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Pfister M, Teuben MPJ, Teuber H, Nocito A, Probst P, Muller MK. Mid-term quality of life after gastric band removal and single-stage conversion to gastric bypass: a single-center cohort study. Langenbecks Arch Surg 2022; 407:2755-2762. [PMID: 35896813 DOI: 10.1007/s00423-022-02618-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Revision surgeries in patients with failed gastric banding including band removal are increasingly necessary. However, long-term outcomes after band removal alone are unsatisfactory due to weight regain and limited improvement in quality of life. This study aimed to report mid-term quality of life outcomes after gastric band removal and single-stage conversion to Roux-en-Y gastric bypass. METHODS Data of 108 patients who underwent conversion surgery from 2011 to 2017 were extracted from a prospective database and retrospectively analyzed. During follow-up visits, physical and laboratory data as well as quality of life questionnaires were obtained. RESULTS Postoperative mean Moorehead score increased significantly after 1 year (1.62 ± 0.86, p < 0.001) and after 5 years (1.55 ± 0.84, p < 0.001) compared to baseline values (0.72 ± 1.1). The mean follow-up time was 53 months. Moorehead scores at 1, 2, and 5 years postoperative were available in 75% (n = 81), 71% (n = 77), and 42% (n = 45) of cases, respectively. Mixed ANOVA analysis showed a significantly superior increase in Moorehead score in males (p = 0.024). No other significant predictors were identified. Lasting BMI reduction (- 4.6 to 33.0 ± 6.7 kg/m2, p < 0.001) and weight loss (- 12.9% (- 13.6 kg), p < 0.001) 5 years after conversion surgery were seen. Postoperative complications occurred in 35% (n = 38) of patients with a re-operation rate of 30.5% (n = 33). CONCLUSION The current study shows that band removal with single-stage gastric bypass in patients with failed gastric banding leads to a lasting improvement in quality of life and may be the rescue procedure of choice in this setting.
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Affiliation(s)
- M Pfister
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, CH-8501, Frauenfeld, Switzerland
| | - M P J Teuben
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, CH-8501, Frauenfeld, Switzerland
| | - H Teuber
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - A Nocito
- Department of Surgery, Cantonal Hospital Baden, Im Ergel 1, CH-5404, Baden, Switzerland
| | - P Probst
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, CH-8501, Frauenfeld, Switzerland
| | - M K Muller
- Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, CH-8501, Frauenfeld, Switzerland.
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Alratrout H, Almuttawa A, Siciliano I, Keller P. Laparoscopic Roux-en-Y Gastric Bypass for Failed Gastric Banding: One-Step or Two-Step Revisional Surgery? Obes Surg 2020; 31:646-653. [DOI: 10.1007/s11695-020-05027-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/31/2022]
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Falk V, Sheppard C, Kanji A, Birch D, Karmali S, de Gara C. The fate of laparoscopic adjustable gastric band removal. Can J Surg 2020; 62:328-333. [PMID: 31550094 DOI: 10.1503/cjs.001918] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Long-term complications and lack of weight loss have caused a surge in laparoscopic adjustable gastric band (LAGB) removal. This study reviews the trend of LAGB removal and examines outcomes of patients undergoing subsequent revision bariatric surgery at a single tertiary care centre in Canada. Methods All LAGB removals performed between January 2008 and December 2016 were reviewed. A subset of patients who underwent revision surgery was then analyzed for patient demographics, weight, body mass index and postoperative complications. Results During the study period, 211 patients underwent LAGB removal (87.7% female). Most bands were inserted out of province. Reasons for band removal included dysphagia, band slip and weight recidivism. Fifty-nine patients (28%) underwent revision surgery at a mean of 12.8 ± 9.3 (range 0–55) months after LAGB removal. Mean age was 47 ± 9.7 (range 26–63) years, and mean pre-LAGB weight was 131.0 ± 30.0 kg. Following LAGB, the mean weight decreased to 120.5 ± 26.4 kg, but most regained weight after removal to a mean prerevision weight of 125.1 ± 27.0 kg. The lowest mean weight was achieved 12 months after revision surgery (98.7 ± 30.2 kg). The mean percent total weight loss was not significantly different after revision laparoscopic Roux-en-Y gastric bypass compared with revision laparoscopic sleeve gastrectomy (22.8 ± 9.6% v.17.5 ± 6.5%, p = 0.179). The overall revision surgery 30-day complication rate was 18.6% and increased to 23.7% long-term. No deaths occurred. Conclusion The number of LAGB removals is increasing. Revision bariatric surgery leads to improved weight loss; however, revision surgery is associated with complications.
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Affiliation(s)
- Vanessa Falk
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (Falk, Kanji, Birch, Karmali, de Gara); and the Centre for Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Kanji, Birch, Karmali, de Gara)
| | - Caroline Sheppard
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (Falk, Kanji, Birch, Karmali, de Gara); and the Centre for Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Kanji, Birch, Karmali, de Gara)
| | - Aliyah Kanji
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (Falk, Kanji, Birch, Karmali, de Gara); and the Centre for Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Kanji, Birch, Karmali, de Gara)
| | - Daniel Birch
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (Falk, Kanji, Birch, Karmali, de Gara); and the Centre for Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Kanji, Birch, Karmali, de Gara)
| | - Shazeer Karmali
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (Falk, Kanji, Birch, Karmali, de Gara); and the Centre for Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Kanji, Birch, Karmali, de Gara)
| | - Christopher de Gara
- From the Division of General Surgery, University of Alberta, Edmonton, Alta. (Falk, Kanji, Birch, Karmali, de Gara); and the Centre for Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Sheppard, Kanji, Birch, Karmali, de Gara)
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Park JS, Han SM. Outcomes of primary sleeve gastrectomy versus conversion sleeve gastrectomy in morbidly obese patients. Ann Surg Treat Res 2019; 96:259-265. [PMID: 31073516 PMCID: PMC6483934 DOI: 10.4174/astr.2019.96.5.259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/11/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Our aim for this study was to evaluate early and late complications and outcomes of primary sleeve gastrectomy (PSG) versus conversion sleeve gastrectomy (CSG). Methods From February 2013 to December 2016, a total of 180 patients underwent sleeve gastrectomy (150 PSG and 30 CSG). All patients received a metal clipping at the end of the stapling line and a continuous seromuscular suture at the resection margin, for reinforcement. Results There were no differences in the percentages among males and females or age between the 2 groups, but the body mass index (BMI) of the PSG group was higher at 36.8 ± 4.7 than that of the CSG group (32.4 ± 5.7, P < 0.001). Three early postoperative complications were noted in the PSG group; 1 patient underwent repeat laparoscopic exploration due to pancreatic injury, and 2 other patients developed pulmonary atelectasis. On the contrary, 2 early minor complications were noted in the CSG group. Thirty-eight patients (25.3%) in the PSG group developed 43 late, minor complications, while 9 patients (30.0%) developed 11 late minor and 1 major complication in the CSG group. However, there was no difference in complication rate between PSG and CSG. Percentage excess BMI loss at 3, 6, and 12 months after surgery was comparable between the groups. Conclusion PSG and CSG were comparable in terms of postoperative complications and loss of weight. Therefore, CSG could be used for failed primary restrictive bariatric surgery. However, the durability of these outcomes remains unknown.
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Affiliation(s)
| | - Sang-Moon Han
- Department of Surgery, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
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5
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Destiny of Failed Adjustable Gastric Bandings: Do All the Patients Need Further Bariatric Surgery? Obes Surg 2018; 28:3380-3385. [PMID: 29978440 DOI: 10.1007/s11695-018-3373-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The number of laparoscopic adjustable gastric banding (LAGB) removal has increased throughout the years. The aim of the study was to evaluate the outcomes in patients undergoing LAGB removal with or without further bariatric surgery. MATERIALS AND METHODS Data prospectively collected from consecutive patients undergoing LAGB removal from 2008 to 2016 at our institution were retrospectively analyzed. Obesity-related comorbidities, complications, and body mass index (BMI) before removal and at 1-year follow-up were evaluated. RESULTS A total of 156 patients were included in the study. Seventy-six patients had further surgery (SURG group): 55 underwent laparoscopic sleeve gastrectomy (LSG) and 21 laparoscopic Roux-en-Y gastric bypass (LRYGB). Eighty patients underwent only LAGB removal (No-SURG group). The mean BMI was lower in the No-SURG group (33.9 vs 36.3 kg/m2, p = 0.0055). Reasons for removal were different in the two groups: dysphagia, frequent vomiting, and LAGB-related complications requiring urgent treatment occurred more commonly in the No-SURG group (p < 0.05): 71.3 vs 51.3%, 67.5% vs. 38.2%, 28.8% vs. 6.6%, respectively. At 1-year follow-up, 96.3% of No-SURG patients regained weight after LAGB removal; two (2.5%) patients showed new-onset comorbidities, four (5%) needed adjustments in pharmacological therapy, and four (5%) complained from persistence of GERD symptoms. Additional surgery provided significant weight loss: the mean %TWL was 23.7% after LSGs and 27.2% after LRYGBs. CONCLUSIONS LAGB is associated with a high rate of reoperation. Further bariatric surgery after LAGB removal should be considered due to weight regain, persistence of GERD symptoms, and new-onset comorbidities.
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6
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Creange C, Jenkins M, Pergamo M, Fielding G, Ren-Fielding C, Schwack B. Gastric band conversion to Roux-en-Y gastric bypass shows greater weight loss than conversion to sleeve gastrectomy: 5-year outcomes. Surg Obes Relat Dis 2018; 14:1531-1536. [PMID: 30449510 DOI: 10.1016/j.soard.2018.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are often used as revisional surgeries for a failed laparoscopic adjustable gastric band (LAGB). There is debate over which procedure provides better long-term weight loss. OBJECTIVE To compare the weight loss results of these 2 surgeries. SETTING University hospital, United States. METHODS A retrospective review was conducted of all LAGB to RYGB and LAGB to LSG surgeries performed at a single institution. Primary outcomes were change in body mass index (BMI), percent excess BMI lost, and percent weight loss. Secondary outcomes included 30-day complications and reoperations. RESULTS The cohort included 192 conversions from LAGB to RYGB and 283 LAGB to LSG. The baseline age and BMI were similar in the 2 groups. Statistical comparisons made between the 2 groups at 24 months postconversion were significant for BMI (RYGB = 32.93, LSG = 38.34, P = .0004), percent excess BMI lost (RYGB = 57.8%, LSG = 29.3%, P < .0001), and percent weight loss (RYGB = 23.4%, LSG = 12.6%, P < .0001). However, the conversion to RYGB group had a higher rate of reoperation (7.3% versus 1.4%, P = .0022), longer operating room time (RYGB = 120.1 min versus LSG = 115.5 min, P < .0001), and longer length of stay (RYGB = 3.33 d versus LSG = 2.11 d, P < .0001) than the LAGB to LSG group. Although not significant, the conversion to RYGB group had a higher rate of readmission (7.3% versus 3.5%, P = .087). CONCLUSION Weight loss is significantly greater for patients undergoing LAGB conversion to RYGB than LAGB to LSG. However, those undergoing LAGB conversion to RYGB had higher rates of reoperation and readmission. Patients looking for the most effective weight loss surgery after failed LAGB should be advised to have RYGB performed, while also understanding the increased risks of the procedure.
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Affiliation(s)
- Collin Creange
- Department of General Surgery, NYU Langone Medical Center, New York, New York.
| | - Megan Jenkins
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | - Matthew Pergamo
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | - George Fielding
- Department of General Surgery, NYU Langone Medical Center, New York, New York
| | | | - Bradley Schwack
- Department of General Surgery, NYU Langone Medical Center, New York, New York
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7
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Cost-utility analysis for bariatric surgery compared with usual care for the treatment of obesity in Australia. Surg Obes Relat Dis 2017; 13:2012-2020. [DOI: 10.1016/j.soard.2016.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 11/23/2016] [Accepted: 12/18/2016] [Indexed: 12/16/2022]
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8
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Single-center experience in single-stage conversions of gastric banding to sleeve gastrectomy: is it as safe as 2-stage conversions? Surg Obes Relat Dis 2017; 13:1830-1834. [DOI: 10.1016/j.soard.2017.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/04/2017] [Accepted: 01/04/2017] [Indexed: 01/20/2023]
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9
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Rohner A, Widmer JD, Klasen J, Scheiwiller A, Muller D, Muller MK. Long-term outcomes of gastric band removal without additional bariatric surgery. Surg Obes Relat Dis 2017; 13:261-266. [DOI: 10.1016/j.soard.2016.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/04/2016] [Accepted: 09/06/2016] [Indexed: 02/05/2023]
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Abstract
Revisional bariatric procedures are increasingly common. With more primary procedures being performed to manage severe obesity and its complications, 5% to 8% of these procedures will fail, requiring revisional operation. Reasons for revisional bariatric surgery are either primary inadequate weight loss, defined as less than 25% excess body weight loss, or weight recidivism, defined as a gain of more than 10 kg based on the nadir weight; however, each procedure also has inherit specific complications that can also be indications for revision. This article reviews the history of each primary bariatric procedure, indications for revision, surgical options, and subsequent outcomes.
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Affiliation(s)
- Noah J Switzer
- Department of Surgery, University of Alberta, Room 405 CSC, 10240 Kingsway Avenue, Edmonton, Alberta T5H 3V9, Canada
| | - Shahzeer Karmali
- Department of Surgery, Minimally Invasive Gastrointestinal and Bariatric Surgery, University of Alberta, Room 405 CSC, 10240 Kingsway Avenue, Edmonton, Alberta T5H 3V9, Canada
| | - Richdeep S Gill
- Department of Surgery, Peter Lougheed Hospital, University of Calgary, 3rd Floor West Wing, Room 3656, 3500 26th Avenue Northeast, Calgary, Alberta, T1Y 6J4, Canada
| | - Vadim Sherman
- Weill Cornell Medical College, Bariatric and Metabolic Surgery Center, Houston Methodist Hospital, 6550 Fannin Street, SM 1661, Houston, TX 77030, USA.
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11
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Dang JT, Switzer NJ, Wu J, Gill RS, Shi X, Thereaux J, Birch DW, de Gara C, Karmali S. Gastric Band Removal in Revisional Bariatric Surgery, One-Step Versus Two-Step: a Systematic Review and Meta-analysis. Obes Surg 2016; 26:866-73. [PMID: 26843080 DOI: 10.1007/s11695-016-2082-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We aimed to systematically review the literature comparing the safety of one-step versus two-step revisional bariatric surgery from laparoscopic adjustable gastric banding (LAGB) to Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). There is debate on the safety of removing the gastric band and performing revisional surgery immediately or in a delayed, two-step fashion due to potential higher complications in one-step revisions. A systematic and comprehensive search of the literature was conducted. Included studies directly compared one-step and two-step revisional surgery. Eleven studies were included with 1370 patients. Meta-analysis found comparable rates of complications, morbidity, and mortality between one-step and two-step revisions for both RYGB and SG groups. This suggests that immediate or delayed revisional bariatric surgeries are both safe options for LAGB revisions.
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Affiliation(s)
- Jerry T Dang
- Department of Surgery, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada, T6G 2B7.
| | - Noah J Switzer
- Department of Surgery, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada, T6G 2B7
| | - Jeremy Wu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richdeep S Gill
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Xinzhe Shi
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Jérémie Thereaux
- Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Brest, France
| | - Daniel W Birch
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Christopher de Gara
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Shahzeer Karmali
- Centre for the Advancement of Minimally Invasive Surgery (CAMIS), Royal Alexandra Hospital, Edmonton, Alberta, Canada
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12
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Kirshtein B, Kirshtein A, Perry Z, Ovnat A, Lantsberg L, Avinoach E, Mizrahi S. Laparoscopic adjustable gastric band removal and outcome of subsequent revisional bariatric procedures: A retrospective review of 214 consecutive patients. Int J Surg 2016; 27:133-137. [PMID: 26808324 DOI: 10.1016/j.ijsu.2016.01.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/18/2016] [Accepted: 01/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric band (LAGB) removal is required in cases of slippage, erosion, infection, intolerance, or failure in weight loss. The aim of the study was to follow up the patients who underwent band removal and analyze the outcome of subsequent revisional bariatric procedures. PATIENTS AND METHODS A retrospective review of consecutive patients who underwent LAGB removal during 3.5 years. All patients underwent a phone interview in early 2015. Patients were divided to three groups following band removal: without additional surgery, laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en Y gastric bypass (LRYGB), and Redo LAGB(Re-LAGB). Outcome of different revisional procedures was compared according to causes and symptoms before band removal, patient satisfaction, weight loss, quality of life (QOL) questionnaire, and the bariatric analysis and reporting outcome system II (BAROSII) score. RESULTS Overall 214 patients (73.8% females) with mean age of 41.9 years were enrolled in the study. The mean time between LAGB placement and removal was 81.0 months. Mean % estimated weight loss (%EWL) was 29.6 at time of band removal. There was no difference between groups in patient age, gender, BMI before LAGB, and most co-morbidities. Patients with 1-5 outpatient visits preferred additional surgery. Patients suffering from vomiting from 1 to 10 times per week preferred revision as LSG or LRYGB. Patients with lower BAROS score underwent LSG or LRYGB. Most of the patients with band intolerance underwent conversion to another bariatric procedure, while patients with band erosion and infected band preferred Re-LAGB. Most of the patients without band gained weight. There was a significant improvement in %EWL (39.9 vs 29.6), QOL (1.08 vs 0.07), and BAROS(2.82 vs-0.11) in patients who underwent additional bariatric surgery before and after band removal irrespective of surgery type. CONCLUSIONS Patient selection for different revisional bariatric procedures after LAGB removal is a main point for surgery success. This results in high patient satisfaction, EWL, and QOL. All options (Re-LAGB, LSG, LRYGB) are feasible and safe.
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Affiliation(s)
- Boris Kirshtein
- Department of Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Anna Kirshtein
- Department of Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Zvi Perry
- Department of Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amnon Ovnat
- Department of Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leonid Lantsberg
- Department of Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eliezer Avinoach
- Department of Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Solly Mizrahi
- Department of Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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13
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Paulus GF, Konings G, Bouvy ND, van Heurn LE, Greve JW. Long-Term Follow-Up Is Essential to Assess Outcome of Gastric Banding in Morbidly Obese Adolescents: A Retrospective Analysis. Obes Facts 2016; 9:344-352. [PMID: 27701155 PMCID: PMC5644898 DOI: 10.1159/000448193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/30/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Adolescent obesity is rapidly becoming more prevalent and is associated with chronic health conditions and psychosocial morbidity. Lifestyle intervention is often ineffective in morbidly obese adolescents, and bariatric surgery is gradually becoming an accepted treatment. However, little is known about long-term results. METHODS Hospital charts of patients who had undergone gastric banding more than 5 years ago at an age of 18 years or younger, were retrospectively analyzed. Weight loss, complications, reoperations, and comorbidity reduction were assessed as well as health status, food behavior, and personality. RESULTS BMI loss in 10 adolescents was 10.7 kg/m2 (-0.9 to 12.9 kg/m2) after a median follow-up of 64 months (52-84 months); the major part of weight loss occurred after the first year. In 4 patients the gastric band was removed after 3.5-5.5 years. Two out of 3 patients effectively lost weight after conversion to a bypass type procedure. One patient is maintaining a stable healthy weight after band removal. CONCLUSIONS Laparoscopic adjustable gastric banding in morbidly obese adolescents had a failure rate of 40%, but was a successful therapy in the other 60% without major adverse events. Follow-up longer than 36 months was crucial for optimal evaluation of weight loss and reoperation rate.
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Affiliation(s)
- Givan F. Paulus
- Department of Surgery, Maastricht University Medical Center, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, the Netherlands, Heerlen, the Netherlands
- Department of Surgery, Spaarne Gasthuis, Haarlem, the Netherlands, Heerlen, the Netherlands
- *Givan F. Paulus, MD, Department of Surgery, Maastricht University Medical Center and Nutrition and Toxicology Research, Institute (NUTRIM), P. Debyelaan 25, 6229 HX Maastricht, the Netherlands,
| | - Gerdy Konings
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands, Heerlen, the Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, the Netherlands, Heerlen, the Netherlands
| | - L.W. Ernest van Heurn
- Department of Surgery, Maastricht University Medical Center, and Nutrition and Toxicology Research Institute (NUTRIM), Maastricht, the Netherlands, Heerlen, the Netherlands
| | - Jan Willem Greve
- Department of Surgery, Atrium Medical Center, Heerlen, the Netherlands
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14
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Aarts E, Koehestanie P, Dogan K, Berends F, Janssen I. Revisional surgery after failed gastric banding: results of one-stage conversion to RYGB in 195 patients. Surg Obes Relat Dis 2014; 10:1077-83. [PMID: 25443075 DOI: 10.1016/j.soard.2014.07.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 06/12/2014] [Accepted: 07/08/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND The most performed restrictive bariatric procedure is the laparoscopic adjustable gastric band (LAGB). With many patients still receiving a LAGB in Europe and the United States, inevitably, the number of complications also increases. For many complications revisional bariatric surgery is necessary. In this study, the outcomes of one-stage LAGB conversion to a Roux-en-Y gastric bypass (RYGB) at our institution are presented. The objective of this study was to investigate the safety and efficiency of RYGB performed as a one-stage procedure after failed LAGB. METHODS Patients were retrospectively selected using a prospectively collected database. The gastric band had to be in situ for at least 1 year and minimum postoperative follow-up was 12 months. The revisional RYGB had to be performed as a 1-step procedure. RESULTS A total of 195 patients were included while 3 were lost to follow up. Overall, 178 (91%) procedures were performed without perioperative complications, and only 8 (4%) patients required reoperation within 30 days. The mean follow-up was 40 months (±24) after RYGB. Mean excess weight loss (EWL) increased from 25% (±26/-50- 120%) to 60% (±21.2/0- 130), 65% (±23.5/0- 131), 63% (±24.2/2- 132), 60% (±24.1/0- 111) and 53% (±28.7/-39- 109) in the first 5 postoperative years. CONCLUSION Converting a gastric band to a RYGB in a one-stage procedure is safe and feasible, with acceptable complication rates when performed in a specialized institution. The RYGB conversion results in a good EWL of 65% after 2 years. However, proper patient selection is of the utmost importance.
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Affiliation(s)
- Edo Aarts
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
| | | | - Kemal Dogan
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Frits Berends
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Ignace Janssen
- Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
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15
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Abstract
Obesity is considered a worldwide health problem of epidemic proportions. Bariatric surgery remains the most effective treatment for patients with severe obesity, resulting in improved obesity-related co-morbidities and increased overall life expectancy. However, weight recidivism has been observed in a subset of patients post-bariatric surgery. Weight recidivism has significant medical, societal and economic ramifications. Unfortunately, there is a very limited understanding of how to predict which bariatric surgical patients are more likely to regain weight following surgery and how to appropriately treat patients who have regained weight. The objective of this paper is to systematically review the existing literature to assess the incidence and causative factors associated with weight regain following bariatric surgery. An electronic literature search was performed of the Medline, Embase and Cochrane library databases along with the PubMed US national library from January 1950 to December 2012 to identify relevant articles. Following an initial screen of 2,204 titles, 1,437 abstracts were reviewed and 1,421 met exclusion criteria. Sixteen studies were included in this analysis: seven case series, five surveys and four non-randomized controlled trials, with a total of 4,864 patients for analysis. Weight regain in these patients appeared to be multi-factorial and overlapping. Aetiologies were categorized as patient specific (psychiatric, physical inactivity, endocrinopathies/metabolic and dietary non-compliance) and operation specific. Weight regain following bariatric surgery varies according to duration of follow-up and the bariatric surgical procedure performed. The underlying causes leading to weight regain are multi-factorial and related to patient- and procedure-specific factors. Addressing post-surgical weight regain requires a systematic approach to patient assessment focusing on contributory dietary, psychologic, medical and surgical factors.
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Aarts EO, Dogan K, Koehestanie P, Janssen IMC, Berends FJ. What happens after gastric band removal without additional bariatric surgery? Surg Obes Relat Dis 2013; 10:1092-6. [PMID: 24462304 DOI: 10.1016/j.soard.2013.10.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 10/14/2013] [Accepted: 10/19/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The laparoscopic adjustable gastric band (LAGB) is widely used for the treatment of morbid obesity. Many patients benefit from this procedure initially, but experience complications after a few years. The treatment for many complications is revisional bariatric surgery. A number of patients, however, request only band removal without secondary bariatric surgery. The aim of this study was to assess the perioperative and medium term outcomes of patients who had their LAGB removed without secondary bariatric surgery. METHODS Patients were retrospectively selected using a prospectively collected database. The LAGB had to be in situ for at least 1 year, and minimum postoperative follow-up had to be 12 months. RESULTS Thirty-eight patients who had their LAGB laparoscopically removed between 2000 and 2010 were included. Median follow-up after LAGB removal was 3.0 (1.4 to 8.9) years. Only 2 complications (5%) and no mortality occurred perioperatively. In the 21 patients who did not undergo additional bariatric surgery, the median excess weight loss (EWL) decreased from 41% (-12% to -100%) at band removal to 9% (-10% to 90%), 0% (-20% to 78%), and -11% (-12% to 56%) after 1, 2, and 5 years, respectively. Percentage weight loss (%WL) was 17% (-54% to -5%), 4% (-47% to -9%), 0% (-41% to 11%), and -5% (-29% to 9%) after these same time intervals, respectively. After a median 2.1 (.5 to 9.9) years, 17 patients underwent either a Roux-en-Y gastric bypass (14 patients) or a Scopinaro (3 patients) all because of weight regain. The current EWL and %WL in these patients is 67% (24% to 113%) and 30% (12% to 53%), respectively compared with -11% (-33% to 57%) and -4% (-14% to 34%) in patients without a secondary bariatric procedure (P< .001). CONCLUSION Patients who have their LAGB removed are guaranteed to suffer from weight regain. It is inadvisable to only remove the LAGB without performing an additional bariatric procedure when deemed technically feasible and safe. In this study, no patient was able to maintain the weight loss achieved with the LAGB after its removal.
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Affiliation(s)
- Edo O Aarts
- Department of Surgery Rijnstate Hospital, The Netherlands.
| | - Kemal Dogan
- Department of Surgery Rijnstate Hospital, The Netherlands
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Goitein D, Feigin A, Segal-Lieberman G, Goitein O, Papa MZ, Zippel D. Laparoscopic sleeve gastrectomy as a revisional option after gastric band failure. Surg Endosc 2011; 25:2626-30. [PMID: 21416182 DOI: 10.1007/s00464-011-1615-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 02/07/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) is an effective bariatric procedure with low morbidity and mortality. Unfortunately, it is fraught with high failure rates in long-term follow-up. Laparoscopic sleeve gastrectomy (LSG) is an emerging procedure, quickly gaining momentum in the arsenal of bariatric practice as a first step toward gastric bypass/biliopancreatic diversion or as a stand-alone operation. Recently, it has been described as a revisional option for previous bariatric surgery failures. We report our early experience with LSG as a revisional procedure for failed LAGB. METHODS From January 2007 to April 2010, 46 patients, who had undergone LAGB, underwent LSG. Patient demographics, reason for band removal, interval between removal and LSG, operative times, estimated blood loss, complications, length of hospital stay, and percent of excess weight loss were collected. RESULTS Of the 46 patients, 20 (43%) had their bands removed before LSG (median time interval, 2 years; range, 2 months to 9 years); the rest had concomitant band removal and LSG. Twelve patients were men (26%). Mean age and BMI were 40 (range, 20-60) years and 43.1 kg/m(2) (range, 33-57), respectively. In two cases, surgery was converted to an open procedure due to extensive adhesions related to previous surgeries. Median operative time, estimated blood loss, and length of hospital stay were 118 (range, 70-250) minutes, 41 (range, 5-600) ml, and 3 (range, 1-100) days, respectively. Major morbidity was encountered in three patients (6%; leak in 2 and bleeding in 1). There were no mortalities. Mean follow-up time for our cohort is 17 (range, 1-39) months. Percent of excess weight loss at 2, 6, 12, 24, and 36 months was 24, 37, 53, 51, and 48%, respectively. CONCLUSIONS Our results suggest that LSG is safe, feasible, and effective as a revisional procedure for failed LAGB and can be considered as an appealing option in these cases. Larger series and longer follow-up are needed to confirm this.
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Affiliation(s)
- David Goitein
- Department of Surgery C, Chaim Sheba Medical Center, 56261, Tel Hashomer, Israel.
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Lanthaler M, Aigner F, Kinzl J, Sieb M, Cakar-Beck F, Nehoda H. Long-term results and complications following adjustable gastric banding. Obes Surg 2010; 20:1078-85. [PMID: 20496124 DOI: 10.1007/s11695-010-0190-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study was performed to assess our long-term results with laparoscopic gastric banding in patients with an observation period of at least 9 years calculated from the date of operation. Between January 1996 and December 2000, a total of 276 patients (83% female) underwent laparoscopic gastric banding at our institution. Mean preoperative body mass index (BMI) was 44 +/- 6 kg/m(2). BMI after 1, 5, 7, 9, and 10 years was 33 +/- 6, 30 +/- 6, 31 +/- 6, 32 +/- 7, and 31 +/- 7 kg/m(2), respectively. Mean excess weight loss after 1 year was 57.1 +/- 23.0% and after 5, 7, 9, and 10 years 73.2 +/- 29.6%, 65.9 +/- 29.3%, 61.8 +/- 32.8%, and 64.0 +/- 32.1%, respectively. Median completeness of follow-up was 80%. Of the study population, 146 (52.9%) patients had at least one complication requiring reoperation. Presently, only 148 (53.6%) patients still have their original band, 49 (17.8%) had their original band replaced with a new one, and 79 (28.6%) had their band removed. Thirty-three patients had no second bariatric operation, a Roux-en-Y gastric bypass was done in 39 patients, and six patients underwent sleeve gastrectomy. Our long-term results are good with regard to weight loss in those patients who still have their band in situ. This is accompanied by a high complication rate and a 29% band loss rate.
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Affiliation(s)
- Monika Lanthaler
- Department of Visceral, Transplantation and Thoracic Surgery, Centre for Operative Medicine, Innsbruck, Austria.
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Scholtz S, Le Roux C, Balen AH. The role of bariatric surgery in the management of female fertility. HUM FERTIL 2010; 13:67-71. [DOI: 10.3109/14647273.2010.492700] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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