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Band Erosion: Incidence, Etiology, Banded Vertical Gastric Bypass

Review of Transected Banded Vertical Stomach Bypass (TBVGBP)

Bariatric Surgery - Bariatric Research Studies

Band Erosion: Incidence, Etiology, Outcome of Banded Vertical Gastric Bypass

Prosthetic devices have been used in bariatric operations to control the outlet of the gastric pouch and thus maintain weight loss. A complication of these prostheses is erosion or migration into the gastric lumen. The transected banded vertical gastric bypass (TBVGBP) is one of the modifications of gastric bypass. This modification has a silastic ring placed around the pouch to form the stoma.

Method

The records of patients with band erosion (BE) after this operation were reviewed, to determine the incidence, etiology, management and outcome during a 9-year period.

Results

From May 1992 through May 2001, 2,949 primary and secondary transected banded vertical gastric bypass were performed through the Center for Surgical Treatment of Obesity, utilizing 3 hospitals. 48 patients (1.63%) were documented to have BE: 40 documented by us and 8 by subsequent treating surgeons or at other facilities. Presenting symptoms were weight regain (18), stenosis or obstruction (17), pain (9), bleeding (7), and 5 were incidental findings. Some patients presented with more than one symptom. 8 were treated expectantly with spontaneous extrusion of the band. 16 bands have been removed endoscopically in 14 patients. 26 patients had open surgical revision, with 12 having band removal only and 14 band removal and revision of either the gastroenterostomy with or without band replacement or conversion to a distal Roux-en-Y gastric bypass (DRYGBP). Two patients who had revision to distal Roux-en-Y gastric bypass were re-revised to a longer common limb because of protein malnutrition. Three patients who had revision of the gastroenterostomy with band removal and replacement developed leaks that were managed non-surgically. Two of these re-eroded and the band was removed endoscopically with a subsequent revision to a distal Roux-en-Y gastric bypass. There was no death due to BE.

Conclusion

BE is an uncommon complication of transected banded vertical gastric bypass. Infection, previous bariatric operations and surgical technique play a role in BE. BE is best managed by endoscopic removal but can be treated expectantly or by open surgical intervention. Band removal without replacement or revision to distal Roux-en-Y gastric bypass may result in weight regain.

Source:
Fobi M, Lee H, Igwe D, Felahy B, James E, Stanczyk M, Fobi N. Center for Surgical Treatment of Obesity, 21520 S. Pioneer Blvd., Suite 204, Hawaiian Gardens, CA 90716, USA. 2001

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Laparoscopic or open bariatric surgery, such as gastric banding or bypass is not an easy solution to morbid obesity and weight loss. It is a serious surgical procedure, involving health risks. To produce lasting weight loss it requires a long-term patient commitment to eating a healthy diet and following a regular program of physical exercise. Life-long use of nutritional supplements may also be necessary. So, before deciding, discuss your options fully with your doctor. © 2003-2017 Bariatric-Surgery.Info - Terms - Contact - Information - Resources