Simultaneous Laparoscopic Gastric Band Removal and Sleeve Gastrectomy

Vasileios Drakopoulos, MD, PhD, FACS1, Athanasios Bakalis, MD1, Nikolaos Roukounakis, MD, PhD1, Sotirios Voulgaris, MD1, Sotiria Tsogka, MD2, Eleni Plesia, MD, PhD2, Spiros Drakopoulos, MD, PhD1. 1First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece, 2Department of Anaesthesiology, Evangelismos General Hospital, Athens, Greece

Background. Revision procedures after laparoscopic adjustable gastric band (LAGB) placement are often necessary in cases of severe band-related complications, inadequate weight loss or weight regain. Simultaneous (single-stage) gastric band removal and sleeve gastrectomy seems to be a safe procedure in experienced hands, while others support the two-stage procedure.

Methods. We present a case of a 41 year-old male with insufficient weight loss after LAGB placement (Body Mass Index 55.6 kg/m2 before definitive revision operation). He had underwent two operations of gastric band placement. The first gastric band developed slippage and the second one infection without erosion. A single-stage removal of the band and sleeve gastrectomy was performed. We describe the technique of this single-stage conversion. Nine patients in our institution had underwent this one-stage revision, at the period 2012-2014, with no major complications. Four trocars are used: one 10 mm-trocar is inserted approximately 10cm below the xiphoid process in the midline, one right subcostal of 10mm for liver retraction and another two trocars of 5mm and 10mm at the midclavicular lines bilaterally.

Results. No postoperative complications were mentioned and the patient was discharged three days after surgery. Weight loss in the first six months was 60% of his excess weight.

Conclusions. Single-stage laparoscopic gastric band removal and sleeve gastrectomy for morbid obesity seems to be safe and efficient, especially in cases of absence of gastric erosion.  Inflammation and foreign body reaction make the procedure more demanding, leading to a prolonged learning curve.

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