Laparoscopic Associates of San Francisco

Adjustable gastric band to sleeve conversions/revisions

September 18th, 2010 Posted in Bariatric surgery, LapBand, Realize Band, surgical weight loss, Vertical gastrectomy, weight loss plan, weight loss surgery, Weight loss surgery results

As the popularity of adjustable gastric banding has increased in the United States, so have the problems associated with this approach to weight loss.  Issues with band slips, erosions and most commonly inadequate weight loss surgery results or weight regain have become an increasing problem which weight loss surgery physicians must now address.

Long-term data on the success of the adjustable gastric band (LapBand® and Realize® Band ) has shown consistent results with regards to surgical weight loss.  Published studies in bariatric laparoscopic surgery report average percentage excess weight loss (%EWL) of 30%-60%, but vary widely.   The most accurate reports appear to indicate a range of 40%-55% EWL in patients who have been followed for more than 5 years.  Perhaps a more important issue (and more neglected) is the long-term complication and failure rate of these devices.  Some reports in the literature looking at results in patients 8-10 years after surgery report up to a 25% explantation (removal) rate, 6-10% rate of reoperation to address complications and 40% failure rate.  With more than 400,000 adjustable gastric bands implanted worldwide, this stands to become a sizable problem.

Because of these issues, forward-thinking bariatric surgeons have implemented strategies and algorithms to deal with failures and complications of these devices.  Dr. Paul Cirangle, a pioneer of and one of the world’s experts on the Vertical Sleeve Gastrectomy (VSG), deals with conversions from the adjustable gastric band (AGB) to the Sleeve Gastrectomy on a frequent basis.  He has recently reviewed his extensive bariatric surgery experience with these conversions and has found some very interesting findings.  The incidence of patients complaining of “troubled eating” (pain with swallowing, regurgitation, heartburn or reflux) was extremely high (>60%), even in individuals who were successful in losing weight with the band.  Among those who were not successful in losing an adequate amount of weight, many stated that dense foods were so uncomfortable to consume. This results in gravitating towards softer foods such as mashed potatoes and pasta, making it essentially impossible for them to reach their surgical weight loss goals.

In the time period between July 2005 and July 2010, 69 adjustable gastric bands have been revised to a Vertical Sleeve Gastrectomy.  The results in terms of %EWL, reduction of appetite and overall sense of satiety have been excellent – essentially the same as in patients undergoing a sleeve gastrectomy as a primary procedure.   When asked about the subjective difference, all patients concurred that the VSG produced little or no episodes of “troubled eating” and was universally superior in regards to satiety and suppression of appetite in comparison to the AGB.

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