Gastric Band Removal & Conversion
Some patients who currently have gastric bands are finding that their band is not working for them and are undergoing a band removal and a subsequent sleeve gastrectomy.
This usually comes down to weight regain, gastro-oesophageal reflux disease (GORD) or food intolerance, which presents as either intermittent food bolus obstructions or complete intolerance of solids, meaning patients are living on an unhealthy liquid diet.
Less common causes of band removal are enlargement of the gastric pouch, band slippage and band erosion.
At Circle of Care, we perform band-to-sleeve conversions in two separate operations as we strongly believe this is the safest approach.
Firstly, the laparoscopic removal of the band, port and tubing is performed. This procedure typically takes half an hour and involves an overnight stay in hospital.
Secondly, the sleeve gastrectomy is performed 10 to 12 weeks later, allowing scar tissue surrounding the band to virtually disappear and the gastric stapling device able to divide the stomach more easily, greatly reducing the chance of leakage.
It is important to note that patients who convert to a gastric sleeve from the gastric band on average have an excess weight loss of approximately 60 percent at 12 months.
What is the band removal procedure?
Once a general anaesthetic has been administered, five key-hole ports are inserted into the patient’s abdomen. The port site scars from a previous band insertion are used for this and usually no additional skin incisions are required. A minimalist approach is taken avoid the creation of more scar tissue by unnecessary dissection.
Once the liver is retracted up and away from the stomach, the operation begins by dividing any adhesions or scar tissue between the stomach and liver. The scar tissue capsule that has formed around the outside of the band is then dissected away allowing the band to spin freely around the stomach.
At this point, the tubing on the inside of the abdomen is cut and the band divided into 3 pieces to facilitate removal. The band is re-assembled on the patient’s outside and a photo taken to ensure no foreign material has been left inside the abdominal cavity. The laparoscopic ports are then removed from the abdomen and the gastric port dissected off the sheet of tendon that covers the abdominal wall muscles.
Wounds are closed with buried absorbable sutures and local anaesthetic injected.
This procedure occurs 10 to 12 weeks post band removal once band scar tissue has softened and dissipated. This procedure is very similar to a primary sleeve gastrectomy.
However, careful attention is paid to adequately dissect the stomach at the previous site of the band which may be technically challenging and sometimes avoided by surgeons. If this is not performed properly, problems such as inadequate resection of stomach and sleeve migration into the chest cavity are more likely to occur which can compromise the sleeve and weight loss outcomes.