The Long-Term Effects of the Adjustable Gastric Band on Esophageal Motility in Patients Who Present for Band Removal

Tchokouani, Loic; Jayaram, Anusha; Alenazi, Naif; Ranvier, Gustavo Fernandez; Sam, Gina; Kini, Subhash

doi:10.1007/s11695-017-2842-z

Cited by 11 publications

(5 citation statements)

References 27 publications

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“…New-onset reflux symptoms after sleeve gastrectomy could be due to several pathophysiological changes, including increased intragastric pressure, esophageal dysmotility, decreased lower esophageal sphincter pressure and delayed gastric emptying [ 33 – 37 ]. While changes to esophageal motility after GB could have predisposed RLSG patients to increased risks of reflux symptoms [ 38 ], efforts were made to prevent these patients from undergoing RLSG in this surgical practice.…”

Section: Discussionmentioning

confidence: 99%

Medium Term Outcomes of Revision Laparoscopic Sleeve Gastrectomy after Gastric Banding: A Propensity Score Matched Study

et al. 2023

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Purpose Revision bariatric surgery may be undertaken after weight loss failure and/or complications following primary bariatric surgery. This study aims to compare the efficacy and safety of revision laparoscopic sleeve gastrectomy (RLSG) after gastric banding (GB) to those of primary laparoscopic sleeve gastrectomy (PLSG). Materials and Methods A retrospective, propensity-score matched study was conducted to compare between PLSG (control) patients and RLSG after GB (treatment) patients. Patients were matched using 2:1 nearest neighbor propensity score matching without replacement. Patients were compared on weight loss outcomes and postoperative complications for up to five years. Results 144 PLSG patients were compared against 72 RLSG patients. At 36 months, PLSG patients had significantly higher mean %TWL than RLSG patients (27.4 ± 8.6 [9.3–48.9]% vs. 17.9 ± 10.2 [1.7–36.3]%, p < 0.01). At 60 months, both groups had similar mean %TWL (16.6 ± 8.1 [4.6–31.3]% vs. 16.2 ± 6.0 [8.8–22.4)]%, p > 0.05). Early functional complication rates were slightly higher with PLSG (13.9% vs. 9.7%), but late functional complication rates were comparatively higher with RLSG (50.0% vs. 37.5%). The differences were not statistically significant (p > 0.05). Both early (0.7% vs 4.2%) and late (3.5% vs 8.3%) surgical complication rates were lower in PLSG patients compared to RLSG patients but did not reach statistical significance (p > 0.05). Conclusion RLSG after GB has poorer weight loss outcomes than PLSG in the short-term. Although RLSG may carry higher risks of functional complications, the safety of RLSG and PLSG are overall comparable. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Medium Term Outcomes of Revision Laparoscopic Sleeve Gastrectomy after Gastric Banding: A Propensity Score Matched Study

et al. 2023

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“…This raises the question as to whether all patients who have failed LAGB should undergo HRM in addition to standard studies like EGD prior to revisional surgery. Tchokouani et al [27] recently reported on the preoperative HRM results of 25 patients with LAGB failures requiring revisional surgery; 72% of patients had intact bands at the time of HRM, and all patients with food intolerance had their bands deflated prior to HRM. The threshold for normal esophageal motility was set at > 70% peristalsis based on the Chicago classification system [27].…”

Section: Discussionmentioning

confidence: 99%

“…Tchokouani et al [27] recently reported on the preoperative HRM results of 25 patients with LAGB failures requiring revisional surgery; 72% of patients had intact bands at the time of HRM, and all patients with food intolerance had their bands deflated prior to HRM. The threshold for normal esophageal motility was set at > 70% peristalsis based on the Chicago classification system [27]. Overall, 40% of patients were found to have esophageal dysmotility irrespective of the presence of obstructive symptoms; the authors recommended routine preoperative HRM for the management of all LAGB failures.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Adjustable Gastric Band Failures and Literature Review: Algorithm for Removal and Conversion

Hechenbleikner

Dong

Kini

et al. 2020

SN Compr. Clin. Med.

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Adjustable gastric band (AGB) failures frequently require conversion to sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB); the ideal conversional procedure is not established. We report on management of AGB failures at a university hospital along with literature review and proposed treatment algorithm. From October 2012 to January 2017, 32 patients underwent laparoscopic AGB removal with conversion to SG (n = 23) or RYGB (n = 9). Patient characteristics and outcomes were abstracted from medical records and a quality improvement database. Twenty-three patients (71.9%) were female with mean age of 43 ± 10.6 years and mean BMI of 42.7 ± 5.9 kg/m2; 62.5% (n = 20) had 2-staged conversion while 37.5% (n = 12) had 1-stage conversion to SG/RYGB. GERD significantly increased likelihood of conversion to RYGB vs. SG (44.4% vs. 0, p = 0.03). Preoperative diagnostics included upper gastrointestinal series (n = 15,46.7%), esophagogastroduodenoscopy (n = 32,100%), and high-resolution esophageal manometry (HRM) (n = 11,34.4%). Overall complication rate was 9.4% (n = 3). AGB-to-SG patients had mean % total body weight loss of 17.0% ± 5.9 compared to 28.3% ± 15 in AGB-to-RYGB, and mean follow-up of 11.7 ± 12.9 months compared to 18.9 ± 14.4 months. Validated criteria for conversional procedure selection following AGB failure do not exist; appropriate procedure selection requires thorough workup. Future research may elucidate the role of HRM in the diagnostic armamentarium.

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“…The findings of increased intrabolus pressure on HRM have also been shown to correlate with the presence of dysphagia and regurgitation symptoms in LAGB patients [24]. However, patients with esophageal dysmotility after LAGB are often asymptomatic, and there has been no correlation found between the presence of symptoms and esophageal dysmotility [25]. Thus, the clinician's threshold to obtain HRM should be low in patients with a prior history of LAGB.…”

Section: Laparoscopic Adjustable Gastric Banding and Esophageal Motilitymentioning

confidence: 99%

Impact of bariatric surgery on gastroesophageal reflux disease and esophageal motility

Nguyen

2021

Current Opinion in Gastroenterology

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Purpose of reviewObesity is rapidly increasing in prevalence, and bariatric surgery has become a popular treatment option that can improve all-cause mortality in obese individuals. Gastroesophageal reflux disease (GERD) and esophageal motility disorders are common in the obese population, and the effects of bariatric surgery on these conditions differ depending on the type of bariatric surgery performed.Recent findingsLaparoscopic adjustable gastric banding has declined in popularity due to its contributions to worsening GERD symptoms and the development of esophageal dysmotility. Although laparoscopic sleeve gastrectomy (LSG) is the most popular type of bariatric surgery, a comprehensive assessment for acid reflux should be performed as LSG has been linked with worsening GERD. Novel methods to address GERD due to LSG include magnetic sphincter augmentation and concomitant fundoplication. Due to the decreased incidence of postoperative GERD and dysmotility compared to other types of bariatric surgeries, Roux-en-Y gastric bypass should be considered for obese patients with GERD and esophageal dysmotility.SummaryBariatric surgery can affect esophageal motility and contribute to worsening or development of GERD. A thorough workup of gastrointestinal symptoms before bariatric surgery should be performed with consideration for formal testing with high-resolution manometry and pH testing. Based on these results, the choice of bariatric surgery technique should be tailored accordingly to improve clinical outcomes.

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The Long-Term Effects of the Adjustable Gastric Band on Esophageal Motility in Patients Who Present for Band Removal

Abstract: Patients with a history of LABG can have esophageal dysmotility whether they are symptomatic or asymptomatic. Based on existing literature, we recommend pre-operative manometry in these patients requesting revisional surgery.

Cited by 11 publications

References 27 publications

Medium Term Outcomes of Revision Laparoscopic Sleeve Gastrectomy after Gastric Banding: A Propensity Score Matched Study

Medium Term Outcomes of Revision Laparoscopic Sleeve Gastrectomy after Gastric Banding: A Propensity Score Matched Study

Surgical Management of Adjustable Gastric Band Failures and Literature Review: Algorithm for Removal and Conversion

Impact of bariatric surgery on gastroesophageal reflux disease and esophageal motility

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