Laparoscopic adjustable gastric banding’s multiple complications: when complications arise even after 30 years, a case report.

Laparoscopic adjustable gastric banding (LAGB) is a popular bariatric surgical procedure. The introduction of laparoscopy has increased the use of this procedure, making it the most commonly performed bariatric surgery. Patients undergoing LAGB have achieved satisfactory results in terms of weight loss, a reduction in co-morbidities, and improved quality of life. Nonetheless, complications with LAGB are well documented and include migration, erosion, prolapse, infection, pouch dilation, gastric perforation, and most commonly, lack of weight loss following the failure of the procedure. This case report presents a patient with slippage and pouch dilation, erosion of the stomach, and port site problems, including infection, occurring 28 years after LAGB.

Endoscopic Revision (StomaphyX) versus Formal Surgical Revision (Gastric Bypass) for Failed Vertical Band Gastroplasty

Background. Weight regain secondary to VBG pouch dilation is a typical referral for Bariatric surgeons. In this study we compare an endoluminal pouch reduction (Stomaphyx) to RYGB for revision.Methods. A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003–2010.Results. Thirty patients were identified for study 23 RYGB, 14 StomaphyX. Significant post procedure BMI loss was seen in each cohort (RYGB,47.7 ± 7 kg/m2to35 ± 7 kg/m2; StomaphyX43 ± 10 kg/m2to40 ± 9 kg/m2,P=0.0007). Whereas nausea and headache were the only complications observed in StomaphyX patients, the RYGB group had a 43.5% complication rate and 1 mortality. Complications following RYGB include: incisional hernia (13%), anastomotic leak (8.7%), respiratory failure (8.7%), fistula (8.7%), and perforation (4.35%). The median length of stay following RYGB was 6 days compared to1.5 ± 0.5days following StomaphyX.Conclusion. This study suggests that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Further technical modifications of the device and longer follow-up may clarify the role of this approach.