Revisional surgery after failed laparoscopic adjustable gastric banding

Background: Laparoscopic adjustable gastric banding (LAGB) is a restrictive procedure that achieves weight loss without anatomic alteration. However, morbidity requiring surgical reintervention can occur. Methods: A retrospective review of a prospectively maintained database of primary LAGB and revisional Surgery after failed LAGB was performed from January 2001 to October 2006 at an academic private clinic. Results: Of 2467 bariatric procedures, primary LAGB was performed in 242 patients. A total of 53 revisional procedures were performed in 40 patients and 16 in 9 patients who were referred from other centers after failed primary LAGB. The mean follow-up was 45.7 +/- 15.8 months (range 9.5-70). The early Surgical reintervention rate was 6.1%. The revisional procedures included band removal only in 27 (39%), band removal and conversion to sleeve gastrectomy in 10 (14.5%), band removal and conversion to Roux-en-Y gastric bypass in 5 (7.2%), band repositioning in 7 (10%), device-related reintervention in 6 (8.7%), subsequent conversion to another bariatric procedure in 3 (4.3%), and other procedures in 11 (15.9%). Of the 49 patients, 21 (43%) presented with acute band-related morbidity. A total of 55 procedures (96.5%). amenable to minimal invasive surgery, excluding wound and port site-related procedures, were completed laparoscopically. The major early and late complication rate was 4.1% and 2%, respectively. Conclusion: Primary LAGB was associated with acceptable major early complication and surgical reintervention rates. However, a late surgical reintervention rate of 15.2% was observed. Band removal was required in 14% of our primary LAGB patients because of band-related morbidity, with conversion to another bariatric procedure in 6.2%. Our results have shown that LAGB can be associated with significant morbidity and that revisional surgery is common. (Surg Obes Relat Dis 2008;4: 740-747.) 0 2008 American Society for Metabolic and Bariatric Surgery. All rights reserved.