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

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 %EBM IL 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.