Annals of Surgery

Skip Navigation LinksHome > June 2013 - Volume 257 - Issue 6 > Erosions After Laparoscopic Adjustable Gastric Banding: Diag...
Annals of Surgery:
doi: 10.1097/SLA.0b013e31826bc21b
Original Articles

Erosions After Laparoscopic Adjustable Gastric Banding: Diagnosis and Management

Brown, Wendy A. MBBS(Hons), PhD, FRACS, FACS*,†; Egberts, Kristine J. BBiomedSci(Hons), GradDipEBM*; Franke-Richard, Danielle BSci (Psych)*; Thodiyil, Paul MD*,‡; Anderson, Margaret L. BHIM, GradDip HA*; O'Brien, Paul E. MD, FRACS*

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Abstract

Objective: To define the changing prevalence of erosion after Laparoscopic Adjustable Gastric Banding (LAGB), describing the range of clinical presentations, the approaches to treatment and the outcomes from these approaches over a 15-year study period.

Background: A recent systematic review of the literature of erosion after LAGB identified 25 relevant studies and reported a total of 231 erosions in 15,775 patients giving an overall incidence of 1.46%. The review highlighted a broad variation of incidence from 0.2% to 33%. The review was unable to identify either common presentations or an optimal pattern of management.

Methods: Patients who underwent a primary LAGB operation between September 1994 and January 2010 by 2 surgeons (P.O.B. and W.B.) were identified in a prospectively maintained database. Those patients who had an erosion of their LAGB were identified. Presentation, operative details, demographics, body mass index, weight history, and perioperative problems were analyzed.

Results: In total, 2986 patients were identified. All bands placed were Lap-Bands (Allergan, CA). Hundred erosions were experienced by 85 patients (2.85%) at a median time of 33 months from initial surgery to the erosion (range: 11–170 months). The rate of erosion was highest when the band was placed by the perigastric approach at 6.77%. Since the adoption of the pars flaccida approach, the rate of erosion has dropped to 1.07%. The majority of patients who had experienced an erosion (71 patients; 83.5%) experienced only 1 erosion, 13 patients (15.3%) had 2 erosions, and 1 patient had 3 erosions. The most common presentation was loss of satiety. The band has been successfully replaced in 56 patients. It has been explanted in 27 patients and 2 patients were converted to other bariatric procedures. The weight loss in patients who had a LAGB reinserted after erosion was not significantly different to the background cohort.

Conclusions: Erosion of LAGB is uncommon and its clinical course is benign. It is best treated with a staged surgical approach; initially, with removal and repair followed later by replacement. With this approach, weight loss is maintained and reerosion is uncommon.

© 2013 Lippincott Williams & Wilkins, Inc.

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