Jacob Chisholm1, Normayah Kitan, James Toouli, Lilian Kow. 1. Department of General and Digestive Surgery, Flinders Medical Centre and Circle of Care, Bedford Park, Adelaide, SA, 5042, Australia. jacob.chisholm@health.sa.gov.au
Abstract
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) remains the most popular bariatric procedure performed in Australia and Europe. Gastric band erosion is a significant complication that results in band removal. The aim of this study is to assess the prevalence of band erosion and its subsequent management with a particular focus on rebanding results. METHODS: Patients who underwent LAGB in a prospective cohort study from August 1996 to October 2010 were evaluated. Patients that developed band erosion were identified and clinical presentations, band characteristics and subsequent management were evaluated. RESULTS: One thousand eight hundred seventy-four morbidly obese patients underwent LAGB. Band erosion developed in 63 patients (3.4%). Median preoperative BMI was 41.5 kg/m(2) (range 30-61 kg/m(2)). Median time from operation to diagnosis was 39 months (range 6-132 months). Twenty nine patients (46%) were asymptomatic (sudden loss of restriction, weight gain, turbid fluid, or absence of fluid). Symptoms included abdominal pain in 24 (38%), obstruction in 7 (11%), recurrent port infection in 5 (8%), reflux symptoms in 2 (3%) and sepsis in 2 (3%). Fourteen patients (22%) had discolouration of the fluid in their band. Endoscopic removal was attempted in 50 patients with successful removal in 46 (92%). Median number of endoscopies prior to removal was 1.0 (range 1-5). The median duration of the procedure was 46 min (range 17-118 min). Rebanding was performed in 29 patients and 5 (17%) experienced a second erosion. Mean percentage excess weight loss was 54% in the remaining 22 patients with at least 3 months follow-up. CONCLUSIONS: Band erosion prevalence was 3.4%. Endoscopic removal of eroded gastric bands was proven safe and effective. Band erosion is now preferably managed endoscopically in our institution. Rebanding following erosion results in acceptable weight loss but an unacceptable reerosion rate.
BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) remains the most popular bariatric procedure performed in Australia and Europe. Gastric band erosion is a significant complication that results in band removal. The aim of this study is to assess the prevalence of band erosion and its subsequent management with a particular focus on rebanding results. METHODS:Patients who underwent LAGB in a prospective cohort study from August 1996 to October 2010 were evaluated. Patients that developed band erosion were identified and clinical presentations, band characteristics and subsequent management were evaluated. RESULTS: One thousand eight hundred seventy-four morbidly obesepatients underwent LAGB. Band erosion developed in 63 patients (3.4%). Median preoperative BMI was 41.5 kg/m(2) (range 30-61 kg/m(2)). Median time from operation to diagnosis was 39 months (range 6-132 months). Twenty nine patients (46%) were asymptomatic (sudden loss of restriction, weight gain, turbid fluid, or absence of fluid). Symptoms included abdominal pain in 24 (38%), obstruction in 7 (11%), recurrent port infection in 5 (8%), reflux symptoms in 2 (3%) and sepsis in 2 (3%). Fourteen patients (22%) had discolouration of the fluid in their band. Endoscopic removal was attempted in 50 patients with successful removal in 46 (92%). Median number of endoscopies prior to removal was 1.0 (range 1-5). The median duration of the procedure was 46 min (range 17-118 min). Rebanding was performed in 29 patients and 5 (17%) experienced a second erosion. Mean percentage excess weight loss was 54% in the remaining 22 patients with at least 3 months follow-up. CONCLUSIONS: Band erosion prevalence was 3.4%. Endoscopic removal of eroded gastric bands was proven safe and effective. Band erosion is now preferably managed endoscopically in our institution. Rebanding following erosion results in acceptable weight loss but an unacceptable reerosion rate.
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