1-818-812-7222 Office Hours: 8:00 AM to 5:00 PM
10 Congress St., Suite #300
Pasadena, CA 91105

Category: Realize band

Revision from failed AGB to Duodenal Switch

January 10, 2018 2:10 pm

A few times a month during consultation for weight loss surgery , I’m ask as to why I do not offer the adjustable gastric banding as an alternative to the patients. As I have said over the years when a patient considers an weight loss surgery the totality of the risk should be considered. This includes the operative, immediate postoperative course, the maintenance and the follow-ups needed. The potential complications of the procedure in addition to the long-term success off each operation should also be taken into account.

Unfortunately, some patients are led to believe that any perceived benefit in the short operative time and the ease of the adjustable gastric banding also translates to a better outcome. This is in fact the opposite of what the published data have shown, a recent study published in April 2017 by Vinzes et.al, shows that 71% of patient lost their band by 10 years out.

Long-term_AGB_outcome-791x1024

What is also interesting that more patients underwent revision from failed AGB to the duodenal switch than the sleeve gastrectomy (Fig 1.). This is what I also recommend.

More importantly, The patients who underwent a revision from failed AGB to the duodenal switch operation had the best long term results of all patients (Fig 2.) note the “rBPD” line that is the highest of %EBMIL.

Complication’s were broad and frequent (Table 3.)

Further information on revision from failed AGB to Duodenal Switch or other failed weight loss surgeries can be found here.

New Pasadena Office Map and Parking

August 12, 2017 8:35 am

We’ve created a helpful map and parking diagram for our new Pasadena, CA office location.  It also has a general layout of the Huntington Memorial Hospital Campus and Pre-operative intake and testing area.  We hope that you find it helpful on your next visit to see Dr. Ara Keshishian, General and Bariatric Surgeon.

Map and Parking Dr. Keshishian's office
Map and Parking Dr. Keshishian's office

Dr. Ara Keshishian has performed more than 2,000 Duodenal Switch procedures, thousands of Sleeve Gastrectomies and more than 500 revisions from other Weight Loss Surgeries such as RNY Gastric Bypass, Adjustable Gastric Band, and Sleeve Gastrectomy to Duodenal Switch as well as General Surgical cases over the last 18 years of private practice.

Gastric Band Complications

June 21, 2017 10:22 am

For years, we have seen patients who have had Adjustable gastric bands placed and continue to suffer from the complications associated with it. Gastric Band complications include erosion, persistent nausea, vomiting abdominal pain, inadequate weight loss and weight regain, etc. . Unfortunately, when seeking help, they are often told that this never happens to others and that complications are a rare occurrence. Let’s remember that the Adjustable Gastric Band was promoted and sold as a procedure with almost no down side, low risk and easily revisable!

There is an unfounded expectation that the band can be deflated and all the Gastric Band complications will resolve. This could not be any further from the truth. The reality is that there are patients whose symptoms may somewhat improve but will continue to have the abdominal pain, the nausea and or vomiting-albreit, not to the same intensity. There are several Gastric Band complications that are considered emergency situations that require immediate attention by a physician.

Our position has always been, and continues to be, that all Adjustable Gastric Bands should be removed by a surgeon who is experienced with the Gastric Band complications and revisions.

Gastric Band Complications article
Gastric Band Complications article
Gastric Band Complications article
Gastric Band Complications article
Gastric Band Complications article
Gastric Band Complications article

“Normal” Lap Band placement!

April 23, 2013 9:39 pm

One of the most common problems that we see are patients who have been told that their band is in correct placement, and yet they are still having nausea, vomiting, reflux etc. These patients are frequently blamed for their symptoms as if properly placed band completely eliminates the problems being associated with the band.

The image above is an upper GI of a patient with no band in place.
The image above shows the esophagus of a patient with band placed, with no dilation of the esophagus.
The above image, shows the properly placed band with a grossly dilated esophagus above it.
This patient presented with daily nausea and vomiting and severe reflux, not even tolerating liquids even-thought the study was reported as “normal location and position” for Lap band.

Slipped Band

November 02, 2012 10:40 pm

“Slipped band” is actually a misnomer. It suggests that the band “slips” over part of the stomach, which is actually incorrect. In most cases, the band itself is scarred down to the surrounding tissue, as the stomach above and below the band is what migrates. This results in the stomach being partially trapped above or below the band, which causes nausea, vomiting, and abdominal pain. If it is not urgently treated, it may cause erosion and perforation of the trapped stomach tissue.
The treatment may be as simple as completely removing the fluid in the band, which may allow the stomach to return to its proper place. Though in my experience, the majority of the cases require a surgical intervention and removal of the band.