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Band to Sleeve
We have seen an increase in the amount of patients who inquire to AMBI regarding removal of a Gastric Band and conversion to Sleeve Gastrectomy. Patients who have had a Laparoscopic Adjustable Gastric Band and are dissatisfied with the results achieved with the procedure, or have had complications that require removal of the Band, or just simply are not happy with the symptoms that the band produces, often look for a solution that will not only remove their band, but also help them to continue in their quest for successful and sustained weight loss.
If you have a Laparoscopic Adjustable Gastric Band, there is a one in five chance that you will require another surgical procedure to correct a complication. Whether it is a slip, erosion, port disruption, intolerance to the symptoms that the band produces, or you are just not happy with the results of your weight loss, the trend towards a change of bariatric procedure has increased dramatically in the last few years.
So far, the results achieved by Sleeve Gastrectomy are far superior to the results reported with Laparoscopic Banding. If you add the advantage of not having a foreign object in your body and the convenience of not requiring band adjustments, it is not surprising that that we have had a spike in our numbers of this procedure: Band to Sleeve.
How it Works
Using a minimally invasive laparoscopic technique and trying to use the previous incisions, the band is visualized and dissected free. The Band is then divided and removed from its position around the stomach making sure that all its components are removed from the patient. The Sleeve Gastrectomy is then performed, taking great care not to divide the stomach in the area where the band has made a fibrotic scar. The vascular supply to the greater curvature of the stomach is dissected free and all the blood vessels carefully divided. After creating the sleeve and removing the part of the stomach that has been divided, the remaining stomach is sutured for double security and tested with air and colorant solution to ascertain its hermetic closure. The result is a reduction of approximately 85% of the volume of the previous stomach.
Resolution of the undesirable and nagging side effects of the laparoscopic Gastric Band is one of the first noticeable results of this procedure. Multiple studies of Sleeve Gastrectomy have demonstrated excellent results that are comparable to Gastric Bypass in terms of resolution of medical complications of obesity like diabetes type 2 and hypertension. Not having to deal with Band adjustments or a foreign body is a major advantage over Banding. Absence of nutritional complications from a malabsortive procedure is another very important advantage of the procedure.
As with any bariatric procedure, the commitment to a healthy lifestyle and a change in the eating habits of the patient is essential to the success of the operation. All of the prerequisites for eligibility that we have listed for Sleeve Gastrectomy are still important when considering this conversion surgery. It is well documented that patients that have their Gastric Band removed, regain their preoperative weight, making a second bariatric procedure beneficial. Therefore we strongly recommend that even patients who have achieved lower BMIs and are considering removal of the band think about a conversion to Sleeve Gastrectomy.
Risks and Complications
There have been multiple reports on the beneficial results of Sleeve Gastrectomy after band removal. The only controversy exists in the timing of the gastrectomy part. There is some advantage to the practice of first removing the band and waiting several months before doing the Sleeve Gastrectomy, making it a 2-step operation. The proponents of this method of conversion point to the increased possibility of a leak when dividing a stomach that has a band because of the fibrotic ring left by the band. Our policy is to divide the stomach below the indentation left by the band, reducing the possibility of this dreaded complication. Other complications are similar to the ones discussed for Sleeve Gastrectomy.
The area of the port that has now been removed may be more sensitive for some time due to the dissection that is necessary to remove this part of the band. This sensitivity dissipates with time.