Surgical treatment of morbid obesity by adjustable gastric band: the case for a conservative strategy in the case of failure - a 9-year series.
BACKGROUND
Lapaparoscopic adjustable gastric banding (LAGB) has become a widespread method to treat morbid obesity. Long-term complications and failures require a strategy for reoperation.


METHODS
1,180 patients have been operated on from April 1995 to December 2003. 151 had reoperation for complications (12.7%) excluding access-port problems: slippage (105), erosion (22), intolerance (24). 67 patients (5.6%) had their band removed; only 5 had a switch to another procedure. Esophageal dilatation and insufficient excess weight loss (<25%) after 5 years (13.7%) should also be addressed. Two situations are described: 1) Band in place: anterior slip, dilatation, isolated insufficient weight loss. 2) Band to be removed: posterior slip, severe anterior slip (acute, with necrosis or perforation), erosion, intolerance. Four options are recognized: 1) Conservation (adjustment management) or surgical correction (anterior slip). 2) Placement of a new band: for failure of the device, accidental removal (slippage in difficult conditions), and erosion after a delay. 3) RYGBP or BPD in selected cases only. 4) Other procedures.


CONCLUSIONS
1) A new band can be placed if there has been a technical problem. 2) Weight control is possible, including in the case of esophageal dilatation. Reoperation for insufficient weight loss without a technical problem is not an option. Failures of VBG cannot be fairly compared with Lap-Band (R) failures because of adjustability. 3) Reoperation is not often demanded. For failure after LAGB, the future should involve less invasive bariatric procedures and nonsurgical approaches.
Polyclinique de Rillieux, Rillieux-la-Pape, France. jerome.dargent@polyclinique-rillieux.fr
Jérôme
J
Dargent
D000293:Adolescent; D000328:Adult; D000368:Aged; D020878:Device Removal; D004108:Dilatation, Pathologic / Q000209:etiology; D004947:Esophagus / Q000473:pathology; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation; D017211:Treatment Failure; D015431:Weight Loss