Letter to the Editor: Should We Introduce a Gastric Band Removal Schedule?

Abstract

Laparoscopic gastric banding (LAGB) surgery currently represents only 5% of primary bariatric surgery procedures worldwide, yet it remains the fourth most common obesity operation after laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass, and one-anastomosis gastric bypass [1]. While short-term results might be encouraging, long-term complications such as slippage [2] and weight loss failure [3] are frequent indications for band removal. Routine postoperative gastrografin contrast swallow studies might help detect slippage initially; however, Martines et al. have suggested performing a planned endoscopy at least within 2 years postoperatively to guarantee early diagnosis of gastric band erosion [4], especially since management of a misdiagnosed migration can be challenging. Another rare but reported complication is small bowel obstruction (SBO) caused by the connecting tube. Management of SBO after gastric banding is necessarily surgical with division of the adhesion and band removal via the laparoscopic approach being the preferred method of primary management [5]. The lifetime of gastric banding is not defined although long-term studies report results up to 15 years. Carandina et al. reported that the gastric band removal rate increases with time (3–4% per year) and that at 15-year follow-up, almost half of the implanted bands (n = 301) had been removed [6]. Vinzenz et al. found that after 10 years, 71% of 405 patients had lost their band [7], while Trujillo et al. provided evidence that LAGB remains effective in less than 50% of patients who were first operated on more than 10 years ago [8]. A long-term matched comparison of the two restrictive procedures, LAGB versus LSG, showed that weight loss was greater with LSG, and that more reoperations (34% versus 5%, respectively, P < 0.001) and less satisfaction with the outcome were observed after LAGB [9]. Also Furbetta et al. reported a total reoperation rate of 24.1% on 3566 patients with only 26% of patients reaching 10-year follow-up [10]. Historically, our obesity and metabolic surgery unit has many patients in long-term follow-up after LAGB, and laparoscopic band removal is a frequent procedure. In the past 2 years, we have performed 94 gastric band removals due to weight loss failure, slippage, and migration. Interestingly, in 16 patients (17%), we found chronic peritonitis with enteral adhesions (Figure 1) and two patients (2%) showed an important granulomatosis and dense adhesions along the tube and injection port (Figure 2). He et al. reported peritoneal oleogranulomatosis after laparoscopic gastric banding and highlighted the importance of a histological diagnosis, given the macroscopic resemblance to carcinomatosis peritonei [11]. Additionally, one patient with slippage showed an incidental peritoneal carcinomatosis, which after