Laparoscopic Adjustable Gastric Banding After Failed Roux-En-Y Gastric Bypass.

Abstract

Roux-en-Y gastric bypass (RYGB) is associated with approximately 25% weight loss failure, resulting in insufficient weight loss or weight regain. Strategies of revisional surgery focus on alteration of limb length, pouch or stoma size. Altering pouch size and outlet by adding laparoscopic adjustable gastric band (LAGB) might initiate further weight loss. The goal of this study is to review the safety and efficacy of LAGB after failed RYGB in a retrospective cohort of patients in our institute. Patients with secondary LAGB (n=44) were studied between May 2012 and January 2015. Demographics, effects on weight loss and complications were analysed. Mean age and body mass index (BMI) at time of LAGB was 45.8±8.2years and 37.2±5.4kg/m2, respectively. Mean interval between RYGB and LAGB was 2.6±1.3years. Mean follow-up was 14±7.9months, with 25% loss to follow-up at 12months. Due to LAGB, patients lost an additional 17.6%±28.3% excess weight. Patients with weight regain after initial weight loss success showed more excess weight loss (EWL) compared to patients whom never reached 50% EWL after RYGB. Overall complication and reoperation rates were 30 and 21%, respectively, with 16% band removal. One fatality due to septic shock following band erosion was observed. In this largest published cohort, secondary banding of failed RYGB provides only limited additional weight loss. Furthermore, this technique is associated with high morbidity and reoperation rates. A significant difference in effect was found between patients with weight loss failure and weight regain. Larger prospective series are necessary to evaluate if the modest benefits are worth the risks of secondary LAGB.