Fate of Laparoscopic Adjustable Gastric Bands in a University Bariatric Program
Jin S. Kim BS, BA1
Cheyenne C Sonntag, MD1
Amber L. Schilling, M.ED, PharmD2
Ann M. Rogers, MD1
Penn State Health Hershey Medical Center
Department of Surgery
1Division of Minimally Invasive and Bariatric Surgery
2 Division of Outcomes Research and Quality
BACKGROUND: Adjustable gastric banding (AGB) has been touted as a safe, noninvasive, and easily reversible bariatric procedure. Its popularity has waned due to high reoperation rates and inadequate weight loss. Published reoperation rates seem to underestimate surgeons’ clinical experiences. We present an expanded, updated institutional band experience, providing further long-term perspective on reoperation rates, morbidity, and weight loss outcomes.
METHODS: Institutional IRB approval was obtained. 143 patients were identified as having undergone AGB for weight loss at our institution between 2007-2010. A single fellowship-trained bariatric surgeon performed all AGB procedures. Retrospective chart review was performed, including patient follow-up through June, 2016. Demographics included age, sex, race, pre and post-AGB BMI, and pre-operative comorbidities. Outcomes measured included reoperation due to band complication, band removal, conversion to alternate bariatric procedure, time from AGB to first reoperation or conversion surgery, mean weight loss at times of reoperation and removal, and percentage of patients undergoing conversion surgery. Student’s t-tests were used for continuous variables and chi-square tests for binary variables. Kaplan-Meier analysis was used to determine how much time it took for patients to undergo a first reoperation surgery or a band removal. p < 0.05 was considered significant. STATA software (version 12.1, StataCorp, College Station, TX, USA) was used to perform all statistical analyses.
RESULTS: Of the 143 patients, 84 have required at least one reoperation related to their initial band procedure and 76 have had their bands removed. Patients had a mean weight loss of -10.6 pounds (95% CI, -13.7 to -7.5) at time of first reoperation and -12.8 pounds (95% CI, -16 to -9.5) at the time of band removal surgery. 67.1% of patients with band removal converted to an alternate bariatric procedure: sleeve gastrectomy (18.4%) or Roux-en-Y gastric bypass (48.7%). Predictive Kaplan-Meyer analysis showed that at four years, over 50% of patients required at least one reoperation, increasing to roughly 95% at eight years. Similarly, over 50% of patients underwent band removal by four years of follow-up, increasing by Kaplan-Meier prediction to roughly 95% at eight years.
CONCLUSIONS: Our institution’s experience with AGB has shown an excessively high rate of reoperation due to band-related complications and almost universal band removal within eight years of follow-up. As a result, this procedure is no longer offered at our institution. To verify the failure rates associated with AGB, gastric band outcomes should continue to be followed in these patients.