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Sustained Weight Loss After Gastric Banding Revision for Pouch-Related Problems

Beitner, Melissa M. MBBS*,†; Ren-Fielding, Christine J. MD; Kurian, Marina S. MD; Schwack, Bradley F. MD; Skandarajah, Anita R. MD*; Thomson, Benjamin N. DMedSc*; Baxter, Andrew R. MD; Pachter, H. Leon MD; Fielding, George A. MD

doi: 10.1097/SLA.0000000000000327
Original Articles

Objective: To assess the impact of revisional surgery after laparoscopic adjustable gastric banding (LAGB) on weight loss at 12 and 24 months.

Background: There is no uniform consensus as to the optimal procedure for patients requiring revision after LAGB. Few studies address the issue of weight loss after band salvage procedures, despite this being a critical factor in deciding which reoperative procedure to choose.

Methods: A retrospective analysis was conducted of adult patients who underwent LAGB from January 1, 2001 to June 30, 2009 at a single institution. Patients who required revision for pouch-related problems including band slippage, pouch dilation, and hiatal hernia were studied. Demographic data, body mass index (BMI), percentage excess weight loss (% EWL), and operative details were recorded. Weights were recorded at 12 and 24 months after revision. These were compared with initial weight, weight before revision, and weight in patients who did not have a reoperation.

Results: Of 3876 patients, 390 patients were included in analysis of weight outcomes after revision. The procedure-related mortality was 0%. Early (30-day) complications occurred in 0.5%, late complications (erosion) in 0.5%, and 29 patients (7.4%) required a second revision. For patients undergoing revision, the initial weight was 124.06 ± 21.28 kg and BMI was 44.80 ± 6.12 kg/m2. At reoperation, weight was 89.18 ± 20.51 kg, BMI was 32.25 ± 6.50 kg/m2 and, %EWL was 54.13 ± 21.80%. Twelve months postrevision, weight was 92.24 ± 20.22 kg, BMI was 33.32 ± 6.41 kg/m2, and %EWL was 48.81 ± 22.71%. Weight was 92.42 ± 19.91 kg, BMI was 33.53 ± 6.25 kg/m2, and %EWL was 47.50 ± 22.91% twenty-four months postrevision.

Conclusions: Reoperation for pouch-related problems after LAGB is safe and effective. Weight loss is maintained after reoperation.

This study assesses weight loss after revisional surgery for pouch-related problems after laparoscopic adjustable gastric banding. Our results show that band revision can be performed safely and effectively. Weight loss is sustained after revision for pouch-related problems.

*The University of Melbourne, Victoria, Australia

New York University School of Medicine, New York, USA.

Reprints: Melissa M. Beitner, MBBS, NYU Langone Medical Center, 530 First Ave, 10S, New York NY 10016. E-mail: melissa.beitner@nyumc.org.

Disclosure: Dr. Fielding currently receives payment from Allergan, Inc. for lectures unrelated to this study. He has previously acted as a consultant for Allergan, Inc. and has appeared on a TV commercial for the Allergan, Inc. LAP-BAND®. Dr. Ren-Fielding is a current board member and consultant for Allergan, Inc. She holds a grant from Allergan, Inc. for unrelated work and receives funding for lectures and meeting expenses. She has previously been a board member for ExploraMed and consultant for CAVU Medical, Inc. Dr. Kurian has previously received an honorarium from Allergan, Inc, for teaching unrelated to this study. Dr. Schwack receives an honorarium from Allergan, Inc, unrelated to this study. and has previously received funding for travel expenses from Allergan, Inc. and Ethicon Endo-Surgery, Inc. Thomson currently receives payment from Novartis Oncology for lectures unrelated to this study and has previously received funding for meeting expenses from Novartis Oncology. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.