Does pregnancy increase the need for revisional surgery after laparoscopic adjustable gastric banding?
BACKGROUND
Over 80% of laparoscopic adjustable gastric banding (LAGB) patients are women, and approximately half of these are of reproductive age; therefore, pregnancy post-LAGB is common. It is not known if pregnancy increases the need for revisional procedures. We compare the incidence of revisions in two matched cohorts of LAGB patients, with or without subsequent pregnancy.


METHODS
From September 1994 to May 2009, 5,467 patients underwent LAGB at the Centre for Bariatric Surgery, Australia. Women with births post-LAGB were matched to controls, with a "matched follow-up date" calculated equivalent to pregnancy. Rates of primary and overall revisions for band-related (erosions and proximal pouch dilatations) and port/tubing complications were compared for cases and controls at 2 and 3 years post-pregnancy.


RESULTS
One hundred eighty-nine women had ≥1 pregnancies post-LAGB, including 137 with follow-up at 2 years and 104 at 3 years post-pregnancy. There was no significant difference in band or port/tubing revisions between groups at either time point: 16.8% vs 10.5% (p = 0.13) and 23.9% vs 14.6% (p = 0.09) for primary band revisions, and 5.8% vs 5.3% (p = 0.84) and 10.5% vs 6.6% (p = 0.35) for primary port/tubing revisions at 2 and 3 years, respectively. Percentage excess weight loss (%EWL) 3 years post-pregnancy was similar (47.9% vs 47.7%). Pregnancy LAGB management was not found to affect revisions; however, less time between LAGB and pregnancy was associated with a higher rate of primary band revisions (p = 0.03).


CONCLUSIONS
These data suggest that pregnancy post-LAGB does not affect revision rate or %EWL; however, a shorter time between LAGB operation and pregnancy may predispose to band revisions.
Haward
Rebecca N
RN
The Centre for Obesity Research and Education (CORE), Monash University Medical School, The Alfred Hospital, Melbourne, Australia. rhaward@gmail.com
Brown
Wendy A
WA
O'Brien
Paul E
PE
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D015391:Gastroplasty / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D015431:Weight Loss; D055815:Young Adult