Sleeve gastrectomy for gastric band failures - a prospective study

We prospectively evaluated the feasibility and efficacy of a strategy of performing concomitant laparoscopic band removal and sleeve gastrectomy on all-comers who had a failed laparoscopic adjustable gastric band (LABG) and analysed the impact of the reason for revision surgery on outcomes.

Over a two-year period, 23 patients who previously had LAGB insertion were referred for revision surgery. Of this cohort, three patients elected to undergo band removal alone. Of the remaining 20 patients, 10 presented with weight regain and 10 presented with pathological symptoms secondary to band migration (band complication group). All patients were listed for simultaneous LABG removal and sleeve gastrectomy and the outcomes of the two groups analysed.

Simultaneous band removal and sleeve gastrectomy was achieved in all cases of weight regain and in 7 cases of band complications. There were no complications in the weight regain group and three major morbidities in the band complication group. At the time of revision, the mean body mass index was 40.3 ± 1.5; however at a mean follow-up period of 2.2 ± 0.28 years the mean BMI of the cohort had fallen to 35.9 ± 1.4. The mean BMI was significantly lower in the band complication group (p = 0.03).

Gastric band removal and revision sleeve gastrectomy following failed LABG is feasible as a single-stage procedure with good outcomes. The optimum peri-operative results of this approach are seen in patients with weight regain whilst the longer term outcomes are superior in those with band complications.