Validity of laparoscopic sleeve gastrectomy following gastric band failure:

Mohammed Alkubaisi, MD, FICS, FIBMS, DMAS, Abdulsalam Altaie, MD, FICS, FRCS. Altaie Center For Laparoscopic & Obesity Surgery, Dubai, UAE.

Background:
Laparoscopic adjustable gastric banding (LAGB) is an effective bariatric procedure with low morbidity and mortality. Unfortunately, high failure rates in long-term follow-up were seen.
Laparoscopic adjustable gastric banding (LAGB) has a failure rate in the US approaching 40–50 %.
Laparoscopic sleeve gastrectomy (LSG) is an emerging procedure initially described by Gagner’s group as the first stage of the laparoscopic duodenal switch in super-obese patient, recently and quickly gaining position in the field of bariatric practice either as a first step toward gastric bypass/ biliopancreatic diversion or as a stand-alone operation
It has been described as a revision option for previous bariatric surgery failures. We report our experience with LSG as a revision stand alone procedure for failed LAGB.

Methods:
From June 2009 to September 2011, 60 patients who had undergone LAGB followed by LSG. As result of gastric band failure were studied. Demographics, reason for band removal, interval between removal and LSG, operative times, estimated blood loss, complications, length of hospital stay, and percent of excess weight loss were collected.

Results:

Of the 60 patients, 10 (17%) had their bands removed before LSG median time interval 36 months;( range, 4 months to 10years); the rest50 (83%) patient had concomitant band removal and LSG.
Twenty patients were men (33.3%). Mean age and BMI were 30Y (range, 18–44) years and 38.8kg/m2 (range, 33.47–57), respectively. Forty women (66.7%) were operated. Mean age and BMI were 32y (range, 17-58) and 43.11(range, 34-63) .All done as laparoscopic procedure. Median operative time100 minute (range, 70–180) minutes, estimated blood loss avarage50 ml (range, 10–500) ml.
And length of hospital stay were 2days (range, 2.5d–14d) days respectively.
Major morbidity was encountered in two patients3.3%; (leak in1 and bleeding in 1). There were no mortalities. Mean follow-up time for our patients is 12m (range, 1–24) months. The mean weight at time of LAGB operation was 131.40 kg, while it was 111.25 kg at time of lap. Gastric band removal and lap. sleeve gastrectomy and was 102.99 after 2 months follow up after last surgery. ,Percent of excess weight loss at 2, 6, 12,24, was 24, 35, 51, 49, respectively.

 

Conclusions:

Our results suggest that LSG is safe, feasible, and effective and valid procedure for failed LAGB and can be considered as revisional option in these cases. Larger series and longer follow-up are needed to confirm this.

Keywords Bariatric _ Obesity _ Clinical papers/trials/

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