Seth R Holland, DSc, PAC, Michael Smith, DSc, PAC, Jason Pfluke, MD. San Antonio Military Medical Center
Introduction: The high failure rate of Laparoscopic Adjustable Gastric Banding (LAGB) due to mechanical failure, gastroesophageal reflux disorder (GERD), dysphagia, or failure of satisfactory weight loss is well established. Controversy exists regarding the best procedure for revising the failed LAGB. Laparoscopic sleeve gastrectomy (LSG) and roux-en-Y gastric bypass (RNYGBP) are the most commonly performed revisional procedures in cases of failed LAGB. We hypothesized that patients undergoing revision of LAGB to LRNYGBP would have greater percentage excess weight loss (%EWL) than those revised to LSG.
Design and Methods: A single-center retrospective review was conducted. 45 LAGBs were revised to LSG (n=34) or LRNYGBP (n=11) from July 2009 to May 2013. The medical records were reviewed for demographic information, and postoperative follow-up at 1, 3, 6 and 12 months. Preoperatively collected data points were reasons for LAGB failure, pre-revision weight, Ideal Body Weight (IBW), and comorbidities. Postoperatively collected data points included complications, comorbidity improvement at 12 months, and %EWL at 1, 3, 6 and 12 months.
Results: There was no difference between the groups when comparing age, weight, and comorbidities. There was a significant difference in the %EWL at 12 months (p < 0.006) favoring LRNYGBP. Mean %EWL was 57.2 ± 12.6 in the LRNYGBP group, compared with 33.4 ± 26.7 in the LSG group. No difference in the rate of comorbidity improvement was detected (p>0.05). No patient in either group experienced a staple-line or anastomotic leak. One patient in the LSG group required reoperation for bleeding from the staple line (2.9%), and one patient in the LRNYGBP group demonstrated intra-abdominal hematoma that was drained percutaneously (9%).
Conclusion: LRNYGBP as a revision for failed LAGB showed an overall improvement in %EWL compared with LSG at 12 months. LRNYGBP and LSG are both effective at achieving additional weight loss following removal of LAGB. However, the LRNYGBP produced greater weight loss. Further studies with larger sample size and longer follow-up are needed to establish the optimal revision strategy for patients who fail LAGB.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78842
Program Number: MSS07
Presentation Session: Full-Day Military Surgical Symposium – General Surgery Presentations
Presentation Type: MSSPodium