Reoperation after laparoscopic adjustable gastric banding: analysis of a cohort of 500 patients with long-term follow-up

Silecchia, Gianfranco; Bacci, Vincenzo; Bacci, Sabrina; Casella, Giovanni; Rizzello, Mario; Fioriti, Mariachiara; Basso, Nicola

doi:10.1016/j.soard.2007.09.007

« Previous Next »Surgery for Obesity and Related Diseases
Volume 4, Issue 3 , Pages 430-436, May 2008

Reoperation after laparoscopic adjustable gastric banding: analysis of a cohort of 500 patients with long-term follow-up

Presented at the 24th Annual Meeting of the American Society for Bariatric Surgery, June 11–16, 2007, San Diego, California

Gianfranco Silecchia, M.D., Ph.D.
- Center for Minimally Invasive Treatment of Morbid Obesity, Policlinico Umberto I, University “La Sapienza,” Rome, Italy
Vincenzo Bacci, M.D.
- Dietology Unit, Department of Medical Clinics and Therapeutics, University “La Sapienza,” Rome, Italy
Sabrina Bacci, M.D., M.Sc.
- Department of Public Health Sciences, University “La Sapienza,” Rome, Italy
Giovanni Casella, M.D.
- Center for Minimally Invasive Treatment of Morbid Obesity, Policlinico Umberto I, University “La Sapienza,” Rome, Italy
Mario Rizzello, M.D.
- Center for Minimally Invasive Treatment of Morbid Obesity, Policlinico Umberto I, University “La Sapienza,” Rome, Italy
Mariachiara Fioriti, M.D.
- Center for Minimally Invasive Treatment of Morbid Obesity, Policlinico Umberto I, University “La Sapienza,” Rome, Italy
Nicola Basso, M.D.
- Center for Minimally Invasive Treatment of Morbid Obesity, Policlinico Umberto I, University “La Sapienza,” Rome, Italy

Received 15 May 2007; received in revised form 21 August 2007; accepted 18 September 2007. published online 29 January 2008.

Abstract

Background

To assess the rates and causes of reoperations in a long-term follow-up of a cohort of morbidly obese patients treated by laparoscopic adjustable gastric banding.

Methods

A retrospective study was performed to evaluate a cohort of 498 consecutive patients who had undergone laparoscopic adjustable gastric banding since 1996. The first 50 patients were excluded to avoid the learning curve bias. A perigastric technique was used until 2002 (37% of patients) and was then rapidly replaced by a pars flaccida approach. The patients who underwent band removal or port reposition/removal were considered, respectively, as having required a major or minor reoperation.

Results

Of the 448 patients (83% women) followed up for an average of 3.2 ± 2.2 years, 79 (mean age 37.7 years, mean body mass index 44.0 kg/m²) underwent repeat surgery between 1997 and 2006. Of these procedures, 29 were minor and 59 were major reoperations. Ten patients underwent band removal after a port complication developed. The main causes were pouch dilation (37%), insufficient weight loss (20%), erosion (20%), and psychological (15%). Ten patients underwent revisional surgery. A 13% incidence of major reoperations was observed for the entire group; the rate of major and minor reoperations was 4.1 and 2.1 interventions per 100 persons-years, respectively. In patients with follow-up >5 years (perigastric technique), the cumulative incidence reached 24%.

Conclusion

The need for a major reoperation appears to be substantial in patients who have undergone laparoscopic adjustable gastric banding, particularly when the long-term follow-up data are considered, and can occur at any point after surgery. More severe obesity (body mass index >50 kg/m²) seems to carry a greater risk of reoperation. These findings highlight the need for lifelong multidisciplinary management and surveillance for these patients.

Keywords: Morbid obesity, Bariatric surgery, Gastric banding, Complications, Long-term results