Revisional surgery after failed laparoscopic adjustable gastric banding

Laparoscopic adjustable gastric banding (LAGB) is a restrictive procedure that achieves weight loss without anatomic alteration. However, morbidity requiring surgical reintervention can occur.

A retrospective review of a prospectively maintained database of primary LAGB and revisional surgery after failed LAGB was performed from January 2001 to October 2006 at an academic private clinic.

Of 2467 bariatric procedures, primary LAGB was performed in 242 patients. A total of 53 revisional procedures were performed in 40 patients and 16 in 9 patients who were referred from other centers after failed primary LAGB. The mean follow-up was 45.7 +/- 15.8 months (range 9.5-70). The early surgical reintervention rate was 6.1%. The revisional procedures included band removal only in 27 (39%), band removal and conversion to sleeve gastrectomy in 10 (14.5%), band removal and conversion to Roux-en-Y gastric bypass in 5 (7.2%), band repositioning in 7 (10%), device-related reintervention in 6 (8.7%), subsequent conversion to another bariatric procedure in 3 (4.3%), and other procedures in 11 (15.9%). Of the 49 patients, 21 (43%) presented with acute band-related morbidity. A total of 55 procedures (96.5%), amenable to minimal invasive surgery, excluding wound and port site-related procedures, were completed laparoscopically. The major early and late complication rate was 4.1% and 2%, respectively.

Primary LAGB was associated with acceptable major early complication and surgical reintervention rates. However, a late surgical reintervention rate of 15.2% was observed. Band removal was required in 14% of our primary LAGB patients because of band-related morbidity, with conversion to another bariatric procedure in 6.2%. Our results have shown that LAGB can be associated with significant morbidity and that revisional surgery is common.