Que faire en cas d’échec de l’anneau gastrique ajustable ?
ABSTRACT L’anneau gastrique ajustable est l’intervention la plus utilisée en Europe, car ce procédé est relativement simple, totalement
réversible, a gagné une très grande popularité parmi les chirurgiens bariatriques. Cependant, bien que les résultats à court
terme soient bons, avec une perte d’excès de poids de plus de 50 % chez la plupart des patients au bout de deux à cinq ans,
les résultats à long terme sont « entachés » d’un taux important de complications. Les complications sont soit spécifiques
de l’anneau (problèmede matériel, slippage, érosion gastrique, dilatation de la poche gastrique et/ou de l’œsophage, reflux
gastro-œsophagien) ou dues à une perte de poids insuffisante. Cet article prend en considération les différentes stratégies
thérapeutiques possibles, face à l’échec de la gastroplastie par anneau.
The adjustable gastric band is currently the most commonly used surgical intervention in Europe, as it is simple, reversible
and increasingly popular with bariatric surgeons. However, although short-term results are good, with a loss of over 50% of
excess weight in most patients after 2 to 5 years, long-term results are marred by a significant complication rate. These
are either band-specific (problems with the material, slippage, gastric erosion, dilation of the gastric and/or oesophageal
pouch, gastro-oesophageal reflux) or connected with insufficient weight loss. This article reviews the various treatment strategies
that can be tried should gastric banding fail.
[Show abstract] [Hide abstract]
ABSTRACT: Laparoscopic adjustable gastric banding (LAGB) has gained widespread acceptance. However, the technique has problems intrinsic to the material wear and tear around the port and connecting tubing that can lead to failure. Port complications are considered to be minor; however, few studies have analyzed them, and the optimal technique of port implantation and management has not been elucidated. All patients who suffered from complications involving the tubing or access-port were included in this study. Their complaints, imaging studies, operative reports and hospitalization files were retrospectively reviewed. 1,272 of the patients were available for a mean follow-up period of 37 months. During this time, 91 patients (7.1%) experienced port complications that required 103 revisional operations. Of these patients, 62 had system leaks, 19 infectious problems, and 10 miscellaneous problems requiring operative correction. Overall port problems led to band removal in 6 patients, and replacement in 1 patient. Access-port complications after the Lap-Band procedure are among the most common and annoying ones, and can render the device susceptible to failure. Careful surgical technique and routine use of radiologic guidance for band adjustments are the keys to avoiding complications.Obesity Surgery 04/2005; 15(3):361-5. DOI:10.1381/0960892053576604 · 3.74 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: The most common bariatric surgical operation in Europe, laparoscopic adjustable gastric banding (LAGB), is reported to have a high incidence of long-term complications. Also, insufficient weight loss is reported. We investigated whether revision to Roux-en-Y gastric bypass (RYGBP) is a safe and effective therapy for failed LAGB and for further weight loss. From Jan 1999 to May 2004, 613 patients underwent LAGB. Of these, 47 underwent later revisional Roux-en-Y gastric bypass (RYGBP). Using a prospectively collected database, we analyzed these revisions. All procedures were done by two surgeons with extensive experience in bariatric surgery. All patients were treated with laparoscopic (n=26) or open (n=21) RYGBP after failed LAGB. Total follow-up after LAGB was 5.5+/-2.0 years. For the RYGBP, mean operating time was 161+/-53 minutes, estimated blood loss was 219+/-329 ml, and hospital stay was 6.7+/-4.5 days. There has been no mortality. Early complications occurred in 17%. There was only one late complication (2%)--a ventral hernia. The mean BMI prior to any form of bariatric surgery was 49.2+/-9.3 kg/m2, and decreased to 45.8+/-8.9 kg/m2 after LAGB and was again reduced to 37.7+/-8.7 kg/m2 after RYGBP within our follow-up period. Conversion of LAGB to RYGBP is effective to treat complications of LAGB and to further reduce the weight to healthier levels in morbidly obese patients.Obesity Surgery 03/2006; 16(2):137-41. DOI:10.1381/096089206775565212 · 3.74 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Laparoscopic adjustable gastric banding (LAGB) is a safe technique with few direct postoperative complications. However, long-term complications such as slippage and pouch dilatation are a well-known problem and re-operations are necessary in a substantial number of patients. In this study, the results of laparoscopic re-operations after LAGB are evaluated. 33 patients had a re-operation because of failed LAGB. 29 patients had major re-operation and 4 patients minor re-operation under local anesthesia. The charts of these patients were retrospectively studied. Mean time between the first band placement and re-operation was 28.1 +/- 17.6 months. The cause of band dysfunction was anterior slippage (n=17), band erosion (n=5), band intolerance (n=3), posterior slippage (n=2) and band leakage (n=2). Symptoms of band dysfunction were vomiting (n=16), pyrosis (n=13), nausea (n=8), retrosternal pain (n=11) and regurgitation (n=5). Laparoscopic refixation of the band was performed in 19 patients: the band was replaced in 4 patients while in 1 patient the band was removed; in 3 patients, the laparoscopic procedure was converted to open surgery; 5 patients underwent conversion to a bypass procedure (biliopancreatic diversion in 3 and gastric bypass in 2). There were no direct postoperative complications except for wound infections (n=2). Postoperative follow-up was 100% with a mean period of 34 +/- 19 months. BMI decreased further from 37.5 +/- 6.4 kg/m(2) before re-operation to 33 +/- 7 kg/m(2). Obesity-related co-morbidity also decreased further or completely dissolved. 3 patients (9%) again developed anterior slippage and a second laparoscopic re-operation was necessary. A laparoscopic re-operation for band-related complications after LAGB is safe and feasible. With band slippage, a laparoscopic refixation was possible in 89%. Re-operation leads to further decrease in BMI and obesity-related co-morbidities.Obesity Surgery 08/2006; 16(7):821-8. DOI:10.1381/096089206777822386 · 3.74 Impact Factor