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Richard M Peterson, MD MPH FACS Chief UT Medicine Center for Bariatric and Metabolic Surgery Director Christus Weight Loss Institute Assistant

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Richard M Peterson, MD MPH FACS

Chief – UT Medicine Center for Bariatric and Metabolic Surgery

Director – Christus Weight Loss Institute

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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

(4)

Laparoscopic sleeve

gastrectomy (LSG)

Restrictive procedure

Third most common

(5)

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?

(6)
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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

(8)

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

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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)

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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)

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• Scarred, thickened upper stomach

– Sleeve resection will appear wide at upper portion

– Careful not to squeeze too tightly against bougie

(18)

• Leave room to oversew

(19)

• 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

(20)

 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

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References

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