Back to Annual Meeting Posters

Background:
Laparoscopic adjustable gastric banding (LAGB) is known to have a considerable revisional surgery rate, reported from 10% to 40+%. Mechanical complications such as band slip, esophageal dilation or development of a hiatal hernia can lead to symptoms of GERD, dysphagia, and epigastric pain; weight loss failure/regain are also prevalent factors that lead patients to seek surgical revision. Weight loss data for conversion to sleeve gastrectomy is sparse. We present our initial series of patients who have undergone revision from LAGB to laparoscopic sleeve gastrectomy (LSG).
Methods:
A prospectively maintained clinical database was reviewed retrospectively. Data were reviewed for the period August 2010 to August 2012. Data collected included indication for revision, and degree of weight reduction. Indications for revision included slipped LAGB, epigastric pain, dysphagia, GERD, emesis, and weight loss failure or weight regain. All candidates met NIH criteria for bariatric surgery. Patients underwent laparoscopic gastric band removal and conversion to sleeve gastrectomy either in one or two stages. Operative technique was similar in all cases.
Results:
Twenty patients (17 female, 3 male) underwent revision from LAGB to LSG between August 2010 to August 2012 by two surgeons (MB and BS). A one-stage procedure was done in 14 patients (70%), while two-stage procedure was done in 6 patients (30%). Mean preoperative weight and BMI before the original LAGB placement were 281.7 (220-373) lb and 46.70 (39.01-56.57) kg/m2, respectively. Mean weight, BMI and % excess weight loss (%EWL) at the nadir of the LAGB were 220.77 (156-322) lb, 37.33 (30.63-51.75) kg/m2, and 43.55% (13.95-66.60) respectively. The average interval between LAGB placement and LSG was 4.79 (1.74-7.71) years. Mean preoperative weight and BMI before conversion to LSG were 261.3 (197-360) lb and 42.62 (35.07-54.96) kg/m2, respectively. Mean %EWL was 21.41%, 31.82%, and 39.02% at 3, 6, and 12 months, respectively. Data was available for 9, 14, and 15 patients at the 3, 6, and 12 month time points, respectively. There were no mortalities.
Discussion:
Our data indicates that revisional surgery from LAGB to LSG at one year averages 39.02% EWL (range 0% to 70.92%). Published data for primary LSG have shown results of approximately 60% EWL (ranges reported approximately 30% to 80%) at one year. Our preliminary data suggests that weight loss after conversion from LAGB to LSG may not result in weight loss equivalent to primary LSG. This relatively small number of patients does not allow comment as to the etiology of the relatively poor weight loss seen here, although factors such as nadir weight loss achieved with the band, interval between banding and sleeve (one or two stage), preoperative LSG weight, or others, may provide insight as more data becomes available.