Surgical Management of Adjustable Gastric Band Failures and Literature Review: Algorithm for Removal and Conversion

Adjustable gastric band (AGB) failures frequently require conversion to sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB); the ideal conversional procedure is not established. We report on management of AGB failures at a university hospital along with literature review and proposed treatment algorithm. From October 2012 to January 2017, 32 patients underwent laparoscopic AGB removal with conversion to SG ( n = 23) or RYGB ( n = 9). Patient characteristics and outcomes were abstracted from medical records and a quality improvement database. Twenty-three patients (71.9%) were female with mean age of 43 ± 10.6 years and mean BMI of 42.7 ± 5.9 kg/m2; 62.5% ( n = 20) had 2-staged conversion while 37.5% ( n = 12) had 1-stage conversion to SG/RYGB. GERD significantly increased likelihood of conversion to RYGB vs. SG (44.4% vs. 0, p = 0.03). Preoperative diagnostics included upper gastrointestinal series ( n = 15,46.7%), esophagogastroduodenoscopy ( n = 32,100%), and high-resolution esophageal manometry (HRM) ( n = 11,34.4%). Overall complication rate was 9.4% (n = 3). AGB-to-SG patients had mean % total body weight loss of 17.0% ± 5.9 compared to 28.3% ± 15 in AGB-to-RYGB, and mean follow-up of 11.7 ± 12.9 months compared to 18.9 ± 14.4 months. Validated criteria for conversional procedure selection following AGB failure do not exist; appropriate procedure selection requires thorough workup. Future research may elucidate the role of HRM in the diagnostic armamentarium.