Revisional Adjustable Gastric Band in Roux-en-Y Gastric Bypass—Is It Worth It?

Abstract

Purpose A subset of patients undergoing Roux-en-Y gastric bypass (RYGB) presents with either insufficient weight loss or weight regain. Data on the revisional restrictive options including laparoscopic adjustable gastric band (LAGB) is scarce. This study analyzes the mid-term efficacy and safety of LAGB as a revisional procedure after RYGB. Methods Data of all patients with revisional LAGB after primary RYGB between January 2011 and May 2019 were retrospectively reviewed. Outcomes included assessment of weight changes, resolution of comorbidities, and early and late complications during the study period. Results Twenty patients were included. The median Body Mass Index (BMI) before revisional LAGB was 34.8 (interquartile range [IQR] 31.9–38.1) kg/m2. After a median follow-up of 33.5 (IQR 19.5–76.5) months, the median BMI was 28.7 (IQR 26.1–32.2) kg/m2. The median additional Excess Weight Loss (EWL) was 37.6% (IQR 23–44.4), leading to a median total EWL of 79.5% (IQR 54.4–94.6). BMI and EWL post-LAGB improved significantly compared to BMI and EWL pre-LAGB (p<0.001 and p<0.001, respectively). Obstructive sleep apnea syndrome resolved 6 months after LAGB in one patient. Three band deflations occurred during the follow-up. Six patients underwent band removal after a median time of 19 (IQR 15.8–26) months. Overall, thirteen patients underwent a reoperation. There was no loss of follow-up until 5 years. After that, two patients were lost to follow-up. Conclusion LAGB may be a salvage option after failed RYGB. However, the high rate of revisions after secondary LAGB needs to be taken into consideration.

Gastric Banding with Previous Roux-en-Y Gastric Bypass (Band over Pouch): Not Worth the Weight

“…These results are consistent with previous evidence on EWL outcomes with this salvage procedure. 10 – 17 Importantly, there is paucity of data on long-term outcomes with LAGB after failed RYGB. Median/mean follow-up in previous studies ranges from 14 months to 33.5 months.…”

“…Median/mean follow-up in previous studies ranges from 14 months to 33.5 months. 10 – 17 Liu et al followed 20 patients (out of 86 study participants) for 5 years and reported a 65.9% EWL. 15 The series with the longest overall follow-up (33.5 months) by Lazardis et al reported a 37.6% EWL, which is comparable to our EWL outcomes at 4 years of 28.2%.…”

“… 15 The series with the longest overall follow-up (33.5 months) by Lazardis et al reported a 37.6% EWL, which is comparable to our EWL outcomes at 4 years of 28.2%. 10 …”

“… 1 – 3 Surgical and endoscopic options in this scenario include revision of gastric bypass with changes in alimentary or biliopancreatic limb, limb distalization, pouch resizing, LAGB, reduction in gastrojejunal stoma, and transoral gastric outlet reduction (TORe), among others. 10 , 11 , 19 – 23 While some of these procedures such as revision of RYGB and pouch resizing are effective, the associated pitfalls such as creation of new anastomosis, re-operation in a previous surgical field, micronutrient deficiencies, protein calorie malnutrition and even need for parenteral nutrition cannot be overlooked. 20 , 21 Given that reduction in gastrojejunal stoma has suboptimal EWL outcomes, possibly secondary to redilatation of stoma over time, TORe is likely to have similar outcomes.…”

“…Despite the theoretical plausibility of this procedure, there is paucity of evidence on its effectiveness, especially long term EWL, outcomes regarding resolution of comorbid conditions, and safety. 10 – 17 This study aims to assess the effectiveness and safety of band over pouch as a revisional procedure in patients with failure after initial RYGB procedure.…”