Clinical outcome of revisional gastrectomy postgastric banding failure: A systematic review.

Clinical Snapshot

Key Findings

• P Value: Not applicable; no inferential statistical testing reported for pooled outcomes

• Effect Size: Mean overall complication rate: 9.95% (range 0–37.5% across 22 reporting studies); leak rates: 0–8.1% across 39 studies, with stage-specific rates 2.8–5.8%; bleeding: mostly isolated cases across 30 studies; infection: low incidence across 9 studies; thrombosis: reported in 1 study only

• Primary Outcome: Postoperative complication rates following revisional laparoscopic sleeve gastrectomy after failed LAGB, including leak, bleeding, infection, and overall complications

• Nnt Or Sensitivity: Not calculable from available data; no NNT, hazard ratio, or odds ratio reported. Revision BMI range 33–52 kg/m² at time of revisional procedure. No standardised excess weight loss or percentage total weight loss figures provided in the abstract.

• Confidence Interval: Not reported; no meta-analytic pooling performed

Clinical Application

Revisional LSG following failed LAGB is technically feasible and widely performed internationally. Surgical complexity is higher than primary LSG due to adhesions, altered anatomy, and the need for band removal (simultaneous or staged). The decision between simultaneous versus staged procedures requires individualised assessment. Centres performing this procedure should have dedicated bariatric surgical expertise and multidisciplinary team support including dietetics, endocrinology, and psychology. In Australia, LAGB was historically one of the most commonly performed bariatric procedures, with significant numbers of patients now presenting with long-term band failure requiring revision. The Therapeutic Goods Administration (TGA) has approved LSG as a primary and revisional bariatric procedure. Medicare Benefits Schedule (MBS) item numbers exist for revisional bariatric procedures (MBS 31575 and related items), though access and funding criteria vary. The RACGP and the Australian and New Zealand Metabolic and Obesity Surgery Society (ANZMOSS) guidelines support revisional bariatric surgery in appropriately selected patients with documented band failure. PBS-listed nutritional supplementation (iron, vitamin B12, folate) is relevant given the nutritional deficiency risks identified. The high prevalence of LAGB in the Australian bariatric population makes this review particularly pertinent to Australian surgical practice, though the predominantly Middle Eastern and European study populations may limit direct demographic applicability. Adults with morbid obesity who have undergone LAGB and experienced band failure due to erosion, slippage, port complications, or inadequate weight loss, and who are being considered for revisional bariatric surgery. Patients with BMI 33–52 kg/m² and mean age 30–50 years represent the studied cohort.

Abstract

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) has been widely used for obesity management; however, its long-term failure, due to complications such as band erosion, slippage, and inadequate weight loss, has necessitated revisional bariatric procedures. Revisional laparoscopic sleeve gastrectomy has emerged as a common alternative, yet its safety and efficacy remain debated. METHODS: A systematic review was conducted in accordance with PRISMA guidelines; this review was prospectively registered with Prospective Register of Systematic Reviews (CRD42024568094). A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane databases was performed up to July 19, 2024. Studies published in English that reported postoperative outcomes following revisional laparoscopic sleeve gastrectomy after failed LAGB were included. Data were extracted independently by 2 reviewers, focusing on patient demographics, complication rates (including leaks, bleeding, and infections), and nutritional outcomes. Quality assessment was performed using a standardized tool for observational studies, cohort and cross-sectional studies. RESULTS: Fifty studies involving a total of 16,192 patients were analyzed. Patients had a mean age between 30 and 50 years and a revision body mass index ranging from 33 to 52 kg/m2. Infection was reported in 9 studies, though incidence was low. Bleeding was examined in 30 studies, with mostly isolated cases; thrombosis was reported in only 1 study. Leak rates were reported in 39 studies, ranging from 0% to 8.1%, with stage-specific rates between 2.8% and 5.8%. Four studies noted nutritional deficiencies, including increased ferritin deficiency and some cases contributing to readmission. Overall complication rates were reported in 22 studies, averaging 9.95% and ranging from 0% to 37.5%. CONCLUSION: Revisional laparoscopic sleeve gastrectomy following failed LAGB appears to offer a safe and effective alternative, with acceptable complication rates and favorable weight loss outcomes. However, heterogeneity in study designs and patient characteristics underscores the need for standardized reporting and further research to optimize clinical protocols.

References

1. 1.Rashdan, M., Alzoubi, R., Tarazi, A., Abualrub, R., Almanaseer, Z., Alhashki, H., & Al Rekabat, S. (2026). Clinical outcome of revisional gastrectomy postgastric banding failure: A systematic review. Medicine. https://doi.org/10.1097/MD.0000000000049479