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.
Dargent
Jérôme
J
Polyclinique de Rillieux, Rillieux-la-Pape, France. jerome.dargent@polyclinique-rillieux.fr
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