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Revision of failed Gastric Band Surgery

The gastric band surgery (ring), was one of the most popular procedure in the last decade. Recently, more studies have shown its poor results on the long term, with a high complication rate. The current trend is now to convert the failed gastric band surgeries to another bariatric procedure, adding some metabolic component or some malabsorption. At Advanced BMI we do offer the laparoscopic revisional surgery for the gastric band on a frequent basis. We convert the gastric band surgery to gastric sleeve or to gastric bypass. Both procedures have excellent results on the short term and on the long term (more than 3 years). But what is important to keep in mind, is that after any gastric band surgery that you have done, you are supposed to have a sliding hiatal hernia. During the revision surgery, the key of success is to repair this hiatal hernia, and to dissect the lower part of the esophagus, in order to get a complete normal anatomy, before performing the sleeve gastrectomy or the gastric bypass. This is the most frequent and important reason of failure of any revision surgery. Dr Nagi Safa is highly specialized in the revision surgeries, and have performed hundreds of laparoscopic revisional surgeries. He is one of the pioneers to have converted the gastric band surgery to gastric sleeve surgery, by removing the band and cutting the stomach at the same time. He have published in 2012 with his team in Canada, the largest study in the world about the gastric band removal and sleeve gastrectomy as single procedure (Laparoscopic Sleeve Gastrectomy (LSG)—A Good Bariatric Option for Failed Laparoscopic Adjustable Gastric Banding)

Video of a Gastric Band Surgery Revision in Lebanon

Conversion of a failed gastric band to a gastric sleeve.

What are the options?

Patients with Lap Band may need revision weight loss surgery for a number of reasons.

  • The Lap Band may slip leading to a slow chronic or an acute condition requiring emergency surgery. This leads to the Lap Band malfunction. These issues may require removal, repositioning or replacement the Lap Band all together. Removal of the Lap Band obviously has a risk of a potential weight regain.
  • The Lap Band erosion is another complication of Lap Band surgery. Lap Band erosion develops when the Lap Band produces a hole to be worn into the stomach wall, rendering the Lap Band ineffective. Patients might experience an episode of vomiting blood as the first signal of Lap Band erosion. The most frequent symptom observed in Lap Band erosion is the infection around the site of the port. Due to this erosion, saliva leaks through the hole in the stomach wall and flows along the tubing of Lap Band, so the tissue under the skin of the port to gets infected. Treatment requires the removal of the Lap Band, leaving a patient with no weight loss surgery and a high possibility of regain of weight. It is being recommended that to treat Lap Band erosions by converting the patient to some Vertical Sleeve Gastrectomy based procedure; this can be the Vertical Sleeve Gastrectomy itself, or gastric bypass. Since the portion of stomach that has been eroded is weak and more prone to leakage, these weight loss surgical procedures can be completed with a little cutting to the eroded area.
  • The Lap Band may fail to produce the desired results, so require revision of surgery. Lap Band is a restrictive weight loss surgical procedure and a few patients may not be having the metabolism needed for losing weight with the Lap Band. Some patients may not be able to eat the way that is needed to achieve the goals after Lap Band. This may lead to maladaptive eating behaviours ultimately resulting in failure of surgery and /or weight regain. Lap Band Surgery failures may be converted into any other weight loss surgery but a patient will more likely achieve a success if a more metabolically active procedure is performed in place of a purely restrictive weight loss surgery.

For a patient who wants a restrictive weight loss surgery, Vertical Sleeve Gastrectomy is one of the best options. Vertical Sleeve Gastrectomy is limited by the metabolic activity of the surgery itself, in addition to the patient’s metabolism, but there are several other reasons why the Vertical Sleeve Gastrectomy can produce better results than the Lap Band over the time. As mentioned previously, Duodenal Switch and gastric bypass are two different weight loss surgical procedures that offer patient’s metabolic mechanisms to cause weight loss in addition to restriction. If one is willing to undergo gastric bypass or Duodenal Switch, these surgical procedures will offer weight loss advantages beyond what the Lap Band can possibly offer.