Conversion of Adjustable Gastric Banding to Adjustable Banded Roux-en-Y Gastric Bypass: Should We Leave the Band in Place?

Frederik P. D. M. Lecot*, Evert-Jan G. Boerma, Rochelle Sigterman-Nelissen, Berry Meesters, Sofie Fransen, Jan Willem Greve

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Web of Science)

Abstract

Objective Laparoscopic adjustable gastric banding (LAGB) is rapidly becoming a deprecated bariatric procedure due to disappointing weight loss results and a high rate of band intolerance. Conversion to Roux-en-Y gastric bypass is a common revisional procedure after failed LAGB. The aim of this study was to evaluate the feasibility, safety, and risk profile of conversion to adjustable banded Roux-en-Y gastric bypass (ABRYGB).

Methods A retrospective patient file review of all consecutive laparoscopic conversions of LAGB to ABRYGB 2008-2017. Pre/perioperative data, weight change, and long-/short-term complications were retrieved.

Results Study population 98 patients. Mean BMI before revision was 40,15 kg/m(2). Most revisional procedures were performed for band intolerance and/or weight regain or weight loss failure. All procedures were performed laparoscopically. During follow-up, 16 bands had to be removed due to one of the following reasons: infection, anastomotic leakage, anastomotic peptic perforation, adhesions around the anastomosis, internal hernia around the tubing, adhesions to the tubing, tubing failure, and erosion of the band. Three of those bands were replaced with a non-adjustable Silastic (Minimizer) ring. In total, issues with tubing requiring an intervention were found in 20 patients after conversion to ABRYGB. Seven revisional procedures had to be performed for symptomatic internal hernias not related to the tubing and incidental internal hernias were found in another 7 procedures.

Conclusion Although conversion of LAGB to ABRYGB is technically feasible, initially well-tolerated, and has good weight loss results, the number of additional procedures during follow-up is rather high, suggesting that leaving the band in place should not be advised.

Original languageEnglish
Pages (from-to)3912-3918
Number of pages7
JournalObesity Surgery
Volume29
Issue number12
DOIs
Publication statusPublished - Dec 2019

Keywords

  • Obesity
  • Metabolic surgery
  • Bariatric surgery
  • Revisional surgery
  • Banded procedures
  • Gastric bypass
  • Gastric banding
  • WEIGHT-LOSS FAILURE
  • LONG-TERM OUTCOMES
  • FOLLOW-UP
  • METAANALYSIS
  • SURGERY

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