Reasons and outcomes of laparoscopic revisional surgery after laparoscopic adjustable gastric banding for morbid obesity.
BACKGROUND
Laparoscopic adjustable gastric banding (LAGB) is a purely restrictive procedure that has been proved to be an effective tool in achieving weight loss. The low operative morbidity and reversibility are often seen as advantages of this procedure compared with other bariatric approaches. We have attempted to define the reasons for revisional surgery after LAGB and the outcomes.


METHODS
A retrospective review of a prospectively maintained database was performed from February 2001 to October 2008 at a center of excellence after institutional review board approval. The patients who had undergone revisional surgery after primary LAGB were evaluated.


RESULTS
Of 343 patients who had undergone primary LAGB, 60 subsequently underwent a revisional procedure. In addition, 28 revisional procedures were performed on patients who had undergone primary LAGB at an outside institution. These procedures included 39 (44.3%) band removals alone, 12 (13.6%) band removals with conversion to sleeve gastrectomy, 13 (14.8%) band removals with conversion to Roux-en-Y gastric bypass, 9 (10.2%) band repositioning, and 2 (2.3%) band replacements. In addition, 13 (14.8%) port-related procedures (3 relocations, 6 reconnections, and 4 replacements/removals) were performed.


CONCLUSIONS
Although reversible and efficacious, LAGB appears to have a high incidence of complications requiring revisional surgery and/or band removal. The results of our study have shown that laparoscopic revisional surgery after primary LAGB is safe and can be performed with minimal morbidity.
Patel
Sheetal
S
Section of Minimally Invasive Surgery, Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida, USA.
Eckstein
Jeremy
J
Acholonu
Emeka
E
Abu-Jaish
Wasef
W
Szomstein
Samuel
S
Rosenthal
Raul J
RJ
D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors