Joshua B Alley, MD FACS, Amit Parikh, DO, Stephen J Fenton, MD, Donovan N Tapper, MD, Richard M Peterson, MD MPH FACS. University of Texas Health Science Center at San Antonio; Wilford Hall Medical Center
Introduction: Approximately 33% of patients undergoing laparoscopic adjustable gastric banding are reported to experience failure of weight loss, intolerance of the band, or both, resulting in removal of the band and conversion to another weight loss operation. We present our experience with single-stage laparoscopic removal of adjustable gastric band and conversion to sleeve gastrectomy.
Methods: We retrospectively reviewed all patients from January 2005 to September 2010 who underwent laparoscopic removal of adjustable gastric band with revision to sleeve gastrectomy. Outcomes, including weight loss, body mass index (BMI) change, and postoperative morbidity, were documented.
Results: Ten patients underwent laparoscopic removal of adjustable gastric band with conversion to sleeve gastrectomy. Seven patients had their initial band surgery in our program, out of 82 patients who had band insertions during the study period. Three patients were referrals from outside programs. Mean (±SD) preoperative age and BMI were 46.5 ± 9.8 and 36.4 ± 2.5. Failure of weight loss (n=6) was the most frequent reason for removal and conversion. Nine of 10 patients underwent postoperative contrast swallow studies, and no patient demonstrated a radiographic or clinical leak. One patient (10%) returned to the operating theater for bleeding at the gastric staple line; this was the only morbidity. Length of stay was 2.1 ± 0.7 days (range, 1-4). Mean follow up was 5.2 ± 3.1 months. Excess weight loss (EWL) and excess BMI loss (EBL) were 31.6% and 41.7% at 6 months (n=6), and 40.3% and 49.3% at 12 months (n=1). There was no statistically significant difference in %EWL and % EBL between the revision group and our primary laparoscopic sleeve gastrectomy group.
Summary: For patients with failure of weight loss, intolerance of adjustable gastric band, or both, single-stage laparoscopic adjustable gastric band removal with conversion to sleeve gastrectomy is feasible. It can be accomplished with low morbidity, and yields early weight loss results comparable to primary sleeve gastrectomy.
Program Number: S060