Revision of the Laparoscopic Gastric Band

Abstract

The popularity of the laparoscopic adjustable gastric band (LAGB) has seen a significant decline over the past decade. Reasons for this can be appreciated by understanding the two general indications for its removal: failure to maintain adequate long-term weight loss and serious complications due to the band itself. The efficacy of the LAGB in maintaining adequate long-term weight loss has been both refuted and supported. Though some have argued for the band to be a potentially effective weight loss tool, it became increasingly clear that the band was being placed at the expense of significant morbidity, with some cohorts demonstrating complication rates as high as 40–50%. Common complications include port- or catheter-related problems, band leakage, band infection, gastroesophageal reflux disease, and esophagitis. The most concerning complications include gastric pouch dilation, band slippage, and band erosion. As a consequence of its morbidity, surgeons have been forced to become adept at the explantation of these bands, with both minimally invasive and endoscopic techniques having been tried, described, implemented, and popularized. As the band creates a particularly challenging operative field, secondary to gastric and perigastric inflammation and fibrosis, the safety of one-stage versus two-stage revisional procedures have been debated. Regardless, after band removal, standard options for revisional surgery include conversion to either revisional laparoscopic Roux-en-Y gastric bypass or revisional laparoscopic sleeve gastrectomy. As with many clinical situations, an experienced surgeon in conjunction with a patient-tailored treatment plan should maximize the chances of performing a successful revision of the laparoscopic gastric band.