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.
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.
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.
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.
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.
From a cohort of 2986 patients who underwent laparoscopic adjustable gastric banding over a 15-year period, we identified 85 patients who experienced intraluminal erosion of the prosthesis. We describe the changing prevalence, clinical presentation, management, and the effect of the erosion on weight-loss outcomes.
*Centre for Obesity Research and Education
†Department of Surgery, Monash University, Commercial Road, Melbourne, Australia
‡Weil Cornell Medical School, New York Methodist Hospital, Brooklyn, NY.
Reprints: Wendy A. Brown, MBBS(Hons), PhD, FRACS, FACS, Centre for Obesity Research and Education, Monash University, L6, 99 Commercial Road, Melbourne 3004, Australia. E-mail: Wendy.Brown@monash.edu.
Disclosure: The Centre for Obesity Research and Education (CORE) at Monash University receives a grant from Allergan for research support. The grant is not tied to any specified research projects and Allergan has no control of the protocol, analysis, and reporting of any studies. CORE also receives a grant from Applied Medical toward educational programs. W.A.B. received an Honorarium from Allergan to attend a Surgical Advisory Panel in London in 2009. P.E.O. has written a patient information book titled “The Lap-Band Solution: A Partnership for Weight Loss”: some are given to patients without charge, some are sold to surgeons, and for others he receives a royalty. He is employed as the National Medical Director for the American Institute of Gastric Banding, a multicenter facility, based in Dallas, Texas, that treats obesity predominantly by gastric banding.