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Salvage banding is an option after failed bypass
Bypass patients who have not achieved 50% excess weight loss (%EWL) at two years should consider salvage laparoscopic adjustable gastric banding (LAGB), according to a study presented by Dr John Loy, NYU Langone Medical Center, New York. The topic was discussed at this year’s Annual Scientific Meeting of the British Obesity and Metabolic Surgery Society in Leamington Spa, UK, from 22 – 24 January.
“Patients weight loss failure after Roux-en-Y gastric bypass (RYGB) have limited options; surgical options such as lengthening the bypass or performing a duodenal switch have been associated with complications such as malnutrition,” he said. “Salvage LAGB provides good further weight loss, although the higher rate of re-operation for band-related complication merits appropriate patient counselling and close follow-up.”
He began his presentation by stating that up to 15% of RYGB patients can fail to achieve the desired 50%EWL) at two years, and despite various reports of endoscopic therapies most have had limited success.
Although salvage LAGB over the primary gastric bypass is well known, there have been few studies in the literature that are sufficiently powered to assess its efficacy.
As a result, Loy and colleagues from NYU Langone Medical Center, updated what is thought to be the largest published series of salvage band over bypass to date in 43 patients from their institution. He reported these data with a further three years follow-up, as well as with an additional 82 patients.
The researchers undertook a retrospective review of their database and collected data on some 125 patients (102 female, 23 male) who underwent salvage LAGB for weight loss failure after primary RYGB. The majority 102 (83%) having undergone initial surgery elsewhere. An average of 12.7 years (range 15-1324 months) had elapsed from primary RYGB.
The mean BMI before RYGB was 51.2 (+/-8.78) and before salvage LAGB was 43.0 (+/- 6.57). Following salvage LAGB, the mean BMI fell to 35.9 (+/-6.75) at one year, 33.8 (+/-7.19) at two years and 33.9 (+/-6.37) at three years.
In addition, there was an improvement in excess BMI loss from 30.4% (+/-19.6) on referral, to 50.1% (+/-38.7) on average 28 (+/-21) months after salvage LAGB.
A total of 19 (15.2%) patients required re-operation for complications related to the LAGB including six (4.8%) for band erosions, ten (8%) port/tubing revisions for leakage or migration, two (1.6%) band slips and one (0.8%) port infection.
The significant factor in predicting band erosion was length of interval from initial bypass surgery (301 months versus 152 months p<0.05).
Addition authors of the study were Drs Heekoung Youn, Bradley Schwack, Marina Kurian, George Fielding and Christine Ren-Fielding.