More than 300,000 people have undergone laparoscopic adjustable gastric banding (LAGB) worldwide. This operation has gained great popularity because it is promoted as the safest, most effective and easily reversible operation for patients for whom non-surgical methods of weight loss have failed.
Studies have shown that re-operations due to LAGB failure occur at a rate of 5.9%. A number of complications, such as band slippage, pouch dilation, band migration or band erosion, can occur leading to re-operation after lap band surgery..
5-Year Study Evaluates Band Erosions
One of the most common and significant complications after laparoscopic gastric banding is the erosion of the band. A study published in February 2010 reviewed all band erosions that occurred between 2003 and 2007 in 865 patients that were operated by a bariatric surgeon in the Shropshire Upper GI and Laparoscopic Surgery Unit, Princess Royal Hospital, Telford, in England.
Of the 865 LAGBs that were inserted during this 5-year frame, 213 were Swedish adjustable gastric bands (Ethicon Endosurgery Inc.) and 652 were LAP-BANDS (Allergan, Ltd).
Band Erosion Rates
According to the literature, the frequency of erosions is low. Depending on the surgical technique, the surgeons learning curve and type band devices used, it ranges from 0.5% to 11%.
In this study, 17 of the 865 patients presented band erosion and needed to undergo re-operation so that the band would be removed. Of these 17 patients, 12 had received the Swedish adjustable gastric band and 5 had received the LAP-BAND. That means, erosions appeared in 5.6% (12/213) of the Swedish bands and only 0.8% (5/652) in the LAP-BANDs, giving an overall erosions occurrence of 1.96% (17 out of 865).
However, if the first 300 operations are excluded from the analysis (because this is when most band erosions occurred, reflecting the surgeons inexperience), then the overall erosions rate is only 0.53%.
Are LAP-BANDs Safer Than Swedish Bands?
Studies have shown that there is no difference between the Swedish bands and LAP-BANDs in terms of weight loss and complications rates after 1-3 years of follow-up assessment. In this study, however, the Swedish bands were associated with a higher rate of band erosions than the LAP-BANDs. This is because most of the Swedish bands in this study were implanted during the surgeon’s learning curve, with his inexperience affecting the complication rates.
Symptoms of Band Erosion
The symptoms that were associated with band erosion were mostly stomach pain and loss of weight loss or even weight gain. Patients also experienced port-site infection, vomiting and dysphagia.
When Did the Erosion Symptoms Appear?
The band erosion symptoms appeared for most of the patients within the first year. after the insertion of the band. Specifically, 55% of the patients showed the symptoms in the first year, 34% in the second year, and 11% after the second year.
What Happened to the Patients Who Had Band Erosion?
In three of the 17 patients, the stomach was successfully re-banded and the patients are doing well so far (two years later). More than half of the remaining patients gained all the weight back, despite the fact that the initial band insertion had lead them to lose an average of 22.5 kg (50 lbs).
The study, authored by Dr Cherian and published in the journal Surgical Endoscopy, concluded that:
“Band erosion is an unusual but significant source of morbidity after LAGB, with at least one-third of erosion patients in our series not achieving their final goal of weight loss despite appropriate treatment”