Laparoscopic Sleeve Gastrectomy Following Failed Laparoscopic Gastric Banding Among Morbidly Obese Adolescents

Aslam Ejaz, MD, Pankti Patel, MD, Robert Kanard, MD, Raquel Gonzalez-Heredia, MD, PhD, Pablo Quadri, MD, Lisa Sanchez-Johnsen, PhD, Enrique Elli, MD, FACS. UIC

Background: Laparoscopic adjustable gastric banding (LAGB) has a high incidence of long-term failure and complications.  Conversion to laparoscopic sleeve gastrectomy (LSG) in patients with failed LAGB has gained popularity in recent years. However, outcomes in the adolescent population have not been previously studied. The aim of this study was to examine reasons for LABG failure, percent excess weight loss, and perioperative and post-operative outcomes in adolescent patients undergoing LSG after failed LAGB.

Methods: All patients who underwent LSG following failed LAGB were identified at our institution between January 2006 and December 2014.  Patient demographics, reasons for lap band removal, pre-surgical comorbidities, perioperative outcomes, post-operative complications, operating time, length of hospitalization, and percent excess weight loss (% EWL) were recorded.

Results: Fourteen patients (10 females, 4 males) underwent LSG following failed LAGB.  Mean patient age at LAGB was 16.2 ± 1.6 years and mean preoperative LAGB BMI was 52.4 ± 9.9 kg/m2. The most common causes for LAGB failure were gastric pouch enlargement (n=13, 92.9%) and weight regain (n=4, 30.8%).  Mean time before removal of the LAGB was 3.9 ± 1.6 years.  At the time of LSG, mean preoperative BMI was 48.9 ± 9.7 kg/m2.  Nearly one-half of the patients (n=6, 42.9%) patients underwent a two-stage operation. No patients experienced a perioperative 30-day complication.  Median length of hospitalization following LSG was 3 days (IQR: 2, 3) and did not differ between patients undergoing a one-stage or two-stage operation (p=0.30).  At a median follow-up of 19.6 months, percent excess weight loss was 28.4%.  

Conclusions: Results from this initial study suggests that LSG should be considered as an option for morbid obesity among adolescent patients who experience complications after LAGB and/or failure of LAGB. Future studies with larger samples of adolescent patients as well as a longer follow-up period post LAGB are warranted.    

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