Feasibility and technique of laparoscopic conversion of adjustable gastric banding to sleeve gastrectomy.
BACKGROUND
To evaluate the feasibility, safety, and short-term efficacy of the conversion of laparoscopic adjustable gastric banding (LAGB) to laparoscopic sleeve gastrectomy (LSG) because of inadequate weight loss.


METHODS
The inclusion criteria were an inadequate percentage of excess weight loss (%EWL), defined as <30% at > or =1 year after LAGB. From August 2002 to October 2007, 27 patients (17 women and 10 men) had undergone removal of their LAGB and conversion to LSG. The average age at LSG was 43.6 +/- 11.4 years (range 25-66). Before LAGB, the mean weight and body mass index was 129.8 +/- 21.9 kg (range 95-178) and 45 +/- 8.1 kg/m(2) (range 35-64), respectively. The average interval between LAGB and LSG was 51.2 +/- 30.1 months (range 22-132). Before conversion, the mean weight, body mass index, and %EWL was 117.9 +/- 27.3 kg (range 63-170), 39 +/- 9.6 kg/m2 (range 24-61), and 18.1% +/- 18.3%, respectively. Of the 27 patients, 12 had 19 obesity-related co-morbidities, including arterial hypertension in 7, type 2 diabetes mellitus in 2, degenerative joint disease in 7, and sleep apnea in 3.


RESULTS
The mean operative time was 120.6 +/- 32.4 minutes (range 65-195). No conversion to open surgery was required, and no patient died. The postoperative complications included a subphrenic hematoma that required laparoscopic drainage; no postoperative leaks developed. The mean hospital stay was 3.2 +/- 1.4 days (range 2-8). After a mean follow-up of 18.6 +/- 14.8 months (range 1-59) for 23 patients (4 patients were lost to follow-up), the mean weight, body mass index, and weight loss was 100.7 +/- 23.5 kg (range 61-152), 34.6 +/- 8.7 kg/m2 (range 21-50.4), and 23 +/- 12.4 kg (range 2-55), respectively. The patients had had an additional 16.7% EWL after LSG for a total average %EWL of 34.8% +/- 21.8% (P <.05). Of the 12 patients with obesity-related co-morbidities, 5 had had resolution, including arterial hypertension in 1, type 2 diabetes mellitus in 1, degenerative joint disease in 2, and sleep apnea in 2.


CONCLUSIONS
The results of this study support the safety of LSG in the case of an inadequate %EWL after LAGB. However, the degree of weight loss and co-morbidity resolution is of concern.
Dapri
Giovanni
G
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium. giovanni@dapri.net
Cadière
Guy Bernard
GB
Himpens
Jacques
J
D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications; D016896:Treatment Outcome