Matthew L Dong, MD, MPH, Daniela Guevara, MD, Subhash Kini, MD, Eric Edwards, MD, Daniel Herron, MD, Gustavo Fernandez-Ranvier, MD. Icahn School of Medicine at Mount Sinai
Purpose: Laparoscopic gastric band, once popular due to its technical ease and encouraging initial results, has lost favor due to its long-term complications such as dysphagia, obstruction, and insufficient weight loss. We assessed our 5-year experience with band-removal procedures, comparing outcomes after band removal alone, conversion of band to sleeve gastrectomy (SG) and conversion of band to Roux-en-Y gastric bypass (GB).
Methods: We performed a retrospective analysis of our prospectively collected bariatric outcomes database. Patients who underwent band removal between January 2011 and December 2015 were included. Primary outcomes included 30-day complication rate, length of hospital stay, and weight loss at 6-month follow-up. We also investigated the indications for operation and choice of revisional procedure.
Results: 65 band removal patients were identified. Of these, 25 underwent lap band removal without plan for conversion (Group A), 13 were planned for conversion to GB (Group B), and 27 were planned for conversion to SG (Group C). Of the 13 patients in Group B, 4 were completed in a single stage, 6 were completed in 2 stages, 1 opted for SG instead and 2 have yet to undergo conversion. Of the 27 patients in Group C, 10 were completed in a single stage, 15 were completed in 2 stages and 2 have yet to undergo conversion.
Complications included 1 allergic reaction to adhesive dressing in Group A, 1 readmission for small bowel obstruction in Group B, and 1 case of delayed gastric emptying, requiring TPN, in Group C.
Mean length of stay in Group A was 0.9 days, with most being performed as outpatient procedures. Mean inpatient stay for Group B was 2.0 while Group C was 3.1 (median 1.5). Conversion to GB or SG resulted in modest weight loss at 6 months (9.9 and 9.7% of total preoperative body weight, respectively), while simple band removal resulted in 3.2% weight gain at 6 months follow-up.
The most common indications for removal were inadequate weight loss, pain, or obstructive symptoms such as nausea/vomiting, severe reflux or esophageal dysmotility. Patients with band erosion or with obstructive symptoms were more likely to have band removal without plan for conversion.
Conclusion: Complications after gastric band placement are relatively common. Patients who undergo band removal and conversion to SG or GB enjoy moderate improvement in weight loss whereas patients with band removal alone experience mild weight regain.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80241
Program Number: P483
Presentation Session: Poster (Non CME)
Presentation Type: Poster
