Skip to main content

Laparoscopic Removal of Poor Outcome Gastric Banding with Concomitant Sleeve Gastrectomy

Obesity Surgery volume 23, pages 782–787 (2013)Cite this article

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

Conversion of LAGB by means of concomitant LSG is a safe and efficient procedure and achieves similar outcomes as primary LSG surgery alone.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. O’Brien PE, Dixon JB, Laurie C, et al. Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: A randomized trial. Ann Intern Med. 2006;144:625–33.

    PubMed  Article  Google Scholar 

  2. Mittermair RP, Obermüller S, Perathoner A, et al. Results and complications after Swedish adjustable gastric banding—10 years experience. Obes Surg. 2009;19:1636–41.

    PubMed  Article  Google Scholar 

  3. Arapis K, Chosidow D, Lehmann M, et al. Long-term results of adjustable gastric banding in a cohort of 186 super-obese patients with a BMI ≥ 50 kg/m2. J Visc Surg. 2012;149:e143–52 [Epub 2012 Mar 2].

    PubMed  Article  CAS  Google Scholar 

  4. Michalik M, Lech P, Bobowicz M, et al. A 5-year experience with laparoscopic adjustable gastric banding—focus on outcomes, complications, and their management. Obes Surg. 2011;21:1682–6.

    PubMed  Article  Google Scholar 

  5. Lim CS, Liew V, Talbot ML, et al. Revisional bariatric surgery. Obes Surg. 2009;19:827–32 [Epub 2008 Oct 30].

    PubMed  Article  CAS  Google Scholar 

  6. Müller MK, Attigah N, Wildi S, et al. High secondary failure rate of rebanding after failed gastric banding. Surg Endosc. 2008;22:448–53.

    PubMed  Article  Google Scholar 

  7. Suter M, Giusti V, Héraief E, et al. Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience. Surg Endosc. 2003;17:603–9 [Epub 2003 Feb 17].

    PubMed  Article  CAS  Google Scholar 

  8. Gumbs AA, Pomp A, Gagner M. Revisional bariatric surgery for inadequate weight loss. Obes Surg. 2007;17:1137–45.

    PubMed  Article  Google Scholar 

  9. Topart P, Becouarn G, Ritz P. Biliopancreatic diversion with duodenal switch or gastric bypass for failed gastric banding: Retrospective study from two institutions with preliminary results. Surg Obes Relat Dis. 2007;3:521–5.

    PubMed  Article  Google Scholar 

  10. Gagner M, Gumbs AA. Gastric banding: Conversion to sleeve, bypass, or DS. Surg Endosc. 2007;21:1931–5 [Epub 2007 Aug 20].

    PubMed  Article  Google Scholar 

  11. Kehagias I, Karamanakos SN, Argentou M, et al. Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2. Obes Surg. 2011;21:1650–6.

    PubMed  Article  Google Scholar 

  12. Fischer L, Hildebrandt C, Bruckner T, et al. Excessive weight loss after sleeve gastrectomy: A systematic review. Obes Surg. 2012;22:721–31.

    PubMed  Article  Google Scholar 

  13. Lalor PF, Tucker ON, Szomstein S, et al. Complications after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2008;4:33–8 [Epub 2007 Nov 5].

    PubMed  Article  Google Scholar 

  14. Goitein D, Feigin A, Segal-Lieberman G, et al. Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure. Surg Endosc. 2011;25:2626–30 [Epub 2011 Mar 17].

    PubMed  Article  Google Scholar 

  15. Jacobs M, Gomez E, Romero R, et al. Failed restrictive surgery: Is sleeve gastrectomy a good revisional procedure? Obes Surg. 2011;21:157–60.

    PubMed  Article  Google Scholar 

  16. Alqahtani A, Alamri H, Elahmedi M, et al. Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: A comparative study. Surg Endosc. 2012. doi:10.1007/s00464-012-2345-x, May 31, 2012.

  17. Alqahtani AR. Surgical approaches to pediatric obesity. In: Ferry Jr, Robert J, editors. Management of pediatric obesity and diabetes (nutrition and health). firstth ed. New York: Springer; 2011.

    Google Scholar 

  18. Suter M, Calmes JM, Paroz A, et al. A 10-year experience with laparoscopic gastric banding for morbid obesity: High long-term complication and failure rates. Obes Surg. 2006;16:829–35.

    PubMed  Article  CAS  Google Scholar 

  19. Schouten R, Japink D, Meesters B, et al. Systematic literature review of reoperations after gastric banding: Is a stepwise approach justified? Surg Obes Relat Dis. 2011;7:99–109 [Epub 2010 Oct 27].

    PubMed  Article  Google Scholar 

  20. Foletto M, Bernante P, Busetto L, et al. Laparoscopic gastric rebanding for slippage with pouch dilation: Results on 29 consecutive patients. Obes Surg. 2008;18:1099–103 [Epub 2008 Apr 12].

    PubMed  Article  Google Scholar 

  21. Chisholm J, Kitan N, Toouli J, et al. Gastric band erosion in 63 cases: Endoscopic removal and rebanding evaluated. Obes Surg. 2011;21:1676–81.

    PubMed  Article  Google Scholar 

  22. Van Gemert WG, Van Wersch MM, Greve JW, et al. Revisional surgery after failed vertical banded gastroplasty: Restoration of vertical banded gastroplasty or conversion to gastric bypass. Obes Surg. 1998;8:21–8.

    PubMed  Article  Google Scholar 

  23. Niville E, Dams A, van der Speeten K, et al. Results of lap rebanding procedures after Lap-Band removal for band erosion: A mid-term evaluation. Obes Surg. 2005;15:630–3.

    PubMed  Article  Google Scholar 

  24. Slegtenhorst BR, van der Harst E, Demirkiran A, de Korte J, Schelfhout LJ, Klaassen RA (2012) Effect of primary versus revisional Roux-en-Y gastric bypass: inferior weight loss of revisional surgery after gastric banding. Surg Obes Relat Dis, in press

  25. Deylgat B, D’Hondt M, Pottel H, et al. Indications, safety, and feasibility of conversion of failed bariatric surgery to Roux-en-Y gastric bypass: A retrospective comparative study with primary laparoscopic Roux-en-Y gastric bypass. Surg Endosc. 2012;26:1997–2002.

    PubMed  Article  Google Scholar 

  26. Peterli R, Wölnerhanssen BK, Peters T, et al. Prospective study of a two-stage operative concept in the treatment of morbid obesity: Primary lap-band followed if needed by sleeve gastrectomy with duodenal switch. Obes Surg. 2007;17:334–40.

    PubMed  Article  Google Scholar 

  27. Dolan K, Fielding G. Bilio pancreatic diversion following failure of laparoscopic adjustable gastric banding. Surg Endosc. 2004;18:60–3 [Epub 2003 Nov 21].

    PubMed  Article  CAS  Google Scholar 

  28. Dapri G, Cadière GB, Himpens J. Laparoscopic conversion of adjustable gastric banding and vertical banded gastroplasty to duodenal switch. Surg Obes Relat Dis. 2009;5:678–83 [Epub 2009 Jul 10].

    PubMed  Article  Google Scholar 

  29. Berende CA, de Zoete JP, Smulders JF, et al. Laparoscopic sleeve gastrectomy feasible for bariatric revision surgery. Obes Surg. 2012;22:330–4.

    PubMed  Article  Google Scholar 

  30. Mognol P, Chosidow D, Marmuse JP. Laparoscopic conversion of laparoscopic gastric banding to Roux-en-Y gastric bypass: a review of 70 patients. Obes Surg. 2004;14:1349–53.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

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.

Disclosures

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.

Author information

Authors and Affiliations

  1. Department of Surgery, College of Medicine, King Saud University, PO Box: 84147, Riyadh, 11671, Saudi Arabia

    Aayed R. Alqahtani, Mohamed Elahmedi, Hussam Alamri, Rafiuddin Mohammed & Fatima Darwish

  2. King Fahad Medical City, Riyadh, Saudi Arabia

    Ali M. Ahmed

Authors
  1. Aayed R. Alqahtani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed Elahmedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hussam Alamri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rafiuddin Mohammed
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fatima Darwish
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ali M. Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aayed R. Alqahtani.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Alqahtani, A.R., Elahmedi, M., Alamri, H. et al. Laparoscopic Removal of Poor Outcome Gastric Banding with Concomitant Sleeve Gastrectomy. OBES SURG 23, 782–787 (2013). https://doi.org/10.1007/s11695-013-0895-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-013-0895-1

Keywords

  • Gastric Banding
  • Revision
  • Concomitant Sleeve Gastrectomy
  • Obesity
  • Bariatric