Shannon E Stogryn, MBBS, MSc, FRCSC1, Azusa Maeda, PhD1, Steve J Maclellan, MD, FRCSC1, Ashley Vergis, MMEd, MD, FRCSC, FACS2, Allan Okrainec, MD, MHPE, FRCSC1, Timothy Jackson, MD, MPH, FRCSC, FACS1. 1University of Toronto, 2University of Manitoba
Introduction: Laparoscopic Adjustable Gastric Banding (LAGB) is a common bariatric procedure that has experienced a significant decline. This is primarily due to poor sustained weight loss and high revision rates compared to its contemporary bariatric procedures. Explantation of LAGB is commonly performed at our institution and often concurrently converted to other bariatric procedures. Previously reported adverse event rates for LAGB removal alone was 6.8%. The objective of this study is to evaluate the outcomes after LAGB removals at our institution including conversions to other bariatric procedures.
Methods: Patients were identified using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database from the Toronto Western Hospital site, filtered by LAGB removal based on the principal procedure code and concurrent procedural terminology (CPT) codes (43773, 43774). Patients undergoing simultaneous conversion to other bariatric procedures were included. Outcomes were evaluated for 30-day morbidity, mortality, and readmission.
Results: Between 2011-2018, 93 patients met our inclusion criteria. The majority of patients were female (84.95%) with a mean body mass index (BMI) of 42.31 (+/-SD 9.48) and mean age of 49.12 years (+/- SD 10.77 years). All LAGB removals were performed laparoscopically with only 1 conversion to open (1.08%). The majority were elective procedures (96.77%) with only 3 emergency cases (3.23%). Mean length of stay was 2.19 days (+/- SD 2.29 days). Post-operative complications at 30 days occurred in 11.83% of patients with a 4.30% readmission rate. There were no deaths. Surgical site infections (SSI) accounted for 81.82% of complications (54.55% superficial SSI, 27.27% deep SSI). Thirty-day adverse event rate for LAGB removal alone was 15.00%. Emergent LAGB explantation had a 33.33% complication rate. LAGB was converted to another bariatric procedure in 56.99% of cases (48.39% Laparoscopic Roux-en-Y Gastric Bypass (LRYGB), 8.6% Sleeve Gastrectomy (LSG)). Conversion to LSG was associated with the highest 30-day post-operative complication rate (37.50%) compared to conversion to LRYGB at 2.22% (p=0.375).
Conclusion: Thirty-day complication rates for removal of LAGB and conversion to other bariatric procedures is significant and may be higher than rates previously reported for LAGB removal alone. This case series suggests that conversion to sleeve gastrectomy may have the highest post-operative complication rate.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94026
Program Number: P178
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster