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4th INTERNATIONAL CONSENSUS SUMMIT FOR SLEEVE GASTRECTOMY IV: Sleeve as a Revisional Surgery Laparoscopic Adjustable Gastric Band Failure: Remove, Replace, or Revise? by NATAN ZUNDEL, MD, FACS, FASMBS, and JUAN D. HERNANDEZ, MD Bariatric Times. 2013;10(5 Suppl A):A14–A15 AUTHOR AFFILIATIONS: Dr. Zundel is Clinical Professor of Surgery and Vice-Chairman Department of Surgery at Florida International University, Herbert Wertheim College of Medicine in Miami, Florida. Dr. Hernandez is Assistant Professor of Surgery and Anatomy, Hospital Universitario Fundacion Santa Fe de Bogota, Universidad de los Andes, Bogota, Colombia. ADDRESS FOR CORRESPONDENCE: Natan Zundel, MD, FACS, Clinical Professor of Surgery, Vice-Chairman, Department of Surgery, Herbert Wertheim College of Medicine, 11200 S.W. 8th St., Modesto A, Maidique, Miami, FL 33199; Phone: (305) 3083035; Fax: (305) 466-4970; E-mail: drnazuma99@yahoo.com FUNDING AND DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article. KEY POINTS • LAGB is a good operation for weight loss, but may need to be removed in some patients for different reasons (e.g., if the patient is not experiencing enough weight loss or has regained weight, the band is causing complications). • With the proper selection of patients, LSG can be used safely and successfully as a re-do operation when an adjustable gastric band has to be removed. • Appropriate patient selection is paramount in deciding the best bariatric operation after removing an adjustable gastric band. I n instances where a laparoscopic adjustable gastric (LAGB) banding procedure has "failed" (e.g., the patient is not experiencing enough weight loss, the band is causing complications for the patient) both surgeon and patient face a difficult decision—remove, replace, or revise? If the surgeon and patient decide to revise LAGB to another procedure, A14 they must consider the health risks associated with new interventions and also decide which revisional procedure is best for the situation. LAGB is a purely restrictive procedure that has proven to be an effective tool in achieving weight loss, with the additional arguable advantage of its reversibility.1,2 It has also been reported that LAGB is a procedure safer than gastric bypass and vertical banded gastroplasty.3 However, a percentage of patients regain weight in spite of a properly placed and adjusted LAGB. In this case, the bariatric team should examine the patient's eating habits, behavior modification, dieting, and physical activity, as these are all important components of an effective weight management. If these conditions have not been part of the treatment or if the patient has moved away from them, they need to be reinitiated. After a period of time under a proper follow up, the team can re-evaluate whether the LAGB has failed and determine whether a different approach is needed. Bariatric Times • May 2013 • Supplement A One aspect of LAGB failure is complications with the band. The band can cause serious complications that frequently result in the band being explanted.1,2,4,5 The main problems are as follows: band displacement, pouch dilatation, erosion, port dislocation, catheter rupture, disconnection or leak, and infection of either the port or the band itself. Postoperative complications have been reported to be as high as 31 to 60 percent,5,6 with overall reoperative rates ranging between 1.7 and 66.7 percent.7,8 When LAGB fails in achieving sufficient weight loss or causes any of the abovementioned complications and practicing another bariatric intervention is the selected conduct, several operations can be considered. Revisional procedures considered after LAGB include revision of the band, laparoscopic gastric sleeve (LSG), Roux-en-Y gastric bypass, and biliopancreatic diversion (BPD). In selecting which approach to take for a failed LAGB, the authors support tailoring the decision to the individual patient's characteristics. It is important