank the participants who took part in the study.
Aayed R. Alqahtani, Mohamed Elahmedi, Hussam Alamri, Rafiuddin Mohammed, Fatima Darwish, and Ali M. Ahmed have no conflicts of interest or financial ties to disclose.
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