Tung T Tran, MD, MSc, Vinay Singhal, MD, Ryan Juza, MD, Eric Pauli, MD, Jerome Lyn-Sue, MD, Randy Haluck, MD, Ann Rogers, MD
Penn State Milton S. Hershey Medical Center
INTRODUCTION: Increasing experience with laparascopic adjustable gastric bands (LAGB) has demonstrated a high rate of complications and inadequate weight loss. Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have been reported to be safe and effective in selected patients. The purpose of our study was to evaluate the incidence and outcomes of revisional weight loss surgery after laparoscopic gastric banding at our institution.
METHODS: From June 2006 to August 2012, all patients undergoing LAGB and those requiring revision were retrospectively analyzed. All procedures were performed by two surgeons with extensive experience in bariatric surgery. Parametric data are presented as mean ± SD, nonparametric data are presented as median and interquartile range [IQR].
RESULTS: During the study period, 253 patients underwent LAGB. 101 patients (40%) required reoperation. 55 patients (51 women, mean age 46±12) with a median BMI of 42 [39-45] successfully underwent reoperative weight loss surgery (48 RYGB, 7 LSG). Indications for surgery included dysphagia in 34 patients (62%), inadequate weight loss in 16 patients (29%), symptomatic reflux in 2 patients (4%), gastric prolapse in 2 patients (4%) and needle phobia in 1 patient (2%). 2 of the 55 patients required conversion to an open RYGB due to extensive adhesions. Revisional surgery was undertaken approximately 33±13 months after LAGB. A staged removal of gastric band and revisional weight loss procedure was performed in 15 patients with a median interval of 2.5 [1.2-7] months between procedures. Median operative time was 160 [142-183] min. Median hospital length of stay was 2 [1-3] days. Early complications occurred in 9 patients (16%) including 2 anastomotic leaks. 12 patients (22%) presented with late complications requiring intervention. There was one death. At a median follow up of 7 months, excess body weight loss was 42 ± 24% and 49% of patients achieved a BMI of less than 33.
CONCLUSION: LAGB is associated with a high incidence of reoperation. Reoperative weight loss surgery can be performed in selected patients with a higher rate of complications than primary surgery. Good short term weight loss outcomes can be achieved.
Session: Podium Presentation
Program Number: S085