Sep - Oct 2017

Band to Sleeve: Revision Surgeries on the Rise

By Carl A. Weiss, III, MD PhD FACS

 

More overweight people are choosing to have weight loss surgery. As more surgeries occur each year, the number of revision surgeries—procedures to correct a failed surgery—is also soaring. Although most weight loss surgeries have a good track record, some patients and procedures simply don’t fare well.

 

For instance, failure to have success with the adjustable gastric band often leads to discussion about what might be the next surgical option.  Many patients ask about laparoscopic sleeve gastrectomy as a possible consideration. 

 

How well a patient reaches their weight loss goals revolves around the central concept of behavioral change. Whether someone has the adjustable gastric band, sleeve gastrectomy (creating a long tube out of the stomach), or gastric bypass (small gastric pouch to which bowel is connected and reconnected downstream) the same concepts of behavioral change apply. The ability to exercise regularly and make protein based food choices in small portions is the fundamental guiding principle. To expect an operation to magically create behavioral change seems unlikely unless there is good understanding, support and education that is focused on the patient’s needs.

 

Understanding Laparoscopic Sleeve Gastrectomy  

Patients who do not have success with the adjustable gastric band are often frustrated. At the end of the day they have not likely been able to make good food choices and exercise regularly. If comfortable restriction is not able to be established, success is unlikely. In this context either gastric bypass or sleeve gastrectomy is an option.  Sleeve gastrectomy is changing the shape of the stomach to a long narrow tube and removing the gastric reservoir. This is a metabolic approach that seems to profoundly change appetite and portion size and create satiety or fullness that was previously absent . This approach seems to lead to more consistent positive results for patients compared with the adjustable gastric band. 

 

Surgical Considerations

From a surgeon’s standpoint, the issue of whether to proceed as a one stage or two stage operation is the relevant consideration after determining that the patient is a good candidate for sleeve gastrectomy from a behavioral standpoint. There has to be a careful discussion with your surgeon regarding risks and benefits. There are increased surgical risks when performing reoperative bariatric surgery. If there are anatomic concerns with the adjustable gastric band such as pouch dilation or slip or erosion, most often the choice will be to proceed with removal of the adjustable gastric band and port followed by sleeve gastrectomy at a later date. If there are no anatomic problems then a one stage conversion from adjustable gastric band to sleeve may be an option. This is up to the surgeon’s discretion and judgment.

 

Once the decision to have surgery has been made, surgeons and patients need to work together to ensure a healthy outcome.