Sleeve gastrectomy is an attractive option when complications or failure of weight loss occurs after Lap-Band surgery, according to results from a study presented at the annual meeting of the American Society for Metabolic and Bariatric Surgery.
The Lap-Band has a proven track record for the majority of patients, yet for some it does not lead to a successful outcome. Complications or unsatisfactory weight loss may lead a patient to consider other options, including revision to another bariatric procedure.
One alternative that is quickly becoming popular among patients who are struggling with the Lap-Band is a revision to sleeve gastrectomy. This study shows that the laparoscopic removal of the Lap-Band and reversal to sleeve gastrectomy is a safe and feasible option.
For this study, Dr. Hawasli and his associates at St John Hospital and Medical Center in Detroit and Beaumont Hospital in Grosse Pointe, Michigan evaluated all patients who underwent a reversal of Lap-Band to sleeve gastrectomy from January 2004 to October 2011.
During the study period, 489 patients underwent Lap-Band placement. Of these patients, 34 (7%) had a reversal of Lap-Band to sleeve gastrectomy. The band to sleeve patients were divided into two groups depending on whether the reversal was due to complications (Group 1 = 20 patients, slippage in 15 cases, erosion in 3 cases, and infection in 2 cases) or for dissatisfaction with weight loss (Group 2 = 14 patients). The majority of patients (32) underwent band removal and sleeve gastrectomy in one operation while 2 patients underwent a staged procedure.
The time before reversal was 36.5 months due to slippage, 22.7 months due to erosion, 13.5 months due to infection, and 43.3 months due to dissatisfaction with weight loss.
The mean operative time was 159 minutes for patients with Lap-Band slippage and 174 minutes for patients with Lap-Band erosion or infection, and 106 minutes for group 2 patients.
Length of stay in the hospital was about two days in both groups, although patients undergoing a reversal due to erosion or infection reached a mean length of stay of about 3-1/2 days.
In group 1, there were two complications (one leak and one narrowing, both treated conservatively) and no readmissions. In group 2, there were no complications and two readmissions (one for nausea and one for dehydration). Dr. Hawasli said the simultaneous removal of the band and reversal to sleeve gastrectomy did not appear to increase the risk of complications except in patients with erosion, who may benefit better from a staged reversal.
All patients lost weight after the reversal, although the total BMI lost during the study period was greater in group 1 (mean BMI loss, -15.9) than in group 2 (mean BMI loss, -11.9). Patients in group 1 lost more weight before the reversal (mean BMI loss, -11.7) than after the reversal (mean BMI loss, -3.8); patients in group 2 lost more weight after the reversal (mean BMI loss, -8.0) than before the reversal (mean BMI loss, -3.6).
Weight loss results were expected, said Dr. Hawasli, as group 2 patients struggled with weight loss before the reversal. He further explained that the patients in group 2 did not get enough time to lose more weight, due to the short post-reversal follow-up period (a mean of 9 months).
As concluded by Dr. Hawasli in his study, “sleeve gastrectomy is an attractive option for reversal of the Lap-Band either after complication or failure of weight loss.”
Source References: “Reversal of Lap-Band to Sleeve Gastrectomy Feasible,” Clinical Endocrinolgy News, July 18, 2012; “Laparoscopic Reversal of Lap-Band to Sleeve Gastrectomy,” Abdelkader A. Hawasli, MD, PL-127, ASMBS 29th Annual Meeting.
