Richard M Peterson, MD MPH FACS
Chief – UT Medicine Center for Bariatric and Metabolic Surgery
Director – Christus Weight Loss Institute
Laparoscopic adjustable
gastric banding (LAGB)
◦
Restrictive weight loss
procedure
◦
Removable
◦
Failure of weight loss,
removal, or revision in up to
half of cases
1
1 - Boza C, Gamboa C, Perez G, et al. Laparoscopic adjustable gastric banding (LAGB): surgical results and 5-year follow-up. Surg Endosc. (2011) 25:292–297
Laparoscopic sleeve
gastrectomy (LSG)
◦
Restrictive procedure
◦
Third most common
What to do for the LAGB patient with failure
of weight loss?
◦
Roux-en-Y Gastric Bypass
◦
Biliopancreatic Diversion
◦
Vertical Sleeve Gastrectomy
◦
Future Direction
Plication?
Our criteria for offering band to sleeve
conversion:
◦
At least 12 mos post-LAGB
◦
Good-faith effort at diet, exercise
◦
LAGB adjusted to restriction
◦
Cessation of weight loss or weight re-gain
◦
BMI still >40 or >35 with comorbidities
IRB-approved retrospective review
LAGB to LSG conversions 7/2009-9/2010
6 laparoscopic AGB removal with LSG
conversion for weight loss failure
◦
Denominator: 82 in 3 yr (7.3%)
4 additional LAGB referred into program
requiring conversion
Band to sleeve conversion cohort (n=10)
Mean
± SD
Range
Age
48.1
± 9.4
(28-57)
Time from LAGB to LSG (mos)
23.3
± 5.9
(14-141)
Pre-LAGB BMI
41.2
± 1.7
(38.7-43.5)
Pre-LSG BMI
37.1
± 1.6
(35.1-40.5)
12m postop BMI
31.2
± 3.3
(26.7-34.2)
OR Time (minutes)
152.1
± 26.9
(95-196)
1 month
3 month
6 month
12 month
Mean
± SD
Mean
± SD
Mean
± SD
Mean
± SD
%EWL
20.1
± 3.8
29.7
± 7.4
40.8
± 11.4
38.4
± 16.9
%EBMIL
27.1
± 5.6
40.9
± 10.9
55.2
± 16.8
50.8
± 24.1
• No leaks, DVT/PE, or mortality
• Morbidity: 10% (1 pt returned to OR for postoperative
bleeding)
• Scarred, thickened upper stomach
– Sleeve resection will appear wide at upper portion
– Careful not to squeeze too tightly against bougie
• Leave room to oversew
• Lap AGB to sleeve conversion is safe and feasible
• Stomach is scarred and thickened
• %EWL and %EBMIL less than with primary
sleeve…
• But patients can have additional meaningful
weight loss
Boza C, Gamboa C, Perez G, et al. Laparoscopic adjustable gastric banding (LAGB): surgical
results and 5-year follow-up. Surg Endosc 2011; 25:292–29
Lee CM, Cirangle P, Jossart G. Vertical gastrectomy for morbid obesity in 216 patients: report of
two-year results. Surgical Endoscopy 2007; 21(10):1810-1816
Bernante P, Foletto M, Busetto L, et al. Feasibility of laparoscopic sleeve gastrectomy as a
revision procedure for prior laparoscopic adjustable gastric banding. Obes Surg 2006;16:1327-1330
Acholonu E, McBean E, Court I, et al. Short-term outcomes of laparoscopic sleeve gastrectomy
as a revisional approach for failed laparoscopic adjustable gastric banding in the treatment of morbid obesity. Obes Surg 2009;19:1612-1616
Foletto M, Prevedello L, Bernante P, et al. Sleeve gastrectomy as revisional procedure for failed
gastric banding or gastroplasty. Surg Obes Rel Dis 2010;6:146-151
Frezza EE, Jaramillo-de la Torre EJ, Enriquez CC, et al. Laparoscopic sleeve gastrectomy after
gastric banding removal: a feasibility study. Surg Innovation 2009;16(1):68-72
Gagner M, Gumbs AA. Gastric banding: conversion to sleeve, bypass, or DS. Surg Endosc
2007;21:1931-1935
Himpens J, Schepper MD, Dapri G. Laparoscopic conversion of adjustable gastric banding to
sleeve gastrectomy: a feasibility study. Surg Laparosc Endosc Percutan Tech 2010;20:162-165
Dapri G, Cadiere GB, Himpens J. Feasibility and technique of laparoscopic conversion of
adjustable gastric banding to sleeve gastrectomy. Surg Obes Rel Dis 2009;5:72-76
Iannelli A, Schneck AS, Ragot E, et al. Laparoscopic sleeve gastrectomy as revisional procedure
for failed gastric banding and vertical banded gastroplasty. Obes Surg 2009;19:1216-1220
van Wageningen B, Berends FJ, Van Ramshorst B et al. Revision of failed laparoscopic adjustable
gastric banding to Roux-en-Y gastric bypass. Obes Surg 2006; 16: 137-41
Uglioni B, Wölnerhanssen B, et al. Midterm results of primary vs. secondary laparoscopic sleeve
gastrectomy (LSG) as an isolated operation. Obes Surg 2009; 19(4): 401-6
Goitein D, Feigin A, et al. Laparoscopic sleeve gastrectomy as a revisional option after gastric