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Post-Surgery Weight Regain: Surgical Factors with LAGB



sharma-obesity-adjustable-gastric-banding2In previous posts, I have discussed the role of nutrition, metabolism, mental health and physical activity in weight regain after bariatric surgery.

While these factors together account for the vast majority of weight regain in patients, our systematic review of post-surgery weight regain published in Obesity Surgery also looks at the role of surgical and anatomical factors that may limit weight loss or promote weight regain.

As one may expect, these factors vary between the different surgical procedures.

“Technical failure” with adjustable gastric banding (AGB), the simplest but least effective of bariatric surgical procedures, may often simply be related to lack of appropriate follow-up and failure to properly adjust the band. Indeed,  failure to periodically readjust the band may well be the most common cause of “technical failure” with this procedure..

Band-failure may also result from enlargement of the gastric pouch, a problem that in one case series was reported in almost 50% of patients at 4 years. In addition, proximal slippage of the band has been described in almost 10% of cases, in turn limiting the effectiveness of this intervention.

Thus, it is important for patients who are experiencing weight recidivism after band placement to be assessed for potential pouch distension or slippage of the band as factors contributing to failure. Pouch distension can oftentimes be managed by complete band deflation, a low calorie diet, reinforcement of portion size and follow-up contrast study in 4–6 weeks.

This conservative management strategy can be successful in over 70 % of patients.

Band slippage can be managed similarly, but oftentimes, surgical intervention is required with band re-positioning or band replacement or removal.

Obviously, weight regain is virtually the rule in cases where the band has to be removed due to intolerance, persistent reflux or other problems. Thus, although “reversibility” is often promoted as a positive “feature” of this operation, this “feature” makes little sense given that band removal will virtually always result in weight regain.

Considering the rather high rates of band removals reported in some case series, one may well wonder about whether this operation can really be considered a “permanent” measure.

As with all bariatric procedures, regular follow-up and dietary compliance is essential for optimal outcomes, but because of its limited mode of action, it is not surprising that the AGB, although the least-invasive operation, may well be the surgical procedure most prone to failure in the long-term.

If you have experienced weight recidivism after gastric banding, I’d certainly like to hear your story.

@DrSharma
Edmonton, AB

ResearchBlogging.org
Karmali S, Brar B, Shi X, Sharma AM, de Gara C, & Birch DW (2013). Weight Recidivism Post-Bariatric Surgery: A Systematic Review. Obesity surgery PMID: 23996349 

 

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7 Comments

  1. I was never able to find the “sweet spot” with my band. It was always too tight or too loose. When it was too tight, I ended up drinking excessive amounts of calories and throwing up every time I ate solid food. This caused a slip an a massive hiatal hernia. After significant weight regain, the band had to be removed. Luckily, the surgeon was able to do a gastric sleeve at the same time. Even though I’m down more than 100 pounds from my highest weight, I’m still in the obese category, despite careful eating and daily exercise. I’ve found the weight loss surgery journey to be long and frustrating. It’s tough when you feel like you’re doing everything right and you still don’t get the results you’re looking for.

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  2. I had lapband surgery in 2006 and it helped me to lose 100 lbs. However I found living with the difficulties of the lapband (getting “stuck”, vomiting, eating too little food) to be very stressful so I had my band unfilled 3 years ago. I have no restriction and it’s a struggle to maintain my original weight loss. I have regained 10-15 lbs a few times and had to work extremely hard to lose it again. I’m still 50 lbs shy of my ideal weight but can’t see ever getting there. I would be content to just maintain my original weight loss but it’s a constant battle. I would like to have the band removed but I fear weight regain. Maybe switch to a gastric sleeve? I haven’t been able to find evidence of its long term effectiveness. I cannot find medical support that is objective and evidence based, but would find that very helpful.

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  3. I’m not sure what to do. My 4 year old band has had almost all fluid removed. 6 weeks ago I had an episode with a migraine involving nausea. The vomiting irritated the band to where I could not keep anything down. After a week of constant reflux and no sleep, I had all the remaining fluid taken out. My doctor’s comments are along the lines of “you are eating the wrong foods” and “if you would just do the right thing, this would work.” So it’s all my fault, I’m a failure, and….why did I sign up for this again? Would a different doctor be any different? What do I do now?

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  4. Alice,
    I think a new doctor would be a great first step. You are very likely not doing anything wrong at all. The problem with the band is that anytime you suffer from stomach upset for any reason it makes it impossible to eat. It takes such a long time for all the swelling to go away and you’re expected to live on protein shakes and pureed foods like you did at the very beginning. But you’re probably much more active now which requires real food as fuel. I’m sorry you’re having so much trouble!

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  5. I had lost 65lbs during the 1st year following my lagb surgery. It was a frustrating year as it took about 8 fills to get it tight enough for me to have any sense of having a pouch at all. In my 2nd year post surgery I put on 30lbs. I just got fed up with following “the rules” for weight loss with my band and learnt how to cheat. Ive now started cbt counselling with a very expensive private psychologist (although cheaper than a band!!) and its really helping. You really need to be brutally honest with yourself about why you overeat in the first place and my therapist has helped me understand my issues and is now helping me change behaviors. I dont regret having the band but its not the whole answer. It slows my eating down which is invaluable but I wished I had tried cbt first and saved some cash. I actually think the 65lbs I lost in the first year was out of fear of getting things stuck. I then learnt how to cope with this and it was downhill from then on!

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  6. i was banded in January 2009, and lost 70lbs of the 120 i needed to lose. Then the band stopped working. Everything I ate, especially the things i NEEDED to eat (protein) got stuck. I went through all the dianostics, including an esophageal manometry, all came up negative. My dr has no idea why the band stopped working. He says, well some people’s bodies don’t work with the band.
    I have regained all of the lost weight, and now have to choose between having the band removed, and/or having another surgery. the band surgery was the most painful of any surgery I have ever had, including my total abdominal hysterectomy.

    I waited on WLS until the band was approved and now I feel i was sold a bill of goods about the “wonder miracle band”. If any other medical device had this rate of failure, there would be a class action lawsuit.

    I am still facing somehow losing 120lbs. It is very very discouraging.

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  7. I got my Lap Band on Oct 20, 2009. I lost 119 lbs in 14 months. I’ve kept the weight off ever since hitting goal.

    Life with my Lap Band is a 80/20 rule:

    The band does 20% of the work: Keeps me not hungry for 4-6 hours.

    I do the other 80% of the work: proper food choices, portion sizes, and EXERCISE.

    I have gotten food stuck 3 times in 4 years. I listen to my band and chew, chew, chew and eat slowly.

    I love my band! Check out my blog: http://lapbandgalsjourney.blogspot.com

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