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Short-term morbidity associated with removal and revision of the laparoscopic adjustable gastric band
Timothy D Jackson1, Fady Saleh2, Fayez A Quereshy2
1Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada.
Background:
Laparoscopic adjustable gastric band (LAGB) insertion is a commonly performed bariatric procedure with low associated short-term risk. Given that a significant number of patients will require additional revision/removal procedures, overall morbidity may be underestimated. The objective of this study was to define the 30-day morbidity associated with LAGB removal and revision procedures.
Methods:
Patients undergoing revision or removal of LAGB were identified within The American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) participant use file using current procedural terminology and ICD-9 coding. Patients having concurrent procedures were excluded. Primary outcomes included 30-day morbidity. The rate of complications in the removal/revision patients versus primary LAGB insertion was compared. We also analyzed trends over time.
Results:
A total of 3,236 patients underwent LAGB removal (n = 1,580), revision (n = 1,111) or port site revision (n = 545) from 2006-2011. The overall 30-day complication rate was 5.6% (95% confidence interval [CI]: 4.8%, 6.4%) and was higher in patients undergoing LAGB removal with a 6.8% (95% CI: 5.6%, 8.1%) adverse event rate (2.5% infectious, 2.3% wound, 2.4% reoperation). A total of 24,438 patients underwent primary LAGB insertion within the data set with a 30-day complication rate of 2.6% (95% CI: 2.4%, 2.8%). Patients undergoing LABG removal had a significantly higher complication rate than those having primary LAGB insertion with an odds ratio of 2.72 (95% CI: 2.18, 3.37). The proportion of LAGB revision/removal compared to primary placement increased annually over the study period (P for trend<.001).
Conclusion:
The 30-day morbidity associated with LAGB revision is significant and higher than that associated with primary LAGB insertions. The potential need for future procedures and the associated additional morbidity should be considered when evaluating LAGB as a treatment option for morbid obesity.
Insights
Laparoscopic adjustable gastric band (LAGB) removal and revision procedures have a higher 30-day complication rate than primary LAGB insertion. These revision risks should be considered when choosing LAGB for obesity treatment.
Area of Science:
- Bariatric surgery outcomes
- Surgical complication analysis
Background:
- Laparoscopic adjustable gastric band (LAGB) insertion is a common bariatric procedure with low initial risk.
- A significant number of patients require subsequent revision or removal procedures, potentially increasing overall morbidity.
- The 30-day morbidity associated with these secondary LAGB procedures is not well-defined.
Purpose of the Study:
- To determine the 30-day morbidity associated with laparoscopic adjustable gastric band removal and revision procedures.
- To compare complication rates between LAGB removal/revision and primary LAGB insertion.
- To analyze trends in LAGB revision/removal rates over time.
Main Methods:
- Utilized The American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) database.
- Identified patients undergoing LAGB removal, revision, or port site revision using procedural and diagnostic codes.
- Excluded patients with concurrent procedures and compared 30-day morbidity between groups, analyzing trends from 2006-2011.
Main Results:
- 3,236 patients underwent LAGB removal (n=1,580), revision (n=1,111), or port site revision (n=545).
- The overall 30-day complication rate for removal/revision was 5.6%, significantly higher than the 2.6% for primary LAGB insertion (OR 2.72).
- LAGB removal had a 6.8% complication rate, with increasing annual rates of revision/removal procedures compared to primary placement.
Conclusions:
- The 30-day morbidity following laparoscopic adjustable gastric band revision is significant and higher than for primary insertions.
- The potential for additional morbidity from secondary procedures necessitates careful consideration when selecting LAGB for morbid obesity treatment.
- Increased rates of revision and removal procedures highlight the long-term implications of LAGB placement.
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