Revisional Surgery After a Failed Gastric Band

The Problem with The Gastric Band

Gastric banding was a popular weight loss operation. The short-term results were good in terms of operative death rate, complications, weight loss and health benefits. However, the long-term results are disappointing in most patients with failure to reach or maintain adequate weight loss in 40-60%, band related complications such was slippage, erosion and prolapse, and patient intolerance. Gastric band removal alone is almost always associated with rapid return to presurgery weight.

Sleeve gastrectomy is quickly becoming the most commonly performed weight loss operation worldwide. It is also becoming a favoured option for patients with failed gastric band.

 

 

Gastric Bands are Removable but Not Truly Reversible!

Proponents of the gastric band often argue that one of the advantages of the gastric band is being reversible since the band can be removed should problems occur. While it is true that the band can be removed, the stomach does not return back to normal after removing the band. A thick band of scar remains on the top part of the stomach where the band was sitting. In addition, suturing the stomach over the band during placement of the band leaves a tunnel after removing the band. This tunnel and scar tissue can compromise the success and safety of further weight loss operations such as sleeve gastrectomy and gastric bypass. For this reason gastric bands showed be viewed as removal but not reversible and this should be taken into consideration before deciding on having gastric band surgery.
There is a growing scientific evidence that waiting 3-6 months after removing the gastric band allows the stomach to recover and the scar tissue to soften before undergoing an alternative weight loss operation. This reduces the complication rate of future operations. 

  

Our Approach for Converting Gastric Bands to Sleeve Gastrectomy

We use the safer two stage approach:

1. Stage One: The gastric band is removed and the tunnel is dissected. An anti-adhesion material applied between the stomach and liver to reduce adhesions. The operation is done at no cost to patients (for insured patients)
2. Waiting for 3 months during which adherence to healthy eating habits and exercise is important to limit weight regain.
3. Placement on Very Low Calorie Diet for 2-3 weeks before the sleeve gastrectomy operation as in other patients having the sleeve operation. This is to reduce the fat in the liver and around stomach to facilitate the operation. 
4. Stage Two: Sleeve Gastrectomy with our standard technique of reinforcing and suturing of the entire staple line.

 

What are the advantages of converting from gastric band to sleeve gastrectomy?

1. Weight loss of 50-60% of excess weight*. (* Results may vary from person to person). This is slightly less than patients having sleeve gastrectomy from beginning
2. Normal sensation of fullness after eating rather than feeling obstructed
3. Better appetite suppression due to removal of source of production of the hunger hormone, Ghrelin
4. Quick recovery
5. No intestinal bypass and no malabosorption

What are the disadvantages of converting from gastric band to sleeve gastrectomy?

1. Require two operations in most patients. One to remove the band and the second to perform the sleeve
2. Higher leak rate of 5%. Due to the scarring and thickening where the band was sitting, the risk of staple line leak increases 3-5 times
3. Slightly less excess weight loss
4. Slightly higher risk of postoperative acid reflux