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Revision of Laparoscopic Adjustable Gastric Band (LAGB)

Revision of Laparoscopic Adjustable Gastric Band (LAGB)

The first laparoscopic adjustable gastric band device (LAGB), called Lap-Band, was approved for use in the United States by the FDA in 2001. In 2007 the FDA approved a similar device, the Realize band but sales of that device were discontinued in 2016. Today, the Lap-Band is the only gastric banding device (LAGB) available in the United States.

The LAGB early showed great promise and in 2008 over 35,000 of the bands were placed. At that time it was the most popular weight loss surgical procedure performed in the United States.  The procedure has drastically declined in popularity due to an increased awareness of the many risks and the limited long-term benefits of the procedure.

Patients with a gastric band are likely to need follow-up surgeries (60% of patients with a gastric band will require its removal). LAGB requires the most follow-up surgeries of any of our available weight loss procedures.

Weight loss from the band tends to be temporary-usually 6-12 months. The long-term success rate of the gastric band overall is 1 in 9 patients.

At MASJax we do not place adjustable gastric bands. We do continue to provide long-term care and management of patient’s with existing bands including those who had their adjustable gastric band procedure performed elsewhere.

A large portion of our practice involves removing adjustable gastric bands due to multiple complications including band slip, band erosion, complications with the port or tubing and, most often, due to a failure to obtain resolution of morbid obesity with its attendant comorbidities.

If you have an LAGB but remain morbidly obese due to weight regain or failure to lose weight then removal of the band with conversion to either a sleeve gastrectomy, gastric bypass or biliopancreatic diversion with duodenal switch can usually be accomplished with a single laparoscopic/robotic procedure. Patients who have had an LAGB can achieve the same success with the weight loss procedures listed above as any other patient who is a candidate for weight loss surgery.

Part of our preoperative evaluation will include an endoscopic evaluation of the esophagus and stomach, esophagogastroduodenoscopy (EGD) to confirm that there are no problems with the band such as a slip or erosion that would require us to remove the band in a separate procedure. Findings of a slip are erosion are not common and occur only 2-3% of the time. In the absence of a concurrent problem we can remove the band and convert to another weight loss procedure during the same operation. If we do need to do an initial separate procedure to remove the band then the second weight loss procedure (sleeve, gastric bypass, duodenal switch) can usually be performed safely within the next three months. This allows time for appropriate healing with resolution of swelling and inflammation .

Due to the fact that there will be some distortion of the anatomy and some postoperative changes from having the previous LAGB surgery these revisional procedures may take a little bit longer and do entail some increased risk. Please feel free to discuss with us any questions that you might have about these procedures and the risk involved. We have performed hundreds of revisional procedures involving removal of LAGB with performance of another weight loss procedure successfully and have achieved successful long-term weight loss. Currently within our practice removal of an LAGB with conversion to a sleeve gastrectomy is our second most commonly performed weight loss surgery (a primary robotic/laparoscopic sleeve gastrectomy is are most commonly performed procedure).

Postoperatively removal of the band with conversion to a sleeve, gastric bypass or duodenal switch has a recovery which is similar to that of our other robotic/laparoscopic primary weight loss procedures.

It is important to understand that you did NOT fail your laparoscopic adjustable band; it failed you. According to researchers from the University of Michigan, “There is now a broad consensus that the use of the gastric band device should be significantly restricted, if not eliminated”.

If you have an LAGB and wish to discuss revisional surgery with us, please contact us so that we can perform an evaluation and see how we can help you achieve success with weight loss and resolution of your comorbidities .

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