Failed Restrictive Surgery: Is Sleeve Gastrectomy a Good Revisional Procedure?

Abstract

The aim of this study is to evaluate the safety and efficacy of converting failed restrictive procedures such as laparoscopic adjustable gastric banding (LAGB), non-adjustable gastric banding (NAGB), and vertical banded gastroplasty (VBG) to laparoscopic sleeve gastrectomy (LSG). A prospective database was maintained of 32 patients who failed restrictive procedures. Twenty-six patients failed LAGB, three patients failed NAGB, one of which was performed open, and three patients failed VBG. These patients were converted to LSG between January 2006 and May 2010. Post-conversion outcomes, BMI, and excess weight loss (EWL) were recorded. Four patients were excluded from the weight loss statistical data secondary to short follow-up (less than 6 months since conversion); however, these patients were included in the overall number of cases and in the discussion of complications. Causes of failed restrictive procedures in our series include inadequate weight loss, 15 (47%); weight gain, six (19%); slippage, five (16%); esophageal dilatation, one (3%); unhappy with device, one (3%); tear of silastic ring, one (3%); infection, one (3%), gastrogastric fistula with VBG and weight gain, one (3%); and intractable nausea and vomiting, one (3%). The average hospital stay was 1.5 days (range, 1-3). The average length of follow-up was 26 months. The mean pre-conversion BMI was 42.69, post-conversion to SG mean BMI was 33.3, mean EWL pre-conversion was 10%, and post-conversion mean EWL was 60%. There was no mortality, no conversion to open, and there was one complication, a contained leak resolved by antibiotic treatment. Conversion to LSG from a prior restrictive procedure may be a feasible and acceptable alternative for patients. Average EWL was 60% at an average of 26 months.

Carbohydrate Content of Post-operative Diet Influences the Effect of Vertical Sleeve Gastrectomy on Body Weight Reduction in Obese Rats

“…Failure of VSG in humans is reflected by body weight regain which typically occurs after 1 or 2 years of follow-up [15]. In our rat model, weight regain after VSG occurred much faster which can most likely be attributed to the overall faster metabolic response to dietary manipulations in rodents.…”

Feasibility and Safety of Conversion Sleeve Gastrectomy after Failed Primary Adjustable Gastric Banding or Sleeve Gastrectomy

“…The overall post-CSG leakage rate was 13.7%, but patients who underwent the two-stage operation did not develop leakage [29]. Another study that analyzed patients with one-stage operations reported only one complication, which was a contained leak that resolved after antibiotic treatment [30]. None of the patients in our study developed a stapler line leakage.…”

“…The leak rate is reportedly higher after revision of AGB into SG -this procedure involves stapling over scarred tissue, a longer stapler line, and dissection at the left crus, which can jeopardize the blood supply at the gastroesophageal junction [24][25][26][27]. However, several studies have demonstrated SG's feasibility as a revision procedure [28][29][30]. The overall post-CSG leakage rate was 13.7%, but patients who underwent the two-stage operation did not develop leakage [29].…”

Revisional laparoscopic sleeve gastrectomy in failed gastric banding and effects of exercise and frequent sweet-eating on its outcome

“…It is usually advocated that a restrictive procedure should be converted to malabsorptive, like gastric bypass or biliopancreatic diversion with or without duodenal switch, if revision is required 9. But many studies have shown successful conversion of LAGB to LSG with promising results in terms of weight loss 10,11. LAGB is not found appropriate bariatric procedure in super-obese patients.…”