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Apollo EndoSurgery Symposium

Complications leading to removal unwarranted in bands

Band complications aretreatable and so band removal is unwarranted in many instances
In cases of band failure migration he recommended a biliopancreatic diversion as the best safest option in the next few months

At the recent European Obesity Summit in Gothenburg, Sweden, Apollo Endosurgery hosted a symposium, which included presentations on revisional surgery, long-term outcomes, low BMI patients, band complications and the banded bypass.

Complications arising from laparoscopic bands, such as slippage and erosion, have resulted in the unnecessary removal and bands despite good weight loss, according to a presentation ‘Save the band: Erosion and slippage have always to lead to an immediate band removal?’, by Professor Rudolf A Weiner from the Clinic for Obesity & Metabolic Surgery, Offenbach am Main, in Germany.

Rudolf A Weiner

He cited a study by Cadière and Himpens (Long-term outcomes of laparoscopic adjustable gastric banding. Arch Surg, 2011) that reported LAGB appears to result in a mean excess weight loss of 42.8% after 12 years or longer. However, because nearly one out of three patients experienced band erosion (migration), and nearly 50% of the patients required removal of their bands (contributing to a reoperation rate of 60%). Such concerns about the long-term effectiveness of the procedure has led to a decline in the number of LAGB procedure, with no such procedure carried out at his centre from January to April in 2016.

However, a paper by O'Brien et al (Weight loss and early and late complications - the international experience. Am J Surg. 2002 Dec;184(6B):42S-45S) of 1,120 patients, found no deaths and no life-threatening perioperative complications. Although significant early complications occurred in 17 (1.5%) of patients and prolapse of the stomach through the band (slippage) occurred in 125 (25%) of their first 500 patients, no erosions occurred in the last 600 patients treated, and both problems were treated laparoscopically by removal and replacement. This demonstrated that band complications were treatable and so band removal is unwarranted in many instances, explained Weiner.

Complications of adjustable bands and treatment

Like all surgeons procedures, laparoscopic gastric bands sometimes result in post-operative complications for a number of reasons. In a paper by Eid et al (Complications associated with adjustable gastric banding for morbid obesity: a surgeon’s guide. Can J Surg. 2011 Feb; 54(1): 61–66.), they reported that minor complications and treatments include port leak - port replacement, port displacement - fluoroscopy fill/readjustment, minor port infection - antibiotics/temporary removal, pouch enlargement - deflation, re-education. With regard to major complications and treatment, these include band slippage – surgical adjustment, band erosion/migration – removal, late port or band infection/intra-abdominal abscess – removal.

Weiner said that in cases of band removal due to migration (erosion) removal, additional bariatric surgical options can be considered to maintain weight loss, however in his opinion these options should not include a sleeve, band or duodenal switch, and a RYGB carries added risk. Therefore, he believes a biliopancreatic diversion is the safest option. The resection line and the anastomosis are fare away from the inflamed area and the previous hole.

Subsequently, he suggested several treatment algorithms to address band complications. For example, in cases of band slippage – reposition, band defect – rebanding, in emergency cases of band slippage - removal of fill with a demonstration of passage using a nasogastric tube, migration – a scheduled band removal (endoscopically or laparoscopically). As previously stated, in cases of band failure migration he recommended a biliopancreatic diversion as the best safest option in the next few months. A later times the gastric bypass procedures (RNYGB, OAGB, MGB) are the most common used option worldwide.

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