Revisional Surgery After Failed Adjustable Gastric Banding: Institutional Experience with 90 Consecutive Cases

Keng-Hao Liu, MD, Michele Diana, MD, Michel Vix, MD, Hurng-Sheng Wu, MD, Jacques Marescaux, MD, FACS, HonFRCS, HonFJSES

1- Chang Gung Memorial Hosp at Linkou, Chang Gung University, Taoyuan, Taiwan 2- IRCAD-IHU, Department of General, Digestive and Endocrine Surgery, University Hospital of Strabourg, France 3- IRCAD-AITS, Show Chwan Health Care System, Changhua, Taiwan

Introduction: Revisional surgery may be required in a high percentage of patients (up to 30%) after Adjustable Gastric Banding (AGB). There is currently no consensus on the most adapted timing and the bariatric procedure to perform after failed AGB. Our aim is to evaluate the results of revisional surgery with respect to age, gender, revisional procedure and timing.

Methods and Procedures: Data originated from our prospectively collected bariatric surgery database and analyzed retrospectively. From January 1996 to November 2011, a total of 243 AGB were placed at our Institute. Within the same period, 130 AGB (53.5%) were removed and 90 patients (37.7% of the total) underwent further revisional surgery. RYGB was performed when gastroesophageal reflux disease, post-AGB esophageal motility disturbance, hiatal hernia, or diabetes were present. Sleeve Gastrectomy (SG) was proposed if not contraindicated. One-stage revisional surgery consisted in removing the AGB and performing the bariatric procedure simultaneously. Two-stage surgery consisted in removing ABG and performing revisional surgery 3-6 months later.

Results: In two cases, revisional surgery by laparoscopy was aborted due to the impossibility to approach safely the upper stomach for severe adhesions. Eighty-eight patients (74 females; mean age 42.79±10.03 years; mean body weight 123.22±23.09 kg; mean BMI 44.73±6.19Kg/m²) successfully underwent revisional SG (n=48) or RYGB (n=40). One-stage surgery was performed in 29 cases and two-stage surgery in 59 cases. The follow up rate was 78.2% (n=61) and 40.9% (n=36) at 12 and 24 months respectively. One major complication after SG (staple-line leakage), was managed surgically. Mortality was nil. During follow-up, 10 additional complications were observed, including 6 port-site hernias, 2 unexplained cases of abdominal pain and vomiting with negative imaging and laparoscopic exploration, 1 internal herniation managed by laparoscopic repair, and 1 gastro-jejunostomy stricture managed through endoscopic dilatations. Overall postoperative Excess Weight Loss (%EWL) was 31.24%, 40.92%, 52.41%, and 51.68% at 3, 6, 12, and 24 months of follow-up respectively. EWL at 1-year was independent of 1) the revisional procedure (49.84% after SG vs. 56.49% after RYGB p=0.18); 2) the reasons for AGB removal (52.82% after failure to lose weight vs. 51.03% if removed for complications; p=0.52); 3) the timing of revision (51.04% one-stage vs.54.11% two-stage p=0.43); 4) initial BMI (42.64% in patients with BMI≥ 50kg/m² vs.55.27% in patients with BMI <50kg/m2 p=0.05). There was a statistically significantly higher %EWL in patients <50 years old (55.90% vs. 41.50% in patients >50 years-old; p= 0.01), in patients of female gender (55.22% vs. 40.73% in male; p=0.04), and in patients in which the AGB was in place for less than 5 years (57.09% vs. 47.43% if > 5 years, p=0.02).

Conclusions: Revisional surgery is safe and feasible in patients who failed to lose weight or who underwent AGB-related complications. Selected patients aged less than 50, of female gender, and with the AGB in place for less than 5 years had better %EWL after revisional surgery. No differences were found regarding timing or type of surgery.

Session: Podium Presentation

Program Number: S102

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