BAND OVER SLEEVE: A Safe Alternative to Achieve Further Weight Loss and Reduction of Co-Morbidities

Amy Banks, MD, R Harrell, MD, J Foote, MD. Grand Rapids Medical Education Partners, Michigan State University and Grand Health Partners.

Introduction: The vertical sleeve gastrectomy was traditionally performed as part one of a staged bypass procedure in the super obese patient population. The weight loss achieved from this surgery alone is often substantial and frequently patients do not require or desire the second stage malabsorbtive procedure. The vertical sleeve gastrectomy is one of the most common weight loss surgeries performed today. Over time, however, weight gain often occurs and we present a new technique of using a laparoscopic placed adjustable gastric band (LAGB) over a vertical sleeve gastrectomy (VSG) to aid in further weight loss and reduction of co-morbidities.
Methods: A retrospective review was performed of five patients who underwent LAGB placement following a VSG. BMI, weight loss from VSG alone and weight loss from LAGB plus VSG were reviewed. Percent excess body weight loss (%EWL) for LAGB alone and for LAGB plus VSG was calculated. Co-morbidities and their resolution as well as any postoperative complications were evaluated.
Results: All five patients achieved further weight loss after placement of the adjustable gastric band over the vertical sleeve gastrectomy with an average of 40.4 lb (range 31-64 lb) and an added %EWL of 32.2% (range 12.7% – 44.1%). Total %EWL following VSG plus LAGB placement was 57% (range 43% – 67.5%). The average BMI decreased from 56.6 pre-operatively to 43.9 post VSG and down to 37.6 after VSG plus LAGB. No major complications occurred during the 31-month average follow up (range 15-46 mo). An average of 3.6 adjustments to the gastric band were needed post operatively. Several co-morbidities resolved after VSG, and there was even further resolution of co-morbidities after LAGB plus VSG. One patient was intolerant of the band and required eventual removal.
Conclusion: This case series introduces a novel approach to add to the repertoire of bariatric procedures following a vertical sleeve gastrectomy. There are advantages to placing an adjustable gastric band over a sleeve gastrectomy in lieu of converting patients to a malabsorptive procedure such as Roux-en-Y gastric bypass or a biliopancreatric diversion with duodenal switch. We demonstrate that certain patients can achieve further weight loss from laparoscopic placement of a gastric band over a vertical sleeve gastrectomy without complications. Further studies still need be done to determine the efficacy of this procedure to provide long-term weight loss in this patient population.

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