Several demographic factors including comorbidities, insurance status, and employment may significantly affect weight loss patterns following LSG. Further studies are needed to evaluate whether demographic differences impact long term weight loss. Differences in outcomes based on patient demographics may be beneficial in the planning of the allocation of healthcare resources.

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Introduction: Laparoscopic adjustable gastric banding (LAGB) has a potential for long-term complications. We report a case of LAGB slippage with extensive gastric necrosis managed with emergent sleeve gastrectomy.Case Report: A 45-year-old man presented to the emergency department after returning from a distant trip and reported a 3-day history of progressively severe abdominal pain, nausea, vomiting, and fever. He had undergone placement of the LAGB 2 years before this presentation, which resulted in subsequent weight loss of 143 lb and resolution of his comorbidities. On admission, the patient was hypotensive, tachycardic, and oliguric, with evident peritonitis. A computed tomography scan revealed extensive intraperitoneal free air and intra-abdominal fluid. After intravenous fluid resuscitation, he underwent emergent exploratory laparoscopy. A slipped band with gastric prolapse and extensive gastric necrosis were found, with multiple perforations involving most of the greater curvature of the stomach. The LAGB was explanted and a laparoscopic sleeve gastrectomy was performed. A liquid diet was introduced on postoperative day 4. Immediate recovery was prolonged because of acute-onset chronic renal failure and requirement for optimization of nutrition. The patient was discharged home on postoperative day 13 and had a subsequent uneventful recovery. Conclusion:Gastric prolapse complicated by gastric necrosis is a rare life-threatening complication of LAGB. Once acute LAGB slippage is suspected, urgent attention and treatment are needed to minimize the chance of gastric ischemia. Laparoscopic explanation of LAGB and emergent sleeve gastrectomy may be considered in similar clinical settings to optimize the outcome and minimize the morbidity of near total or total gastrectomy.

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Background and Objectives:Prior studies have established a 1.7–4.33% readmission rate for laparoscopic sleeve gastrectomy (LSG), a rate that falls within the reported range for other bariatric procedures. The current report describes the incidence of 30-day readmission after primary LSG procedures performed at a single bariatric center of excellence (COE) and examines factors that may be associated with readmission.Methods:Data on 343 consecutive LSG operations performed from February 2010 to May 2014 by a single surgeon (PG) were analyzed. Patients readmitted within 30 d were compared to the remaining patients by using Student's t test for continuous variables and the χ2 test for categorical variables.Results:All LSGs were completed laparoscopically with no conversions to open procedures. There were no reoperations, leaks, perioperative hemorrhages, or mortalities. Twelve patients (3.5%) were readmitted; 1 was readmitted twice. There were no identified risk factors for readmission, including patient demographics, comorbidities, and perioperative factors. Notably, 7 (7%) readmissions occurred in the initial 100 patients and 5 (2%) in the remaining 243 patients (P = .04). Clinical pathways were modified after the initial 100 patients; routine contrast esophagograms were no longer performed, and a 1-day routine postoperative stay was adopted. Operative time also decreased from 94.2 ± 23.8 to 78.2 ± 20.0 min (P < .001).Conclusions:Readmission rates after LSG remain in a range similar to those described for other laparoscopic bariatric procedures. Larger prospective studies are needed to identify patterns of complications and readmissions in patients undergoing LSG that may differ from other bariatric procedures.