Revisional surgery safe, effective after adjustable gastric banding failure
Patients who underwent adjustable gastric banding but either did not lose weight or experienced complications safely benefited from revisional surgery, according to data presented at the Society of American Gastrointestinal and Endoscopic Surgeons Annual Meeting in Baltimore.
Researchers retrospectively evaluated data from 90 patients who received failed adjustable gastric banding (AGB) at a single facility between January 1996 and November 2011 and subsequently underwent revisional surgery.
Patients without contraindications received sleeve gastrectomy (SG, n=48); those with diabetes, hiatal hernia, esophageal motility issues or GERD underwent Roux-en-y gastric bypass (RYGB, n=40). Two laparoscopic procedures were aborted because of an inability to safely approach the upper stomach. Follow-up data were available for 78.2% of the cohort at 12 months and 40.9% at 24 months.
Patients’ postoperative excess weight loss (EWL) was 31.24% at 3 months, 40.92% at 6 months, 52.41% at 12 months and 51.68% at 24 months. Patients aged younger than 50 years experienced more EWL than older participants (55.9% compared with 41.5%; P=.01). Female sex (55.22% vs. 40.73% among males; P=.04) and a shorter duration of ABG placement (57.09% for fewer than 5 years vs. 47.43% for more than 5 years; P=.02) also were associated with increased EWL.
No associations were seen between EWL and performed procedure (P=.18), the reason for AGB removal (P=.52) or undergoing one- or two-stage surgery (P=.43). An association between EWL and initial patient BMI approached statistical significance (42.64% for those with BMI of 50 kg/m2 or greater compared with 55.27% for BMI below 50 kg/m2; P=.05).
During follow-up, staple-line leakage occurred in one SG patient. No deaths were reported.
“Revisional surgery is safe and feasible in patients who failed to lose weight or who underwent AGB-related complications,” the researchers concluded. “Selected patients aged less than 50, of female gender and with the AGB in place for less than 5 years had better EWL after revisional surgery. No differences were found regarding timing or type of surgery.”
For more information:
Liu KH. S102: Revisional Surgery After Failed Adjustable Gastric Banding: Institutional Experience With 90 Consecutive Cases. Presented at: the Society of American Gastrointestinal and Endoscopic Surgeons 2013 Annual Meeting; April 17-20, Baltimore.