Laparoscopic Adjustable Gastric Banding: Lessons learned from 19,221 bands over a seven-year period in the state of New York

Maria Altieri, Dana Telem, MD, Jie Yang, PhD, Ziqi Meng, MS, Caitlin Halbert, DO, MS, Catherine Frenkel, MD, Mark Talamini, MD, Aurora Pryor, MD. Stony Brook University Hospital

Laparoscopic Adjustable Gastric Banding (LAGB) is a common bariatric procedure, which in recent years has fallen out of favor due to concerns for poor long-term outcomes and necessity for revision or removal. We sought to determine the rate of revision and explant over a seven-year period in the State of New York.

Methods

Following IRB approval, the New York Statewide Planning and Research Cooperative System (SPARCS) administrative database was used to identify LAGB placement and revision/removal between 2004-2010. SPARCS collects patient level detail on patient characteristics, diagnoses and treatments, and services for every hospital or surgery center encounter in the State of New York.

LAGB was identified with a primary diagnosis of overweight or obesity (ICD-9 code 278.0, 278.01, or 278.02) and a primary procedure code for LAGB placement, removal or revision. Using a unique patient identifier, we tracked those patients who underwent band placement with subsequent removal/revision, followed by conversion to either Roux-en-Y Gastric Bypass (RYBG) or Sleeve Gastrectomy (SG). Patients under age 18 or with procedures less than 30 days from initial surgery were excluded. McNemar test was used to compare complications between primary procedure and subsequent revision. Chi-square test was used to compare complication and mortality rates. P<0.05 was considered significant.

Results

During a seven-year period (2004-2010) there were 19,221 records of LAGB placements and 6,567 records of revisions or removal in the state of New York. Of the original 19,221 LAGBs, we were able to follow up 1,396 patients (7.26%) who subsequently underwent a band removal or revision over the course of this period. Initial revision procedures were coded as band removal in 31.3% (n=437), band revision in 46.6% (n=651), band removal and replacement in 8.6% (n=120), removal and conversion to SG 4.7% (n=66) or RYGB 8.7% (n=122). From the 1,396 patients, 1,206 (86.39%) required only one revision. One hundred and ninety patients underwent 2 or more revisions. The interval between LAGB and removal/revision was 2.02+/-1.31 years. Twenty-four out of 1,396 (1.7%) patients had complications at their initial operation but 665 (47.6%) had complications during revision (p<0.0001). The top three complications listed were digestive/intestinal (82.4%), surgical error (6.1%), and pneumonia (2.7%). When further broken down by procedure, procedures coded as band revisions had the highest rate of complications (51.1%), followed by band removal (34.4%), band replacement (8.3%), RYGB (4.4%), and sleeve (1.8%) (P<0.0001). There was no significant difference between complications for patients undergoing initial conversion to RYGB (23.77%) compared to SG (18.18%) (P=0.38). In addition, there was no significant difference between all-cause mortality between patients requiring revision (1.004% versus 0.931%, P=0.7918).

Conclusion:

Over a seven-year period, at least 7.26% of LAGB required removal or revision. Based on all case numbers, total revision rate could be as high as 34.2%. Although, there is no difference in mortality, revision procedures are significantly more morbid than the initial procedure, with digestive/intestinal, surgical error, and pneumonia as the most common complication type following these procedures. Fortunately, the majority of patients (86.39%) requiring revision do not need more than one procedure.