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

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.