Swedish adjustable gastric band (SAGB)-distal gastric bypass: A new variant of an old technique in the treatment of superobesity and failed band restriction

Background: Dissatisfied with vertical banded gastroplasty in superobese patients, the authors adopted Salmon's gastroplasty/distal gastric bypass (DGBP) in 1995. When the Swedish adjustable gastric band (SAGB) became available in Switzerland, the authors started using that device instead of the gastroplasty because implanting a SAGE is much easier and gastric restriction with a SAGE is adjustable to the patients' individual demands. Methods: The authors evaluated 40 consecutive patients with SAGB-DGBP (27 primary and 13 secondary operations) for weight loss and complications, and compared weight loss with that obtained by SAGE alone. The mean initial body weight was 156.6 kg in women and 188.1 kg in men for primary and 108.2 kg/147.0 kg for secondary indications, respectively. The band was placed in a high position without tunneling sutures, and DGBP was done with a 50- to 60-cm common channel and a 60- to 80-cm biliopancreatic limb. Results: Weight loss at 1 year was 33.3% of initial body weight for primary operations. Weight loss was significantly more than with SAGE-alone cases. Complications were as follows: no death, no slipping or pouch dilatation; one marginal ulcer, one splenectomy, four cholecystectomies, one Roux-en-O reconstruction, two band leaks, eight port-related reoperations. iron or vitamin deficiencies occurred in 75% of patients, with one case of transient protein malnutrition and one of intermittent diarrhea. Conclusions: The SAGE as gastric restriction in combination with DGBP can be implanted easily. The new-generation SAGE is safe, but longer follow-up is necessary. SAGB-DGBP is more efficient than SAGE alone for weight reduction. It is too early to recommend banded DGBP as a primary procedure. However, in cases of insufficient weight loss after placement of an adjustable band, adding a DGBP without removing the band is an option. Follow-up by a specialized team is mandatory.