Revisional Surgery After Failed Laparoscopic Adjustable Gastric Banding: A Systematic Review

Ahmad Elnahas, MD, Kerry Graybiel, MD, Forough Farrokhyar, MPhil PhD, Scott Gmora, MD FRCSC, Mehran Anvari, MBBS PhD FRCSC FACS, Dennis Hong, MD MSc FRCSC FACS. McMaster University, St. Joseph’s Healthcare Hamilton

 

Background: Laparoscopic adjustable gastric banding (LAGB) has emerged as one of the most commonly performed bariatric procedures worldwide. Unfortunately, revisional surgery is required in 20-30% of cases. Several revisional strategies have been proposed, but there is no consensus regarding the best surgical option. The aim of this systematic review is to determine which revisional surgery (laparoscopic sleeve gastrectomy, laparoscopic roux-en-y gastric bypass, or laparoscopic biliopancreatic diversion with duodenal switch) is best suited to enhance weight loss following failed LAGB due to complications or inadequate weight loss.
 

Methods: EMBASE, MEDLINE, PsycINFO & Cochrane Clinical Trials were searched using the most comprehensive timeline for each database. A total of 24 relevant articles were identified. Two investigators independently extracted data and differences were resolved by consensus. The weighted means were calculated for weight loss measurements.
 

Results: A total of 106, 514, and 71 patients underwent conversion from LAGB to laparoscopic sleeve gastrectomy (LSG), laparoscopic roux-en-y gastric bypass (LRYGB) and laparoscopic biliopancreatic diversion and duodenal switch (BPDDS), respectively. Prior to revisional surgery, the weighted mean BMI was 38.8 (6.9) kg/m2, 43.3 (8.1) kg/m2, and 41.3 (7.2) kg/m2 for the LSG, LRYGB, and BPDDS group, respectively. The majority of data was reported at 12-24 months follow up. The mean BMI within this interval was 28.0 (10.5) kg/m2, 32.2 (6.4) kg/m2, and 33.0 (5.7) kg/m2 for the LSG, LRYGB, and BPDDS group, respectively. In addition, the mean excess weight loss (EWL) was 22.0% (2.8), 57.8% (11.7), 47.1% (14.0) for the LSG, LRYGB, and BPDDS group, respectively. The EWL reached 78.4% (35) in the BPPDS group after two years follow up.
 

Conclusion: Failed LAGB is best managed with conversion to a malabsorptive bariatric procedure. Stable weight loss occurs with salvage LRYGB. Although results for revisional BPPDS appear promising, additional research, with higher methodological quality, is needed.
 


Session Number: ResFel – Residents/Fellows Scientific Session
Program Number: S136

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