Background

Revisional bariatric surgery continues to increase. Laparoscopic adjustable gastric banding (LAGB) after previous Roux-en-y gastric bypass (RNY), known colloquially as “band-over-pouch” has become an option despite a dearth of critically analyzed long-term data.

Methods

Our prospectively-maintained database was retrospectively reviewed for patients who underwent band-over-pouch at our MBSAQIP Center of Excellence in a 15-year period ending February 2019. We evaluated: demographics, comorbidities, operative procedures, and outcomes (30-day and >30-day).

Results

During the period, of 4,614 bariatric procedures performed, 42 were band-over-pouch with 39 (93%) being women. Overall, the mean age was 49.8 years (range 26-75), a mean weight 251 pounds (range 141-447) and mean BMI 42.4 (range 26-75). Co-morbidities included: hypertension (n=31; 74%), diabetes (n=27; 64%), obstructive sleep apnea (n=26; 62%), gastroesophageal reflux disease (n=26; 62%), and osteoarthritis (n=25; 60%). All procedures were performed laparoscopically with no conversions to open. Mean length of stay was 1.2 days (range 1-3). Mean follow-up time was 4.2 years (range 0.5-10). Mean excess weight loss was 14.9%, 24.3%, and 28.2% at 6 months, 1 year and 4 years, respectively. There was one 30-day trocar-site hematoma requiring transfusion. Long-term events included: 1-year (1 endoscopy for retained food; 1 internal hernia), 3-year (1 LAGB erosion; 1 LAGB explant), 4-year (1anastomotic ulcer), 6-year (1 LAGB explant and RNY revision), and 8-year (1 LAGB erosion). Two 5-year mortalities occurred (4.8%); both in association with hospitalization for chronic illness and malnutrition. Both erosions were successfully treated surgically.

Conclusions

Band-over-pouch warrants further analysis before widespread adoption as a revisional procedure.