Adjustable gastric banding, a purely restrictive procedure, is rarely performed these days. However, few years ago, it was a commonly performed procedure. Many Lap Band patients present to our Houston Weight Loss Surgery Center for revision surgery. Some have gastric band related complications like GERD or band erosion, while others have failed to lose weight. Conversion of lap band to gastric sleeve or bypass procedure for failure to lose weight is recommended and is associated with excellent weight loss outcomes. However, concomitant removal of gastric band and sleeve gastrectomy has been associated with increased leak rate in many studies. Consequently, I have always recommended to my patients to stage the procedure. At Houston Weight Loss Surgery Center, we prefer to remove the band first, and after 3 to 6 months perform a gastric sleeve surgery. This month, a new publication in SOARD, titled “Concomitant removal of gastric band and sleeve gastrectomy: analysis of outcomes and complications from the ACS-NSQIP database”, confirms our practice guidelines. The study included 11546 patients who underwent a sleeve surgery between 2010 and 2012. Of those patients, 357 (3%) had a concomitant band removal and sleeve gastrectomy. After multivariate analysis was performed, the odds of developing staple line leak were significantly higher in the concomitant band removal/sleeve gastrectomy group compared to primary sleeve gastrectomy patients (OR=3.81). There was no difference in mortality or rate of return to the operating room.

The study clearly confirms that staple line leak is higher in one stage lap band revision surgery to gastric sleeve. The authors did not analyze band conversion to gastric bypass leak rate and did not include two-stage revisional surgery data. Nonetheless, this article further supports our approach to band conversion to sleeve. There is no doubt in my mind that the safest approach is to stage the revision or revise the band to gastric bypass in one operation.