Large series examining laparoscopic adjustable gastric banding as a salvage solution for failed gastric bypass.

BACKGROUND: The Roux-en-Y gastric bypass (RYGB) has long been considered the gold standard of weight loss procedures. However, there is limited evidence on revisional options with both minimal risk and long-term weight loss results. OBJECTIVE: To examine percent excess weight loss, change in body mass index (BMI), and complications in patients who underwent laparoscopic adjustable gastric banding (LAGB) over prior RYGB. SETTING: Academic hospital. METHODS: Retrospective analysis of a single-center prospectively maintained database. Three thousand ninety-four LAGB placements were reviewed; 139 were placed in patients with prior RYGB. RESULTS: At the time of LAGB, the median BMI was 41.3. After LAGB, we observed weight loss or stabilization in 135 patients (97%). The median maximal weight loss after LAGB was 37.7% excess weight loss and -7.1 change in BMI (P < .0001). At last follow-up visit, the median weight loss was 27.5% excess weight loss and -5.3 change in BMI (P < .0001). Median follow-up was 2.48 years (.01-11.48): 68 of 132 eligible (52%) with 3-year follow-up, 12 of 26 eligible (44%) with 6-year eligible follow-up, and 3 of 3 eligible (100%) with >10-year follow-up. Eleven bands required removal, 4 for erosion, 4 for dysphagia, and 3 for nonband-related issues. CONCLUSIONS: LAGB over prior RYGB is a safe operation, which reduces the surgical risks and nutritional deficiencies often seen in other accepted revisional operations. Complication rates were consistent with primary LAGB. Weight loss is both reliable and lasting, and it can be considered as the initial salvage procedure in patients with failed gastric bypass surgery.

Single-incision laparoscopic adjustable gastric banding is effective and safe: 756 cases in an academic medical center.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) is safe and effective. This less invasive option involving fewer incisions and umbilical approaches is coined as single-incision laparoscopic surgery (SILS). Over the last 3 years, we performed 46 % of our LAGBs as SILS with excellent results. METHODS: This is a retrospective review of 1,644 LAGBs performed between 2008 and 2010. A total of 756 were performed as SILS bands (46 %) and 888 as standard (non-SILS) (54 %). Data points compared include operative time, percent of excess weight loss at 1 and 2 years, complication, and re-operation rates. RESULTS: Groups were matched by age, initial BMI, and gender: 584 non-SILS and 710 SILS patients. The average operating time was 44.3 ± 19.6 min for SILS and 51.1 ± 19.4 min for non-SILS (p < 0.001). The 12-month percent excess weight loss (%EWL) for SILS was 45.0 ± 19.1; it was 40.7 ± 17.5 for non-SILS (p = 0.003). The 24 month %EWL for SILS was 54.4 ± 16.3; it was 46.4 ± 16.1 for non-SILS (p = 0.10). Complication rates were 5.6 % (40 of 710) for SILS and 4.5 % (26 of 584) for non-SILS (p = 0.34). The 30-day readmission/re-operation rates are 1 % (seven of 710) for SILS and 1.5 % (nine of 584) for non-SILS (p = 0.37). There was one death in the SILS group. CONCLUSIONS: We have been performing more SILS bands over time. Our operative times and weight loss figures show that it is an efficient and effective means of weight loss. Furthermore, the data also show that the SILS approach is safe and does not increase operative time. In conclusion, SILS laparoscopic adjustable gastric banding is a safe and effective means of attaining weight loss in selected patients.