Outcomes after laparoscopic adjustable gastric band repositioning for slippage or pouch dilation

Slippage and pouch dilation are the most common surgical complications after laparoscopic adjustable gastric banding, yet few reports have described the specific outcomes after band repositioning for these complications. The objective of this study was to examine the intermediate outcomes of our patients who underwent band repositioning for slippage or pouch dilation.

From October 2000 to December 2005, 1275 patients underwent laparoscopic adjustable gastric banding at our center. Of these, we retrospectively reviewed the data of the first 40 consecutive patients (92.5% women, mean age 41.7 years, mean preoperative weight 123.3 kg [range 86.2-180.5], mean body mass index 44.8 kg/m2 [range 34.6-66.4]) who presented with anterior slippage (52.5%), posterior slippage (20%), or pouch dilation (27.5%, 7 with associated hiatal hernias) that required band repositioning (95%) or explantation (5%).

The average time between laparoscopic adjustable gastric banding and reoperation was 22.9 months. Before band repositioning, the mean weight was 91.5 kg, mean body mass index was 33.2 kg/m(2), and mean percentage of excess weight loss was 49.4% (range 1-79.8%). One patient had a recurrent anterior slippage that required a second band repositioning. Two bands were explanted, one for intraoperative gastric perforation and one at the patient's request. The mean percentage of excess weight loss after band repositioning was 48.1% (range 18.2-77.4%) at an average follow-up of 17.6 months (range 6-36). To date, 38 (95%) of the 40 patients have functioning bands. Co-morbidity resolution was seen in 3 (60%) of 5 patients with diabetes, 13 (65%) of 20 with hypertension, and 8 (72%) of 11 with sleep apnea.

Laparoscopic band repositioning can result in preservation of most of the initial weight loss and co-morbidity resolution.