Outcomes of stepwise treatment of food intolerance secondary to vertical banded gastroplasty.

INTRODUCTION: There is a high rate of long-term complications and persistent symptoms of food intolerance following Vertical Banded Gastroplasty (VBG). This prompts many patients to undergo difficult revisional bariatric surgery due to inflammation, scarring, and adhesions. Here, we demonstrate the outcomes of treating diet intolerance due to nonadjustable gastric bands (NAGBs) using a stepwise algorithm developed at our institution progressing from endoscopic removal using induced mucosal erosion with a stent (IMES) to a minimally invasive septotomy. METHODS: Retrospective chart review was performed on symptomatic patients undergoing stent placement to remove NAGBs at our single institution from 1/1/2018 to 5/6/2024. Patient symptom types and demographic and surgical data were recorded from patient clinical encounters preoperatively and one month after stent removal. Patients with persistent symptoms following NAGB removal were offered restoration of their anatomy via endoscopy-assisted laparoscopic septotomy per our institution's protocol. RESULTS: Twenty-four patients underwent endoscopic stent placement for gastrointestinal symptoms attributable to a NAGB. One patient did not tolerate stent placement and required stent removal on postoperative day one. Stents were removed between 12 and 28 days for all other patients. Six patients with persistent symptoms after IMES subsequently underwent endoscopy-assisted laparoscopic septotomy without complication and none required additional revisional surgery. The remaining 17 patients (71%) had improvement in their preoperative symptoms and were tolerating a regular diet at one-month follow-up without requiring an additional abdominal operation, which is similar to other published data on endoscopic methods of NAGB removal. There were no complications from stent removal or septotomy. CONCLUSION: Our stepwise treatment of gastrointestinal symptoms secondary to NAGBs is safe and effective. For patients with persistent food intolerance following IMES, there is a safe minimally invasive option in endoscopy-assisted laparoscopic septotomy to avoid more extensive revisional procedures.