Laparoscopic Removal of Eroded Non-Adjustable Gastric Band and Conversion to Roux-en-Y Gastric Bypass.

This video shows the case of a 64-year-old morbidly obese woman, with a non-adjustable gastric band, who consulted for weight regain and gastroesophageal reflux disease (GERD) symptoms and was converted to Roux-en-Y gastric bypass (RYGB). The operative technique included extensive lysis of adhesions, complete band dissection, partial gastrectomy of the fundus and body due to band erosion and conversion to RYGB.

Clinical management of patients presenting with non-adjustable gastric band (NAGB) complications.

BACKGROUND: A number of bariatric surgical procedures have been developed to manage morbid obesity and related co-morbidities. The non-adjustable gastric band (NAGB) was one such procedure that created restriction to food intake by gastric segmentation. Benefits of the procedure included a low risk of perioperative complications and substantial early weight loss. Unfortunately, the long term results of NAGB include a high incidence of complications and failure to maintain weight loss. The purpose of this study was to examine the presentation, workup, and treatment of patients presenting with complications following NAGB placement. METHODS: A retrospective review of the diagnosis and management of 11 patients who presented with complications related to NAGB placement. RESULTS: All patients presented with some degree of proximal gastric outlet obstruction. The majority of patients (8/11) presented with vomiting as the main complaint. Other complaints included intolerance to solids, liquids, and reflux. Only 2/11 patients presented with weight loss since undergoing NAGB placement, while the remainder had weight regain to their pre-NAGB level and above. Depending on clinical presentation, desire for additional weight loss and co-morbid conditions, patients underwent a variety of treatments. This included NAGB removal (endoscopic, laparo-endoscopic, and laparoscopic) as well as conversion to another bariatric procedure (sleeve gastrectomy, Roux-en-Y gastric bypass). CONCLUSION: Patients with NAGB complications present with symptoms related to a proximal gastric outlet obstruction, related to constriction imposed by the band. This may result in severe food and liquid intolerance and subsequent weight loss, but more likely results in maladaptive eating and subsequent weight gain. Optimal therapy involves removal of the NAGB. Laparoscopic conversion to another bariatric procedure, optimally a Roux-en-Y gastric bypass, is warranted to treat morbid obesity and associated co-morbidities.