title: Short-term morbidity associated with removal and revision of the laparoscopic adjustable gastric band.
abstract: BACKGROUND
  Laparoscopic adjustable gastric band (LAGB) insertion is a commonly performed bariatric procedure with low associated short-term risk. Given that a significant number of patients will require additional revision/removal procedures, overall morbidity may be underestimated. The objective of this study was to define the 30-day morbidity associated with LAGB removal and revision procedures.
  
  
  METHODS
  Patients undergoing revision or removal of LAGB were identified within The American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) participant use file using current procedural terminology and ICD-9 coding. Patients having concurrent procedures were excluded. Primary outcomes included 30-day morbidity. The rate of complications in the removal/revision patients versus primary LAGB insertion was compared. We also analyzed trends over time.
  
  
  RESULTS
  A total of 3,236 patients underwent LAGB removal (n = 1,580), revision (n = 1,111) or port site revision (n = 545) from 2006-2011. The overall 30-day complication rate was 5.6% (95% confidence interval [CI]: 4.8%, 6.4%) and was higher in patients undergoing LAGB removal with a 6.8% (95% CI: 5.6%, 8.1%) adverse event rate (2.5% infectious, 2.3% wound, 2.4% reoperation). A total of 24,438 patients underwent primary LAGB insertion within the data set with a 30-day complication rate of 2.6% (95% CI: 2.4%, 2.8%). Patients undergoing LABG removal had a significantly higher complication rate than those having primary LAGB insertion with an odds ratio of 2.72 (95% CI: 2.18, 3.37). The proportion of LAGB revision/removal compared to primary placement increased annually over the study period (P for trend<.001).
  
  
  CONCLUSIONS
  The 30-day morbidity associated with LAGB revision is significant and higher than that associated with primary LAGB insertions. The potential need for future procedures and the associated additional morbidity should be considered when evaluating LAGB as a treatment option for morbid obesity.
authors.affiliation: Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada. Electronic address: Timothy.Jackson@uhn.ca.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Jackson
authors.affiliation: Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada.
authors.forename: Fady
authors.initials: F
authors.lastname: Saleh
authors.affiliation: Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada.
authors.forename: Fayez A
authors.initials: FA
authors.lastname: Quereshy
authors.affiliation: Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sockalingam
authors.affiliation: Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Urbach
authors.affiliation: Division of General Surgery, University Health Network, Toronto, Ontario, Canada; Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Ontario, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Okrainec
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D016208:Databases, Factual; D020878:Device Removal / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D009864:Ontario; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: ACS-NSQIP; Laparoscopic adjustable gastric band; Revisional bariatric surgery; Surgical outcomes