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Revisional surgery after failed laparoscopic adjustable gastric banding

The latest issue of Surgical Endoscopy investigates revisional surgery after failed laparoscopic adjustable gastric banding.

News image

Laparoscopic adjustable gastric banding has emerged as one of the most commonly performed bariatric procedures worldwide.

Unfortunately, revisional surgery is required in 20–30 % of cases.

Dr Ahmad Elnahas and colleagues reported that several revisional strategies have been proposed, but there is no consensus regarding the best surgical option.

The research team determined which revisional surgery is best suited to enhance weight loss following failed laparoscopic adjustable gastric banding due to complications or inadequate weight loss.

The research team searched EMBASE, MEDLINE, PsycINFO, and Cochrane Clinical Trials using the most comprehensive timeline for each database.

A total of 24 relevant articles were identified.

The team reported that 2 investigators independently extracted data, and resolved differences by consensus.

The weighted means were calculated for weight loss measurements.

The team of doctors noted that a total of 106, 514, and 71 patients underwent conversion from laparoscopic adjustable gastric banding to laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic biliopancreatic diversion and duodenal switch, respectively.

Before revisional surgery, the weighted mean body mass index was 39, 43, and 41 kg/m2 for the laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic biliopancreatic diversion and duodenal switch groups, respectively.

The majority of data was reported at 12–24 months follow-up.

The calculated pooled gastric cancer incidence-rate was about 0.3% per person-years
Surgical Endoscopy

The researchers found that the mean body mass index within this interval was 28, 32, and 33 kg/m2 for the laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic biliopancreatic diversion and duodenal switch groups, respectively.

In addition, the mean excess weight loss was 22%, 58%, 47% for the laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, and laparoscopic biliopancreatic diversion and duodenal switch groups, respectively.

The researchers noted that the excess weight loss reached 78% in the laparoscopic biliopancreatic diversion and duodenal switch group after 2-year follow-up.

Dr Ahmad Elnahas's team commented, "Failed laparoscopic adjustable gastric banding is best managed with conversion to another bariatric procedure."

"Stable weight loss occurs with salvage laparoscopic Roux-en-Y gastric bypass."

"Although results for revisional laparoscopic biliopancreatic diversion and duodenal switch appear promising, additional research, with higher methodological quality, is needed."

Surgical Endoscopy 2013: 27(3) : 740-745
27 March 2013

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