Corrective surgery and treatment principles after failed Lap-Band gastric banding

Lap-Band gastric bandage

To date, we do not have much experience with corrective surgery for failed Lap-Band gastric banding procedures.

However, we estimate that the type of corrective surgery to be performed will depend on the size of the gastric pouch between the esophagus and the bandage.

The most common reasons for needing corrective surgery after gastric banding are: ① unsatisfactory weight loss (62%); ② partial or complete obstruction (13%); ③ gastric pouch dilatation (9%); ④ banding erosion of the gastric wall (6%); ⑤ gastric wall tissue necrosis (4%); ⑥ reflux esophagitis (2%); ⑦ gastric perforation (2%).

Most bariatric surgeons choose to perform bile-pancreatic diversion and duodenal transposition (BPD-DS) for patients who do not achieve satisfactory weight loss after gastric banding, rather than replacing the gastric bandage.

The surgical techniques are similar to those used in corrective surgery after a failed VBG procedure.

result

The gastrointestinal anatomy is intact, and there is no steatorrhea: distal RYGB or BPD-DS surgery is performed with excellent results.

Steatorrhea: Corrective surgery can cause steatorrhea; distal RYGB surgery or non-surgical treatment may be necessary.

Damage to gastrointestinal anatomy: Gastric reconstruction followed by RYGB surgery yields excellent results; gastric sac dilation after RYGB surgery, reduction of gastric sac size, lengthening of Roux loop, or malabsorption surgery have moderate results; there is no data to support re-closure and repair.

Therapeutic principles

We recommend using RYGB as a corrective surgery when other weight loss surgeries that restrict food intake are not effective, especially for VBG and gastric banding.

There is no need to worry about the feasibility of converting gastric banding to RYGB surgery.

Although rare, we have also had cases of failed JIB, RYGB, gastric banding, or RYGB procedures where, based on the patient's wishes and the understanding of weight rebound after the corrective surgery, we did not perform corrective surgery at the same time.

For patients who have undergone RYGB surgery but do not have significant gastric sac dilatation and whose weight loss is not ideal, the effect of lengthening the Roux loop and reducing shared pathways through corrective surgery is generally limited due to the potential risk of dietary instability.

Similarly, there are also reports of good weight loss results achieved by repeating gastric banding after ineffective RYGB procedures.

Typically, we are dealing with an increasing number of patients with severe protein-calorie deficiency due to secondary high anastomotic stenosis, short shared passage, or short bowel syndrome.

We will temporarily use parenteral nutrition in the initial stage of nutritional therapy.

Then, enteral nutrition is restored by inserting a nasal feeding tube or gastrostomy into the residual stomach.

Corrective surgery can be performed more safely once nutritional indicators return to normal.

summary

The learning curve for bariatric surgery is long and progress is slow.

During the learning phase, unsatisfactory postoperative weight loss results are common, especially for patients with obesity-related comorbidities.

Therefore, there is reason to believe that corrective surgery is more difficult to master, and for this reason, the surgery can only be performed and patients managed by experienced bariatric surgeons and experienced multidisciplinary teams using sophisticated equipment.

While corrective surgery can be beneficial for some patients, the mortality rate and complication rate are much higher than with the initial weight loss surgery.