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Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure

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Abstract

Background

Laparoscopic adjustable gastric banding (LAGB) is an effective bariatric procedure with low morbidity and mortality. Unfortunately, it is fraught with high failure rates in long-term follow-up. Laparoscopic sleeve gastrectomy (LSG) is an emerging procedure, quickly gaining momentum in the arsenal of bariatric practice as a first step toward gastric bypass/biliopancreatic diversion or as a stand-alone operation. Recently, it has been described as a revisional option for previous bariatric surgery failures. We report our early experience with LSG as a revisional procedure for failed LAGB.

Methods

From January 2007 to April 2010, 46 patients, who had undergone LAGB, underwent LSG. Patient demographics, reason for band removal, interval between removal and LSG, operative times, estimated blood loss, complications, length of hospital stay, and percent of excess weight loss were collected.

Results

Of the 46 patients, 20 (43%) had their bands removed before LSG (median time interval, 2 years; range, 2 months to 9 years); the rest had concomitant band removal and LSG. Twelve patients were men (26%). Mean age and BMI were 40 (range, 20–60) years and 43.1 kg/m2 (range, 33–57), respectively. In two cases, surgery was converted to an open procedure due to extensive adhesions related to previous surgeries. Median operative time, estimated blood loss, and length of hospital stay were 118 (range, 70–250) minutes, 41 (range, 5–600) ml, and 3 (range, 1–100) days, respectively. Major morbidity was encountered in three patients (6%; leak in 2 and bleeding in 1). There were no mortalities. Mean follow-up time for our cohort is 17 (range, 1–39) months. Percent of excess weight loss at 2, 6, 12, 24, and 36 months was 24, 37, 53, 51, and 48%, respectively.

Conclusions

Our results suggest that LSG is safe, feasible, and effective as a revisional procedure for failed LAGB and can be considered as an appealing option in these cases. Larger series and longer follow-up are needed to confirm this.

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Disclosures

Drs. David Goitein, Anya Feigin, Gabriella Segal-Lieberman, Orly Goitein, Moshe Papa, and Dov Zippel have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery C, Chaim Sheba Medical Center, 56261, Tel Hashomer, Israel

    David Goitein, Anya Feigin, Moshe Zvi Papa & Dov Zippel

  2. Institute of Endocrinology, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Gabriella Segal-Lieberman

  3. Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel

    Orly Goitein

Authors
  1. David Goitein
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  2. Anya Feigin
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  3. Gabriella Segal-Lieberman
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  4. Orly Goitein
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  5. Moshe Zvi Papa
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  6. Dov Zippel
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Correspondence to David Goitein.

Additional information

Presented at the 18th EAES Congress, June 16–19, 2010, Geneva, Switzerland.

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Goitein, D., Feigin, A., Segal-Lieberman, G. et al. Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure. Surg Endosc 25, 2626–2630 (2011). https://doi.org/10.1007/s00464-011-1615-3

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  • DOI: https://doi.org/10.1007/s00464-011-1615-3

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