Revisional Laparoscopic Sleeve Gastrectomy: A Viable Option After Gastric Band Failure

Talar Tatarian, MD, Michael Kammerer, MD, Danica Giugliano, MD, Alec Beekley, MD, David Tichansky, MD. Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: Laparoscopic adjustable gastric banding (LAGB) for weight loss has decreased in popularity in recent years, secondary to published high failure, complication and explantation rates in the long-term. Band removal with concurrent sleeve gastrectomy (LSG) seems to help these patients and allow for more durable weight loss.  Herein, we investigate revisional LSG after LAGB to determine the weight loss and comorbidity outcomes of patients undergoing this conversion.

Methods: A prospectively maintained bariatric surgery database was retrospectively queried to identify all patients who underwent simultaneous LAGB removal and LSG from August 2012 to December 2014. Patient demographics, medical history, operative details and percentage of excess weight loss (%EWL) were examined.

Results: Thirteen patients underwent simultaneous LAGB removal and LSG during the study period. Twelve patients were female. Median age was 46 years old. Indications for surgery included: failure to lose weight (n=10), dysphagia (n=3), gastroesophageal reflux (n=2), and persistent hypertension (n=2). Preoperative co-morbidities included: hypertension (46.2%), back pain (46.2%), gastroesophageal reflux (46.2%), obstructive sleep apnea (38.5%), hyperlipidemia (15.4%), and diabetes mellitus (7.7%). All procedures were completed laparoscopically with no complications or mortalities. Average follow-up was 15 months. Average pre- and post-operative BMI (kg/m2) was 44.3 and 37.3 respectively with average %EWL=33.8%. Three patients with back pain (50%) and three patients with reflux symptoms (50%) had complete resolution of these symptoms. Four patients’ hypertension improved (66%), no longer requiring at least one of their anti-hypertensive medications.

Conclusions: Revisional LSG after failed LAGB is a safe and feasible option yielding additional weight loss with complications outcomes similar to de novo sleeve gastrectomy. 

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