Laparoscopic Adjustable Gastric Banding

Pouch dilation is a frequent finding after LRYGB even in patients who maintain good weight loss [6]. This procedure involves placing a LAGB on the gastric pouch of the RYGB in an attempt to promote greater gastric restriction for the patient especially recommended for hyperphagic patients. The safety and efficacy of LAGB for failed LRYGB has been well demonstrated wherein LAGB provides external reinforcement to help regulate the pouch size over time [6-9]. As a result, it may reduce hunger and increase satiety in patients who fail to lose weight [10]. Bessler et al. found that LAGB after LRYGB produced an EWL of 38 % and 44 % at 12 and 24 months, respectively [6]. A larger study by Irani et al. reported a mean EWL of 38.3 % on 42 patients with a mean follow-up of 26 months (range 6-66) after LAGB placement [11]. However complications of LAGB (erosion/slippage) were to an extent of 10 %. The study also noted a higher complication rate compared with primary LAGB patients, which was expected given that band placements were part of a revisional procedure. It is also to be noted that salvage banding is technically challenging due to dense adhesions carrying significant morbidity. This approach may still be an option in carefully selected patients who have a dilated pouch and/or stoma following RYGB [12].

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