Surgery (RMH) - Theses

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    Weight loss after reoperations for laparoscopic adjustable gastric banding
    Beitner, Melissa Mary ( 2012)
    Background: Reoperation after laparoscopic adjustable gastric banding occurs with relative frequency and this is often cited as a major weakness of the procedure. There are currently no guidelines for the best reoperative procedure in these cases. Few studies report weight loss after reoperation, especially after band salvage procedures, despite being a critical factor in deciding which reoperative procedure to select. This study aims to assess the impact of major reoperations after laparoscopic adjustable gastric banding on weight loss at 12 and 24 months and on patient satisfaction with the procedure. Methods: An analysis of New York University Langone Medical Centre’s prospectively collected bariatric database was conducted. Adult patients who underwent laparoscopic adjustable gastric banding from 1 January 2001 to 30 June 2009 were identified. Patients who required major reoperation were then studied. Major reoperation included band repositioning, replacement, hiatal hernia repair and band removal. Basic demographic data, weight outcomes and surgical details were recorded. Weights at 12 and 24 months after reoperation were recorded and compared with initial weight and weight at reoperation. Patient satisfaction with the procedure was assessed by a qualitative telephone survey. Results: Of the 4680 patients retrieved, 4652 met inclusion criteria. There were 664 patients who underwent one or more major reoperations. There were no procedure-related deaths in the reoperation group. The 30-day patient complication rate for all reoperations was 1.8%. Patients undergoing 1 reoperation represented the largest subgroup (507 patients). For this subgroup, initial weight and Body Mass Index (BMI) were 122.7±23.3kg and 44.0±6.7kg/m2. At reoperation, weight, BMI and percentage excess weight loss (%EWL) were 91.4±22.7kg, 32.8±7.0kg/m2 and 51±24%. Twelve months after reoperation, weight, BMI and %EWL were 92.7±21.5kg, 33.3±6.8kg/m2 and 49±23% and at 24 months were 91.8±21.0kg, 33.2±6.7kg/m2 and 49±24%. Weight loss was sustained both at 12 months and 24 months after reoperation and did not differ from those without reoperation at the same length of time after primary banding. Patient satisfaction with the band was not affected by reoperation. Conclusion: Reoperation after laparoscopic adjustable gastric banding can be achieved with minimal morbidity. Weight loss is sustained 12 and 24 months after reoperation for laparoscopic adjustable gastric banding.