The fate of laparoscopic adjustable gastric band removal

Background: Long-term complications and lack of weight loss have caused a surge in laparoscopic adjustable gastric band (LAGB) removal. This study reviews the trend of LAGB removal and examines outcomes of patients undergoing subsequent revision bariatric surgery at a single tertiary care centre in Canada. Methods: All LAGB removals performed between January 2008 and December 2016 were reviewed. A subset of patients who underwent revision surgery was then analyzed for patient demographics, weight, body mass index and postoperative complications. Results: During the study period, 211 patients underwent LAGB removal (87.7% female). Most bands were inserted out of province. Reasons for band removal included dysphagia, band slip and weight recidivism. Fifty-nine patients (28%) underwent revision surgery at a mean of 12.8 +/- 9.3 (range 0-55) months after LAGB removal. Mean age was 47 +/- 9.7 (range 26-63) years, and mean pre-LAGB weight was 131.0 +/- 30.0 kg. Following LAGB, the mean weight decreased to 120.5 +/- 26.4 kg, but most regained weight after removal to a mean prerevision weight of 125.1 +/- 27.0 kg. The lowest mean weight was achieved 12 months after revision surgery (98.7 +/- 30.2 kg). The mean percent total weight loss was not significantly different after revision laparoscopic Roux-en-Y gastric bypass compared with revision laparoscopic sleeve gastrectomy (22.8 +/- 9.6% v. 17.5 +/- 6.5%, p = 0.179). The overall revision surgery 30-day complication rate was 18.6% and increased to 23.7% long-term. No deaths occurred. Conclusion: The number of LAGB removals is increasing. Revision bariatric surgery leads to improved weight loss; however, revision surgery is associated with complications.