Lapband surgery after VSG?

[SusieSouth 51]

Does anyone have any information on lapband after VSG surgery or have had it done and can share the experience? MGB or RNY was suggested as possible revisions but I fear these options due to the malabsorption.

Thanks for any comments.

[SusieSouth 51]

Found an encouraging article online:

https://www.sages.org/meetings/annual-meeting/abstracts-archive/band-over-sleeve-a-safe-alternative-to-achieve-further-weight-loss-and-reduction-of-co-morbidities/

BAND OVER SLEEVE: A Safe Alternative to Achieve Further Weight Loss and Reduction of Co-Morbidities

Amy Banks, MD, R Harrell, MD, J Foote, MD. Grand Rapids Medical Education Partners, Michigan State University and Grand Health Partners.

Introduction: The vertical sleeve gastrectomy was traditionally performed as part one of a staged bypass procedure in the super obese patient population. The weight loss achieved from this surgery alone is often substantial and frequently patients do not require or desire the second stage malabsorbtive procedure. The vertical sleeve gastrectomy is one of the most common weight loss surgeries performed today. Over time, however, weight gain often occurs and we present a new technique of using a laparoscopic placed adjustable gastric band (LAGB) over a vertical sleeve gastrectomy (VSG) to aid in further weight loss and reduction of co-morbidities.
Methods: A retrospective review was performed of five patients who underwent LAGB placement following a VSG. BMI, weight loss from VSG alone and weight loss from LAGB plus VSG were reviewed. Percent excess body weight loss (%EWL) for LAGB alone and for LAGB plus VSG was calculated. Co-morbidities and their resolution as well as any postoperative complications were evaluated.
Results: All five patients achieved further weight loss after placement of the adjustable gastric band over the vertical sleeve gastrectomy with an average of 40.4 lb (range 31-64 lb) and an added %EWL of 32.2% (range 12.7% – 44.1%). Total %EWL following VSG plus LAGB placement was 57% (range 43% – 67.5%). The average BMI decreased from 56.6 pre-operatively to 43.9 post VSG and down to 37.6 after VSG plus LAGB. No major complications occurred during the 31-month average follow up (range 15-46 mo). An average of 3.6 adjustments to the gastric band were needed post operatively. Several co-morbidities resolved after VSG, and there was even further resolution of co-morbidities after LAGB plus VSG. One patient was intolerant of the band and required eventual removal.
Conclusion: This case series introduces a novel approach to add to the repertoire of bariatric procedures following a vertical sleeve gastrectomy. There are advantages to placing an adjustable gastric band over a sleeve gastrectomy in lieu of converting patients to a malabsorptive procedure such as Roux-en-Y gastric bypass or a biliopancreatric diversion with duodenal switch. We demonstrate that certain patients can achieve further weight loss from laparoscopic placement of a gastric band over a vertical sleeve gastrectomy without complications. Further studies still need be done to determine the efficacy of this procedure to provide long-term weight loss in this patient population.

[GreenTealael 25,352]

Interesting. Seems the real problem may be to find a doctor to do it.

[QueenMab89 6]

It looks like this study had a very small sample size of only 5 patients. It does not compare the success of those patients against control patients who did not have the lap band placed after VSG. Therefore we can't know if the lap band is what enabled those patients to lose more weight or if it was another factor.

[krash11 35]

I called a ton of Dr's to see if they did this but none did. In fact, they said it couldn't be done. I really miss my band and hate the sleeve.

[SusieSouth 51]

Thanks all. Sad to find out it’s not very common.

[RickM 1,747]

Similar procedures are done with the RNY (Band over Bypass - BoB) without a lot of success - that is something else for your to research to see how well the band works in that application.

The couple of thoughts that I have had on the idea is that there is likely some over-promotion of the idea from the band manufacturers who have seen a dramatic decline in their market as the problems of the bands have become more widely recognized, and they are looking for new markets. The other concern is that acid reflux are relatively common complications of both procedures, so if you haven't had a problem with it post-VSG, will adding the band bring about that problem where it didn't exist before? Another concern (make that three, now) is what are the longer term implications of this, given that the bands have a fairly high revsion/removal rate due to band failures or damage to the stomach via slippage or erosion - will it work any better, or worse, on a sleeved stomach?

[Mhy12784 423]

I work in one of the higher volume surgical practices for bariatrics in NY and I dont think ive ever seen a band over a sleeve. Even band over bypasses which are possible, are quite rare (ive done maybe 4 or 5 in 5 years)

As someone who works in bariatric surgery and is a patient, I would never in a million years want a band over a sleeve. One is its not very effective, and two is theres so many problems with the band that its just an absolutely horrible idea.

A band over a bypass is at least something I would consider a feasible option.

But the data is pretty strong that unless a procedure was done wrong (which usually isnt the case) or you are having real problems from a surgery (ie horrible GERD after a sleeve) then the odds are a second surgery isnt going to make a huge difference.

That said if I had a VSG (which I do) and I needed to do something else. Converting to a bypass is the only option I would even consider. Yes the bypass is scary which is why your first option should be consulting a nutritionist and therapist, possibly even frequently. But if revisional surgery is the way things need to go, then converting to bypass is really the only option.

Also converting a VSG to a bypass is actually easier than going from nothing to a bypass for most surgeons. And I guess having a VSG first will make the transition and experience a little easier.