BACKGROUBD: The adjustable gastric band has been touted as an innovative and less invasive approach to the treatment of severe obesity. This device is still under evaluation by the FDA. A defined incidence of failure needs to be established. Although the exact rate has not yet been determined, in this report we detail our experience in recovery of patients who have a less than ideal outcome.
METHODS: We report our experience in 85 adjustable gastric bands placed since 1995. We have followed another 20 patients who had their bands placed elsewhere.
RESULTS: In our cohort, 28 patients (33%) had bands removed (4 patients twice). Ten had bands removed for inadequate weight loss (12%) and all were converted to gastric bypass (GB). Eighteen had bands removed for obstruction (21%), 7 had band revision, 8 were converted to GB, and 3 were removed. Another 3 patients from other surgeons had band replacement for obstruction, 2 were converted to GB and one had a band revision. Five bands of our 85 were removed for infection (6%). Two were infected peri-operatively (1 skin and 1 bowel flora), 1 eroded, and two developed infections years after band placement. One band was replaced with resolution of infection, and four had conversion to GB. All three patients who underwent band removal regained their weight. Conversion to GB or band replacement for obstruction resulted in maintenance or improvement of weight loss. Eight of the 10 converted to GB for inadequate weight loss, subsequently lost weight. One died of a pulmonary embolus. Other major complications included 3 strictures requiring post-operative dilations, 2 wound infections, and 4 patients developed severe depression after conversion to GB. One patient's stricture was treated with glucocorticoids, and developed a severe but reversible neuropathy. Two of the obstructed patients had megaesophagus that resolved with conversion to GB. A laparoscopic approach was used to convert four of these patients to GB, for 1 band replacement, and for all simple removals.
CONCLUSIONS: After gastric banding one-third of the patients required revision, a higher rate than that reported outside the U.S. Conversion to gastric bypass was influenced by insurance coverage and surgeon experience. Outcomes were generally favorable but major complications including death occurred. As experience accumulates, more conversions can be completed laparoscopically. A cost-effective analysis will be required to determine whether this initially less invasive approach is as effective as GB in the U.S.
