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Gastric Band Around Bypass: Should We Recommend?

Matt B Martin, MD1, Ben T Hoxworth, MD1, David H Newman, MD1, Lauren R Evans, RN, BSN2, Laurie Deaton, RN, MSN2. 1Central Carolina Surgery, PA, 2Cone Health

Introduction:  Weight regain following an initially successful gastric bypass is highly frustrating for the motivated patient.  Beginning in 2011, our bariatric surgery practice began seeing patients who had weight regain following gastric bypass.  Some of those patients were offered gastric band placement around their gastric pouch.

Methods:  This is a retrospective review of the 13 sequential gastric bands around gastric bypass patients that were performed between 2011 and 2017 at Cone Health, Wesley Long by Central Carolina Surgery, PA.

Results:  Thirteen patients underwent placement of a gastric band around their gastric bypass in years 2011 through 2017 at an average 9.5 years after their original bypass.  Three patients had a prior open gastric bypass and the rest had been performed laparoscopically and all were single limb Roux en Y.  Four of the patients had their original surgery in our group and nine came from elsewhere in the U.S.A.   Motivating factors included comorbidity management and one patient needed to achieve weight loss to qualify for a kidney transplant.  All patients underwent UGI or endoscopy to assess their pouch and had psych and dietary evaluations.   The average age at the time of revision was 49 years (38-69) with an average BMI of 43.  The pas flaccida technique was used and the anterior plication was done with the remnant stomach in 12 patients and one patient‘s pouch was used to plicate. Three patients had posterior crural repairs for hiatal hernias. All procedures were completed laparoscopically and patients were kept overnight for observation.  There were no mortalities.   First band fills were performed at 6 weeks.  The average for follow-up of the group is 2 years with average weight loss of 40 lbs.  Overall these patients were not as compliant with follow-up as band only patients.  Two of the bands were removed.  One had too much weight loss (BMI  18) with severe dysphagia and the other had evolving motility issues and worsening GERD.  The patient with ESRD did qualify for transplant but is lost to follow-up.  The patient who lost 135 lbs. and had her band removed for severe dysphagia has since regained all of her lost weight.

Conclusion:  Gastric banding can be performed with low risk to the patient with weight regain after gastric bypass.  Sustained weight loss enhancement is marginal.  These results do not support recommending this procedure to patients that have weight regain after gastric bypass.

 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88197

Program Number: P631

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

32

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