Revisional Surgery after LAGB

Laparoscopic adjustable gastric banding (LAGB) is generally safe and well tolerated but complications are not infrequent. As with all other bariatric procedures, there are patients who experience poor weight loss or even weight regain at long term follow up. Some of these complications require prompt management whereas more chronic problems require careful work up involving the multidisciplinary team. All complications require a resolution and revision tailored to the individual. Revision of failed or complicated LAGB should be performed by an experienced bariatric team. A wide range of endoscopic and laparoscopic procedures can be offered to patients with LAGB complications. Management of these issues often requires explanting the device, with or without proceeding to more definitive measures. Invariably, there will be a subgroup of patients with interval weight regain, especially if the gastric band is removed without any immediate salvage or replacement procedure. Redo surgery for LAGB is still a gray area of bariatric surgery. Large experiences with long follow up are lacking and high grade level evidence based experiences are also absent. Overall, outcomes in terms of weight loss and complications are controversial according to different experiences.