Adjustable silicone gastric banding for obesity

Variation of outcome in weight loss with band volume adjustments under clinical and radiological control following laparoscopic adjustable gastric banding

BACKGROUND

Following laparoscopic adjustable gastric banding (LAGB), patients usually undergo follow-up (FU) to optimize weight loss and detect complications, with band-volume adjustment performed either under radiological or clinical guidance with no current consensus on what is the best standard of care. We, therefore, analyzed our patient cohort to identify differences between the two, if any, over a 3-year period.

METHODS

We retrospectively reviewed our obesity surgery database to find all LAGB patients and grouped them based on method of FU without weight exclusions. We then selected out 70 consecutive patients from each cohort from an arbitrary time-point to achieve sufficient FU and analyzed the results from the data collated. Patients with postoperative complications were excluded to prevent bias.

RESULTS

From 2003 to 2007, there were 865 LAGB performed in our unit. We identified 70 consecutive patients from January 2004 from each cohort. After review and exclusions, we were left with 50 patients in the radiology group (RG) and 49 in the clinical group (CG) [median BMI 43.8 and 47.1, respectively; median age 43 years in both]. Routine FU was at weekly, then fortnightly, and monthly intervals, but results were analyzed at 3-month intervals until the first year and every 12 months until the third year. The median percentage of excessive weight loss was 22% and 36% at 6 months; 28% and 43% at 12 months; 27% and 47% at 2 years; and 33% and 46% at 3 years in the RG and CG, respectively. There was no difference in difficulties to band fill in either group as per clinical records, although there was a greater incidence of port damage in the CG.

CONCLUSIONS

Our study suggests that at medium-term follow-up, clinical fill is superior to radiological FU at least in terms of weight loss, with the added benefit of avoiding unnecessary radiation albeit that the difference between the two methods gets smaller with FU beyond 2 years. This topic merits a future randomized control trial to make recommendations without biases inherent to retrospective analysis.

The Swedish laparoscopic adjustable gastric banding for morbid obesity: radiologic findings in 218 patients

OBJECTIVE

The objective of this study was to determine the prevalence and radiologic features of postoperative complications after Swedish laparoscopic adjustable gastric banding surgery and to emphasize the role of the radiologist in the follow-up of those patients, especially in the treatment of complications.

MATERIALS AND METHODS

We reviewed the radiologic findings in 218 consecutive morbidly obese patients after laparoscopic placement of the Swedish gastric banding system. Radiographic studies of the stomach (obtained with liquid barium sulfate suspension) were performed before surgery and 1 month after band placement in every patient. Additional studies in symptomatic patients were performed when needed.

RESULTS

Surgical complications found included misplacement of the band (five patients, 2.3%), slippage of the band (17 patients, 7.8%), and pouch enlargement (eight patients, 3.7%). Technical problems encountered were inversion of the access port (three patients, 1.4%), leakage of the device (two patients, 0.9%), and spontaneous decrease of the stoma size caused by gastritis (seven patients, 3.2%) or the hyperosmolar properties of the IV contrast material (12 patients, 5.5%). Intrinsic abnormalities of gastroesophageal tract seen included trapping of food in the stoma (four patients, 1.8%) and esophagitis (11 patients, 5%).

CONCLUSION

Although, according to the available data, the gastric banding operation with the Swedish band meets the criteria of a low-risk laparoscopic alternative treatment of morbid obesity, the radiologic appearances of various complications may be seen on the images of patients who have undergone the procedure. The radiologist plays a key role in the early detection of those complications and treatment of specific abnormalities.

Laparoscopic bariatric surgery

At present, laparoscopic bariatric surgery is a controversial topic among bariatric and laparoscopic surgeons. Although difficult to perform, the traditional procedures used for treating severe obesity are now being performed successfully using a laparoscopic approach. In addition, a new procedure, adjustable gastric banding, has been used in Europe; however, it lacks US Food and Drug Administration approval and adequate scientific follow-up data about long-term effectiveness. Appropriate patient selection and adherence to the principles that have been learned by experience through open bariatric surgery remain of paramount importance for the success of laparoscopic bariatric operations.

Adjustable laparoscopic gastric banding in patients with morbid obesity: radiographic management, results, and postoperative complications

PURPOSE

To determine the role of radiographic assessment in patients who underwent an adjustable laparoscopic gastric banding (ALGB) for the treatment of morbid obesity, and to evaluate the frequency and type of postoperative complications.

MATERIALS AND METHODS

From September 1995 to March 1998, 98 consecutive patients (18 men, 80 women; mean age, 39 years; age range, 22-62 years) with morbid obesity (mean body weight, 132 kg; mean body mass index, 47.1 kg/m(2)) underwent ALGB. In all patients, fluoroscopy was performed postoperatively to confirm band position and to exclude perforation and at 6-8 weeks later to measure and adjust the stoma between the pouch and stomach for optimal weight loss. All patients underwent another examination 12 months postoperatively, whereas patients with unsatisfactory weight loss or patients suspected of having complications were examined earlier and on several occasions.

RESULTS

Port puncture was feasible in all cases, and stomal adjustments could easily be repeated. Absolute (ie, total) weight loss after 1 year ranged from 8.8% to 39.2% (mean, 18.3%). Twenty patients showed unsatisfactory weight loss. No early complications occurred. Late complications occurred in 34 patients and included pouch dilatation (concentric or eccentric with posterior slippage), eccentric band herniation, band penetration, disconnection, axial pouch herniation, and port-site infection.

CONCLUSION

ALGB is an effective method in the treatment of morbid obesity. Radiographic assessments are crucial in the management of weight loss and detection of postoperative complications.

Radiology of adjustable silicone gastric banding for morbid obesity

We reviewed the radiological findings in 45 morbidly obese patients (weight range 80-129 kg; mean 95.7 kg) after gastric restriction surgery with adjustable silicone gastric banding (ASBG) according to the Kuzmak technique. Radiographic studies of the stomach were performed before, and at 4 and 12 months after surgery; symptomatic patients underwent additional studies when needed. Patients were evaluated using both liquid barium and a solid opaque meal to assess post-operative gastric morphology as well as emptying time of the proximal gastric pouch. 27 patients had a normal clinical course. Variation of the calibre of the silicone band under radiographic guidance was required in 12 of these patients, based on dilatation of the proximal pouch, variation of the stomal calibre from operative values, or an emptying time longer than 30 min. All these problems disappeared after the adjustment manoeuvres. 18 patients had complications, of which five had stomal stenosis which could not be managed through simple deflation of the band; two had posterior bending and dilatation of the proximal pouch; four had gastritis and oesophagitis; six had infection of the inflatable reservoir; one had cranial displacement of the band, and two had migration of the band into the stomach. Removal of the gastric band was necessary in 11 cases, and removal of the reservoir alone had to be performed in three additional patients. Radiology plays an important role in evaluating complications after gastric restriction surgery. Knowing the variety of findings enables accurate treatment planning and follow-up of these patients.