• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES Top 21 MIS Procedures
    • SAGES Pearls
    • SAGES Flexible Endoscopy 101
    • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Systematic Removal of More Than 50% of Fluid in Patients With Clinically Significant Reflux Or Slippage-like Complications of Adjustable Gastric Banding Is an Effective Treatment Option

Andrea S Bedrosian, MD, Nabeel R Obeid, MD, Bradley F Schwack, MD, Heekoung Youn, RN MA, Christine J Ren Fielding, MD, George A Fielding, MD, Marina S Kurian, MD. New York University Langone Medical Center

 

Introduction
As the patient population with laparoscopic adjustable gastric banding (LAGB) becomes more prevalent, and with it several known clinical complications, we investigated whether systematic loosening for specific band-related problems can prevent re-operation. We hypothesized that removing all fluid in patients with documented band slip, esophageal dilatation, pouch dilatation, or clinically significant reflux may be a sufficient therapeutic intervention, thereby avoiding the risks and cost associated with surgical revision of the band.

Methods and Procedures
We conducted a single-institution restrospective review of 273 patients who had LAGB with Allergan AP-Standard bands performed between June 2006 and July 2011, were at least 120 days from initial surgery with ≥5 mL of fluid in the band, and had ≥50% fluid removed for various reasons. Justification for fluid removal was divided into band-related clinical complications ( documented slip, esophageal dilatation, pouch dilatation, or reflux) and non-band related issues (e.g., pre-procedure fluid removal, patient request, etc.), and the percent of fluid removed was largely provider-dependent. We analyzed rate of re-operation for band-related complications, as well as categorization of documented resolution for those not undergoing surgical revision. Data points studied included demographic information, time from band loosening to re-operation, number of adjustments following band loosening, and weight change.

Results
113 of the original 273 patients had a band-related clinical complication justifying fluid removal of ≥50%: 34.5% had slippage, 28.3% reflux, 23.9% pouch dilatation, and 13.3% esophageal dilatation. Of these, 71.7% had documented resolution of the complication without surgery following fluid removal of ≥50%, while 25.7% underwent re-operation. Resolution was defined as complete alleviation of symptoms or normal follow-up imaging studies, such that the band could be refilled. Overall, 51.7% of patients with band slips had resolution without surgical revision, compared to 81.5% of patients with pouch dilatation, 81.3% with reflux, and 86.7% with esophageal dilatation. Three adjustment groups of fluid removal were selected: 50%, 51-75%, and ≥76%. Of the 10 patients who had 50% of fluid removed, none required band revision. For the 31 patients with 51-75% of fluid removed, 22.6% required band revision. For the 72 patients with >75% of fluid removed, 25% required band revision. In each adjustment group in those not requiring re-operation, an average of 4 adjustments was needed to reach the band’s original fill volume. Patients not requiring surgical revision saw an average of +7.6% change in weight, and weight gain was similar across all adjustment groups.

Conclusions
We found that simple fluid removal of ≥50% in LAGB patients is a good therapeutic option with >71% overall success. Over 80% of patients presenting with pouch dilatation, esophageal dilatation, or reflux had resolution without surgical re-intervention. Even in those with esophagram-proven slips, over 50% did not require re-operation. The small number of office visits to refill the band and <8% weight gain are acceptable when compared to additional surgery.
 


Session Number: Poster – Poster Presentations
Program Number: P482
View Poster

65

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube
  • Instagram
  • TikTok

Important Links

SAGES 2024 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons