Management of failed adjustable gastric banding

Background. About 100, 000 adjustable gastric band placements have been performed worldwide, but more than 10 % of patients have needed reoperation for insufficient weight loss or device-related complications. This study investigates the complications following gastric banding, and the outcome using a structured management strategy. Methods. In the period April 1996 to january 2002, 824 severely obese patients (body mass index 43 +/- 1 kg/m(2) [mean +/- standard error under the mean], age 43 +/- 1 years, 77 % women) underwent gastric banding in a single institution and were followed prospectively. Complications, insufficient weight loss, and subsequent management were analyzed. Results. By the fifth treatment year, excess weight loss (EWL) was 54.8 +/- 1.7 %; 72.8 % of patients lost weight continuously or attained EWL of at least 50 %. Insufficient weight loss occurred in 143 patients, and band-related complications occurred in 131 patients, with a mean annual rate of 5.0 %. Major reoperation was necessary in 121 patients, and the annual reoperation rate was 4.7 %. Following major reoperation, band- and bypass-related complication rates ranged from 6.3 % to 11.7 % per year. Three deaths occurred, 1 after reoperation and 2 due to preexisting cardiovascular disease. Conclusions. Applying a structured reoperation algorithm, 5 % annual failure after banding was corrected in most patients, and 72.8 % of patients attained sufficient weight loss. Reoperation-related mortality was low (.8 %), and its annual morbidity was acceptable (4.6 %).