Reoperative Options After Gastric Banding

Laparoscopic adjustable gastric banding (AGB) was a popular bariatric surgery option since FDA approval in 2001 until about 2008 when the laparoscopic sleeve gastrectomy emerged and joined the Roux-en-Y gastric bypass as the most popular procedures of choice for primary bariatric surgery. With a longer follow-up on banding patients, the number of band removals and of revisional surgeries has been increasing in the last decade. The choice of bariatric revision procedure and the option to have a one- or two-stage approach with band removal and the definitive bariatric procedure may vary. Intraoperatively, it is important to ensure the fundoplication is taken down completely and, when feasible, to incise and partially remove the band capsule to minimize tissue thickness for stapling. Most studies, though retrospective in nature, do not show significant differences in complications when converting an AGB to sleeve or RYGB although the latter results in greater weight loss than that of the LSG. Other revision options, namely, the one anastomosis gastric bypass and stomach intestinal pylorus-sparing revision and biliopancreatic diversion with or without duodenal switch may also have a role but are considered investigational by the ASMBS in the USA.