Yonsei Med J.  2019 Aug;60(8):782-790. 10.3349/ymj.2019.60.8.782.

Explantation of Adjustable Gastric Bands: An Observation Study of 10 Years of Experience at a Tertiary Center

• Cho EJ
• Kim SM

• KMID: 2452960
• DOI: http://doi.org/10.3349/ymj.2019.60.8.782

Abstract

PURPOSE
Although laparoscopic adjustable gastric bands are considered a standard treatment for severe obesity, their use remains controversial. We evaluated rates of band explantation and the incidences of complications leading to and following band explantation.
MATERIALS AND METHODS
This retrospective review was performed on patients that underwent adjustable gastric band explantation. For each of the three groups of patients that underwent explantation, we compared demographic and anthropometric data, band duration in situ, operative approach, and morbidities.
RESULTS
Between January 2009 and October 2018, a total of 267 patients underwent primary laparoscopic adjustable gastric band surgery. Of these 267 patients, 99 (37.1%) underwent band explantation. Numbers (%) of patients in the slippage (SL), band erosion (BE), and intolerance (IT) groups were 13 (13.1%), 39 (39.4), and 47 (47.5%), respectively. Mean %EBMIL values at explantation in these groups were 74.6±45.5, 79.7±40.3, and 36.1±46.0, respectively (p<0.001), and mean times for maintaining bands in situ were 45.1±28.0, 39.4±24.3, and 51.2±22.7 months, respectively. Isolated band removal was performed for slippage (SLi, n=12), band erosion (BEi, n=39), and intolerance (ITi, n=31). The numbers (%) of patients in the SLi, BEi, and ITi groups that experienced a surgical complication (Clavien-Dindo class ≥1) were 0 (0.0%), 24 (61.5%), and 3 (9.7%), respectively (p<0.001). In the BEi group, four patients (4/39, 10.3%) underwent reoperation after AGB removal.
CONCLUSION
During our 10 years of experience, 37.1% of adjustable gastric band had to be removed. Intra-abdominal abscess and intragastric bleeding were rare but serious complications after explantation. Potential candidates for adjustable gastric band should be informed of the high long-term risk of band explantation and its associated morbidities.

Keyword

Laparoscopic adjustable gastric band; slippage; erosion; intolerance

MeSH Terms

Abdominal Abscess
Hemorrhage
Humans
Incidence
Obesity, Morbid
Reoperation
Retrospective Studies

Figure

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  Fig. 1 Flow chart showing the management of adjustable gastric band (AGB) patients (n=267). The patients in the grey rectangle indicate those who are involved in this study. SL, slippage group; BE, band erosion group; IT, intolerance group; LSG, laparoscopic sleeve gastrectomy; SLi, isolated AGB explantation due to slippage; BEi, isolated AGB explantation due to band erosion; ITi, isolated AGB explantation due to intolerance.

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  Fig. 2 Annual incidences and trends of adjustable gastric band (AGB) implantation/explantations over the study period.

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  Fig. 3 Annual case numbers of adjustable gastric band (AGB) explantation according to etiology (n=99). SL, slippage group; BE, band erosion group; IT, intolerance group.

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