Revisional Adjustable Gastric Band in Roux-en-Y Gastric Bypass—Is It Worth It?

Purpose A subset of patients undergoing Roux-en-Y gastric bypass (RYGB) presents with either insufficient weight loss or weight regain. Data on the revisional restrictive options including laparoscopic adjustable gastric band (LAGB) is scarce. This study analyzes the mid-term efficacy and safety of LAGB as a revisional procedure after RYGB. Methods Data of all patients with revisional LAGB after primary RYGB between January 2011 and May 2019 were retrospectively reviewed. Outcomes included assessment of weight changes, resolution of comorbidities, and early and late complications during the study period. Results Twenty patients were included. The median Body Mass Index (BMI) before revisional LAGB was 34.8 (interquartile range [IQR] 31.9–38.1) kg/m2. After a median follow-up of 33.5 (IQR 19.5–76.5) months, the median BMI was 28.7 (IQR 26.1–32.2) kg/m2. The median additional Excess Weight Loss (EWL) was 37.6% (IQR 23–44.4), leading to a median total EWL of 79.5% (IQR 54.4–94.6). BMI and EWL post-LAGB improved significantly compared to BMI and EWL pre-LAGB (p<0.001 and p<0.001, respectively). Obstructive sleep apnea syndrome resolved 6 months after LAGB in one patient. Three band deflations occurred during the follow-up. Six patients underwent band removal after a median time of 19 (IQR 15.8–26) months. Overall, thirteen patients underwent a reoperation. There was no loss of follow-up until 5 years. After that, two patients were lost to follow-up. Conclusion LAGB may be a salvage option after failed RYGB. However, the high rate of revisions after secondary LAGB needs to be taken into consideration.

Obstrucción intestinal, complicación inusual por banda gástrica ajustable laparoscópica: reporte de caso

Background: The main goal of bariatric surgery is the reduction of Body mass index (BMI). Laparoscopic adjustable gastric band (LAGB) was the most popular method due to its relative advantages over others. Clinical case: A 44-year-old woman with abdominal pain and distension, with a history of LAGB placement had a diagnosis of intestinal occlusion secondary to a twist in the device tube, surgical management was given, the patient presented adequate evolution. Conclusion: The occlusion of the small intestine by the tube of the device is a serious and uncommon complication to be considered as a differential diagnosis in bariatric patients. Keywords: Bariatric surgery; complications; gastric band; bowel obstruction; obesity.

A rare complication of laparoscopic adjustable gastric band: acute large bowel obstruction

With many thousands patients carrying laparoscopic adjustable gastric band (LAGB), long-term complications can appear emergently to any surgeon. We present a 64 year-old male who underwent placement of a laparoscopic adjustable gastric band (LAGB) years prior presented to the emergency department with concerning signs of an acute abdomen. Upon imaging review a large bowel obstruction at the level of the sigmoid colon, with ischemic changes, was discovered, caused by the patient’s LAGB catheter. The patient was taken emergently for an exploratory laparotomy during which the LAGB catheter was removed, resulting in restored bowel perfusion. Bowel obstructions are infrequent complications of LAGB. However most commonly they are limited to the small bowel. LAGB catheters resulting in large bowel obstructions are an extremely rare finding. Our review of the literature indicates that this is the first reported cause of a sigmoid obstruction caused by a LAGB. This case brings into view potential complications LAGB that can confront not only bariatric surgeons, but general and acute care surgeons as well. This report illustrates LAGB danger to the colon, and suggests how to manage, perhaps leading to early, life-saving intervention