One Stage Laparoscopic Band Removal and Sleeve Gastrectomy after Failure of Gastric Banding in Morbidly Obese Patients

Abstract

Background: Obesity is one of the public health problems nowadays which is associated with a variety of diseases including the whole systems, specially the cardiovascular system. Bariatric surgeries believed to be the most effective long-term management for morbid obesity that decrease both morbidity and mortality. One of these surgeries is laparoscopic adjustable gastric banding. Objective: To study the safety and effectiveness of single stage revision of failed gastric banding to sleeve gastrectomy only in uncomplicated cases who had failure of weight loss or regain weight after a period from having gastric banding. Patients and methods: The present study is a retrograde observational study including 150 morbidly obese patients who previously had laparoscopic adjustable gastric banding and failed to lose adequate weight or regained weight. Patients were recruited and treated at Ain Shams university hospitals from December 2015 to December 2017. All patients had laparoscopic band removal and sleeve gastrectomy in the same procedure. All patients received information about surgical technique, risks of the operation and other options for treatment. Results: The mean age of the cohort was 36± 10 years (range 20-60). Before band insertion the mean BMI of the cohort was 43.4 ± 5.2 (range 31.6-55.8). The mean interval between primary and revision surgery was 5.5±1 year (range 2.8-9.6). The mean BMI of the study prior to revisional laparoscopic band removal and sleeve gastrectomy was 42 ± 5.5 (range 35-50). The excess body weight loss percentage (EBWL%) in the first 3 months was 32% and 65% after 6 months. Conclusion: Laparoscopic gastric band removal with conversion to sleeve gastrectomy in one operation is applicable for patients with failure of weight loss or regaining weight after adjustable gastric band. It can be done with low incidence of complications, and yet a weight loss results that is similar to primary sleeve gastrectomy.