Long-term outcomes and frequency of reoperative bariatric surgery beyond 15 years after gastric banding: a high band failure rate with safe revisions

Background: Laparoscopic adjustable gastric band (LAGB) has had encouraging early results. However, intermediate and late results were discouraging, and LAGB is presently being replaced by stapled procedures. There is still ongoing debate whether LAGB should be abandoned altogether. Objective: To present our outcomes beyond 15-year follow-up after LAGB. Setting: Private hospital, Bern, Switzerland. Methods: This is a retrospective review of patients receiving LAGB between 1997 and 2002 with minimum 15-year follow-up. Patient characteristics, co-morbidities, reoperative bariatric surgery (RBS), and weight trends were analyzed. Results: A total of 387 LAGB patients were identified. Of them, 342 (88.4%) had a minimum of 15 years of follow-up (range, 15-21 yr). There were 270 (78.9%) women with a mean age of 40.3 years (range, 15-62 yr) and body mass index (BMI) of 43.1 kg/m(2) (range, 30.0-60.1 kg/m(2)) and 72 (21.1%) men with a mean age of 41.2 years (range, 16-61 yr) and BMI of 43.6 kg/m(2) (range, 33.0-72.5 kg/m(2)). During follow-up, 283 (82.7%) patients underwent a mean of 3.3 reoperative bariatric operations (range, 1-5), with 224 (65.5%) converted to Roux-en-Y gastric bypass (RYGB). At the end of the study period, 96 (28%) patients still had a band in place. No deaths were recorded. At most recent follow-up after LAGB, mean excess BMI loss was 65.4% (range, 9.4% to 134.5%) with significant decrease in co-morbidities. Conclusions: Only 28% of patients had sufficient weight loss outcomes after LAGB alone and predictive selection criteria are lacking. The majority of LAGB operations fail even with close structured follow-up. RBS can be performed safely. (C) 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.