Removal (or explantation) of adjustable gastric bands is (eventually) performed in approximately 50% of patients who undergo this procedure for treatment of severe obesity. The high long-term failure rate of laparoscopic adjustable gastric banding has led many bariatric surgeons to abandon this operation.
Dr. Robert Brolin never performed laparoscopic gastric banding due to the relatively poor results associated with open banding that were reported in the 1990’s. Removal of a gastric band caries greater risk than primary placement due to the dense scar tissue produced by the band.
Why Remove a Gastric Band?
Indications for removal of adjustable bands include:
- complications associated with the band (infection, slips, erosion)
- unsatisfactory weight loss
- general “intolerance” of the band
Whether another bariatric procedure is performed at the time of band removal remains a controversial topic in bariatric surgery.
One-Stage vs. Two-Stage
Dr. Brolin has advocated the one-stage approach in which the band is removed and a second procedure, either gastric sleeve or RYGB, is performed at the same time. This approach spares the time and expense of a second surgical procedure.
Surgeons who advocate the two-stage approach tend to believe that the scar tissue produced by the band poses an increased risk for complications such as leak, infection and bleeding.
Most of the published data that compare the one versus two-stage approach do not show a significant difference in complication rates. Likewise, postop weight loss following band removal and concomitant sleeve gastrectomy or RYGB are not affected by the one versus two-stage approach.