When sleeve gastrectomy fails: adding a laparoscopic adjustable gastric band to increase restriction

Abstract

The use of laparoscopic sleeve gastrectomy (LSG) as a procedure for morbid obesity has recently increased. The LSG procedure is used most often as a part of a biliopancreatic diversion with duodenal switch (BPDDS) or as a first stage that can be converted to a BPDDS or Roux-en-Y gastric bypass (RYGB). However, the surgical indications for LSG have rapidly expanded, and some centers use the sleeve as the primary operation for morbid obesity.The utility of LSG as a primary procedure is controversial, with consensus lacking in the literature. Whether the etiology of failed sufficient weight loss is the result of an inadequate sleeve or attributable to dilation or hypertrophy of the sleeve, the incidence of failed sleeve gastrectomies may be significant.In the treatment of a patient with a failed LSG, the options typically include creation of a tighter sleeve or conversion to biliopancreatic diversion or RYGB. These procedures, however, are complex and can carry significant morbidity.The authors report a case of a morbidly obese 42-year-old man who failed to lose sufficient weight after an LSG. Because the patient was dependent on several oral antipsychotic medications, he refused any malabsorptive procedure, and a decision was made to proceed with laparoscopic adjustable gastric banding (LAGB). The case proceeded successfully, and at this writing, 9 months after surgery, the patient has achieved a 57% excess weight loss from an original weight of 390 lb.The insertion of an LAGB into its normal anatomic position is feasible after a sleeve gastrectomy, and its use can induce sufficient restriction and weight loss results equivalent to those of a sleeve or band alone and possibly better.

Laparoscopic Adjustable Banded Sleeve Gastrectomy as a Primary Procedure for the Super-Super Obese (Body Mass Index > 60 kg/m2)

“…There has been a recent report of using human collagen as a band for sleeve gastrectomy at the primary operation [16]. Greenstein et al [17] recently reported placement of a laparoscopically inserted gastric band around the upper part of the stomach that had a previous sleeve gastrectomy that had become dilated and was associated with poor weight loss. At 9 months, the patient had a 57% loss of excess body weight, suggesting the utility of combining banding with sleeve gastrectomy.…”

Morbid Obesity and Sleeve Gastrectomy: How Does It Work?

“…In case of failure, conversion to biliopancreatic diversion or RYGB is the next option. Nowadays, usage of gastric band on the remaining gastric tube with success in EBWL has been reported [26,27].…”

Erosive Esophagitis after Bariatric Surgery: Banded Vertical Gastrectomy versus Banded Roux-en-Y Gastric Bypass

“…Removal of the principal site of ghrelin production leads to a decrease in ghrelin levels, adding a hormonal element to SRSG, that other restrictive procedures, such as adjustable gastric banding lack [13]. Some authors have reported the use of added restriction in SG to increase the intensity and duration of weight loss [6,14,15]. In addition, by placing a Silastic® ring around the stomach in all the patients in this study, both procedures were identical in terms of the portion of the stomach located above the ring.…”