Can the Long-Term Complications of Adjustable Gastric Banding Be Overcome? Preliminary Results of Adding Gastric Plication in Patients with Impending Gastric Band Failure.
BACKGROUND
A small percentage of patients fitted with a gastric band still experience "failure." Here, the authors demonstrate the safety and feasibility of band preserving-laparoscopic gastric plication (BP-LGP), which was designed to improve weight loss and decrease gastric band adjustment frequency and thereby improve patient quality of life.


METHODS
All 6 patients involved in this study had a gastric band in place for more than 1 year; the median interval from gastric banding to BP-LGP was 31.7 months (range, 19.7-49.9 months). Five (83.3%) patients were female. Preoperative median body mass index (BMI) at gastric banding was 35.4 kg/m(2) (range, 31.9-43.9 kg/m(2)), median nadir BMI with the gastric band was 25.7 kg/m(2) (range, 20.9-31.0 kg/m(2)), and percentage excess BMI loss (%EBMIL) ranged from 24.3% to 123.6%. Indications for BP-LGP were as follows: chronic gastric prolapse in 2 patients (33.3%), pouch-esophageal dilatation in 3 (50.0%), and insufficient weight loss in 4 (66.6%), which included 2 patients with weight loss failure (%EBMIL of <30%).


RESULTS
The 6 patients consecutively underwent surgery from May 2014 to January 2015. No conversion to open surgery was necessary, and no perioperative complication or mortality occurred. Mean operative time was 190 minutes. All patients showed weight loss after revision and showed resolution of troublesome signs and symptoms. Median follow-up after revision was 7.3 months (range, 5.7-10.1 months), median BMI at last follow-up was 27.6 kg/m(2) (range, 22.7-34.0 kg/m(2)), and median %EBMIL was 75.7% (range, 21.0%-103.6%). Median fill volume before revision was 6.1 mL (range, 2.7-11.0 mL), and median fill volume after revision was 0.3 mL (range, 0.0-5.3 mL). Three patients (50%) had an empty band at last follow-up.


CONCLUSIONS
This novel method of bariatric revision (modified BP-LGP) might have a role as a salvage procedure in patients with impending gastric band failure.
Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science , Incheon, Republic of Korea.
Su Bin
SB
Kim
Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science , Incheon, Republic of Korea.
Seong Min
SM
Kim
D000328:Adult; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery*; D011788:Quality of Life; D012086:Reoperation; D016879:Salvage Therapy; D015431:Weight Loss; D055815:Young Adult