Revision After Gastric Banding
Laparoscopic adjustable gastric banding (LAGB) was described in 1993 and approved by the FDA to be used in the USA in 2001. It is a purely restrictive procedure designed to confront obesity. By 2010 these operations accounted for 46% of all the bariatric surgeries performed in American College of Surgeons accredited centers .
Since its introduction, LAGB placement has been considered as a safe, reversible, and low-risk procedure with promising short-term outcomes as reported by many of the initial studies [2–4]. However, more recent investigations reviewing long-term outcomes showed high rate of reoperation and revision for complications like band erosion, slippage, and gastric pouch enlargement as well as weight loss failure [1, 5–8].
Based on the National Inpatient Sample (NIS) database, between 2005 and 2014, 159,890 morbidly obese individuals underwent LAGB insertion. Utilization of this procedure started with around 14,000 in 2005, peaking in 2008 at 35,000 cases to decrease to 1170 in 2014. Interestingly the number of procedures for removal and revision during the same period increased progressively from a total of 1405 in 2005 to 7240 in 2014 (an increase of 432%) .
There are multiple potential reasons for failed weight loss following LAGB. These include complications related to the adjustable gastric band prosthesis, lack of compliance with dietary advice or adjustment regimens, or low resting energy expenditure .
In general, AGB have inferior results compared with stapling procedures due to lack of metabolic effect. However, when minimal weight loss or recurrence of obesity occur, a comprehensive evaluation of the patient needs to be done by the team (including dietitian and psychologist) before blaming the AGB. It is our practice to look at the compliance and the number of adjustments done before going forward with further workup.
The current literature shows that up to 60% of patients required revision of the primary surgery between 30 and 80 months after placement, being the most common indication insufficient weight loss [5, 8, 9].
The goal of this chapter is to provide a review of the outcomes after different conversion options available LAGB as well as describe the essential surgical steps during these procedures.
KeywordsGastric banding Gastric sleeve Sleeve gastrectomy Revisional surgery Gastric bypass Single stage Two stage Morbid obesity Bariatric surgery
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