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Pelenyi S, Lee CK, Fleites O, Tiesenga F. Gastric Band Insertion to Revise Sleeve Gastrectomy: A Case Report. Cureus 2022; 14:e22999. [PMID: 35415039 PMCID: PMC8993030 DOI: 10.7759/cureus.22999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/05/2022] Open
Abstract
Bariatric surgery for the treatment of obesity, first introduced in the 1950s and 1960s, is now relatively commonplace. Often patients will first have an adjustable gastric band inserted, as this does not require altering or removing parts of the gastrointestinal tract. This procedure is associated with short hospital stays and quick recoveries and may be adjusted without further surgery. Typically only after banding fails mechanically or fails to bring about a satisfactory reduction in body mass index (BMI) do patients undergo further bariatric procedures which involve altering or removing parts of the gastrointestinal tract. Recent research has suggested that gastric banding is associated with greater weight reduction results as a secondary or follow-up procedure following a failed initial bariatric surgery. Here we report the case of a 43-year-old female with a history of cryptogenic organizing pneumonitis, gastroesophageal reflux disease (GERD), asthma, obesity, and prior sleeve gastrectomy who underwent a laparoscopic gastric band insertion to revise the prior sleeve gastrectomy, in reverse of the typical sequence of bariatric surgeries.
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2
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Wang Y, Kassab GS. Efficacy and Mechanisms of Gastric Volume-Restriction Bariatric Devices. Front Physiol 2021; 12:761481. [PMID: 34777019 PMCID: PMC8585502 DOI: 10.3389/fphys.2021.761481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/07/2021] [Indexed: 12/27/2022] Open
Abstract
Obesity is a chronic disease that affects over 795 million people worldwide. Bariatric surgery is an effective therapy to combat the epidemic of clinically severe obesity, but it is only performed in a very small proportion of patients because of the limited surgical indications, the irreversibility of the procedure, and the potential postoperative complications. As an alternative to bariatric surgery, numerous medical devices have been developed for the treatment of morbid obesity and obesity-related disorders. Most devices target restriction of the stomach, but the mechanism of action is likely more than just mechanical restriction. The objective of this review is to integrate the underlying mechanisms of gastric restrictive bariatric devices in obesity and comorbidities. We call attention to the need for future studies on potential mechanisms to shed light on how current gastric volume-restriction bariatric devices function and how future devices and treatments can be further improved to combat the epidemic of obesity.
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Affiliation(s)
- Yanmin Wang
- California Medical Innovations Institute, San Diego, CA, United States
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
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3
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Hurley CM, Hechtl D, Ng KC, McHugh J, Sehgal R, Regan MC. Biofilm-sealed perforation of the gastric body: a rare sequela of gastric band erosion. J Surg Case Rep 2019; 2019:rjz263. [PMID: 31807272 PMCID: PMC6889854 DOI: 10.1093/jscr/rjz263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/11/2019] [Indexed: 12/01/2022] Open
Abstract
Laparoscopic Adjustable Gastric Banding is one of the cardinal bariatric interventions and due to its early safety profile, became the mainstay. Major long-term complications of gastric banding include pouch-herniation-dilation and gastric erosion. A 59-year-old female presented to the emergency department with a 2-week history of progressive central abdominal pain and distention on a background history of a laparoscopic adjustable band insertion 11 years previously. Subsequent computed tomography demonstrated an intragastric band erosion. An exploratory laparotomy demonstrated a gastric band eroded through the stomach sealed by a biofilm. Secondary findings included small bowel ischemia and portal vein thrombosis. The gastric band was extracted, and the stomach was repaired. The ischemic small bowel was resected with primary anastomosis. The patient recovered uneventfully. Gastric band erosion should be considered in all patients presenting with abdominal pain and previous weight loss surgery. Prompt recognition may avoid fatal consequences.
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Affiliation(s)
- Ciaran M Hurley
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
| | - Daniel Hechtl
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
| | - Kin Cheung Ng
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
| | - Jack McHugh
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
| | - Rishabh Sehgal
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
| | - Mark C Regan
- Department of General and Colorectal Surgery, University Hospital Galway, Galway, Ireland
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4
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Delaney FT, Franz R. Abdominal viscus penetration by laparoscopic-adjustable gastric band tubing: case report and review. BJR Case Rep 2019; 4:20170097. [PMID: 30931132 PMCID: PMC6438395 DOI: 10.1259/bjrcr.20170097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 05/05/2018] [Accepted: 05/10/2018] [Indexed: 11/05/2022] Open
Abstract
Laparoscopic-adjustable gastric band (LAGB) complications are increasingly recognised as follow-up time increases. These are most commonly related to the gastric band or port site, but complications of the connecting tubing are also reported. We present a case of LAGB tubing penetration through the transverse colon causing abdominal sepsis in a complex surgical abdomen and review prior published cases of abdominal viscus penetration by LAGB tubing. Like complications involving all LAGB components, these often present with non-specific abdominal signs and symptoms and undergo abdominal CT as an early investigation. This makes knowledge of normal and pathological imaging features of LAGB components important in radiology practice.
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Affiliation(s)
- Francis T Delaney
- Department of Medical Imaging, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Robert Franz
- Department of General Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia
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5
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Furbetta N, Gragnani F, Flauti G, Guidi F, Furbetta F. Laparoscopic adjustable gastric banding on 3566 patients up to 20-year follow-up: Long-term results of a standardized technique. Surg Obes Relat Dis 2018; 15:409-416. [PMID: 30704912 DOI: 10.1016/j.soard.2018.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/17/2018] [Accepted: 12/06/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND As obesity is a chronic disease, any bariatric procedure should be validated by long-term results. OBJECTIVE To present our long-term results after laparoscopic adjustable gastric banding over a period of >20 years and to investigate the outcomes in terms of efficacy, complications, and reoperations. SETTING Private practice, Italy. METHODS From October 1995 to February 2018, 3566 laparoscopic adjustable gastric banding were performed by a single surgeon. Data were retrieved from a prospectively collected computer database and retrospectively analyzed. Furthermore, patients were stratified according to body mass index and age and results are evaluated for each subgroup. RESULTS All the operations were performed laparoscopically without any mortality and/or major specific complications. Nine hundred twenty-six patients (71.6%) completed at least 10-years follow-up and 180 (58.4%) reached 15-years follow-up. There was a mean of 49%, 52.6%, and 59.2% of excess weight loss at 10, 15, and 20 years, respectively. Major late complications were pouch herniation-dilation (5.8%) and erosion (2.5%), both solved by a replicable, less invasive operation. Total reoperation rate was 24.1%. CONCLUSION Our experience suggested that the combination of a standardized surgical technique and close patient follow-up, performed in collaboration with an interdisciplinary team, may make the laparoscopic adjustable gastric banding system a powerful long-term surgical tool in the treatment of morbid obesity. The best results were obtained in young patients with high body mass index but results were also satisfactory in elderly patients and in those with low body mass index.
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Affiliation(s)
- Niccolò Furbetta
- General Surgery, Department of Surgery, University of Pisa, Pisa, Italy.
| | - Francesca Gragnani
- General and laparoscopic Surgery, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
| | - Giuseppe Flauti
- General and laparoscopic Surgery, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
| | - Francesco Guidi
- Anesthesiologist, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
| | - Francesco Furbetta
- General and laparoscopic Surgery, Clinic "Leonardo," Sovigliana-Vinci (Firenze), Italy
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6
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Giet L, Baker J, Favretti F, Segato G, Super P, Singhal R, Ashton D. Medium and long-term results of gastric banding: outcomes from a large private clinic in UK. BMC OBESITY 2018; 5:12. [PMID: 29686879 PMCID: PMC5897937 DOI: 10.1186/s40608-018-0189-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/29/2018] [Indexed: 01/06/2023]
Abstract
Background Laparoscopic adjustable gastric band (LAGB) has been an established bariatric procedure for the last three decades and was, for many years, the first-choice procedure for the treatment of chronic obesity. However, more recently, the popularity of the LAGB has been in sharp decline and has been replaced by other procedures such as the Roux-En-Y gastric bypass and sleeve gastrectomy. A key driver in this decline has been the high revision and early explanation rates reported in some studies. Methods This was a retrospective study of 2246 patients who underwent LAGB at a large private clinic in the UK between June 2004 and October 2014. Results 2246 patients were included in the study; 1945 (84.6%) were women. All patients were followed up for 2 years following their procedure and subsequent follow up was at the discretion of patients. Mean follow up duration was 43.7 +/− 29.3 months. Operative mortality was zero and there were no in-hospital returns to theatre. Mean preoperative weight and body mass index (BMI) were 111.2 ± 22.1 kg and 39.9 ± 6.7 kg/m2 respectively. Mean excess % BMI loss at 1-, 2-, 5- and 8-years of follow-up was 43.1 ± 25.4, 47.9 ± 31.9, 52.4 ± 41.7 and 57.1% ± 28.6 respectively. There was no significant difference in mean excess % BMI loss between those < 50 or ≥ 50 years old (p value = 0.23) or between patients with an initial BMI of < or ≥ 50 kg/m2 (p value = 0.65). Complications over nine years occurred in 130 (5.8%) patients and included: 39 (1.7%) slippage or pouch dilatation, 2 (0.04%) erosions and 76 (3.4%) problems related to the access port or LAGB tubing. The overall re-operation rate for LAGB complications was 4.2% over 9 years with a LAGB explantation rate of 1.5%. 39 LAGBs were converted to a sleeve or gastric bypass procedure, 11 of these due to complications. Conclusion This is the first study to report on LAGB outcomes from a private clinic in the UK. LAGB is a safe procedure, which delivers significant and durable weight loss with acceptable complications rates and low re-operation rate.
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Affiliation(s)
- Leeying Giet
- 1Heart of England NHS Foundation Trust, Birmingham, UK
| | - Julia Baker
- Healthier Weight Centres, 11 Highfield Road, B15 3DU, Birmingham, UK
| | - Franco Favretti
- Healthier Weight Centres, 11 Highfield Road, B15 3DU, Birmingham, UK
| | - Gianni Segato
- Healthier Weight Centres, 11 Highfield Road, B15 3DU, Birmingham, UK
| | - Paul Super
- 1Heart of England NHS Foundation Trust, Birmingham, UK.,Healthier Weight Centres, 11 Highfield Road, B15 3DU, Birmingham, UK
| | - Rishi Singhal
- 1Heart of England NHS Foundation Trust, Birmingham, UK.,Healthier Weight Centres, 11 Highfield Road, B15 3DU, Birmingham, UK
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Contival N, Menahem B, Gautier T, Le Roux Y, Alves A. Guiding the non-bariatric surgeon through complications of bariatric surgery. J Visc Surg 2017; 155:27-40. [PMID: 29277390 DOI: 10.1016/j.jviscsurg.2017.10.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Complications in bariatric surgery are varied; they are severe at times but infrequent. They may be surgical or non-surgical, and may occur early or late. The goal of this systematic review is to inform and help the attending physician, the emergency physician and the non-bariatric surgeon who may be called upon to manage surgical complications that arise after adjustable gastric band (AGB), sleeve gastrectomy (SG), or gastric bypass (GBP). Data from evidence-based medicine were extracted from the literature by a review of the Medline database and also of the most recent recommendations of the learned societies implicated. The main complications were classified for each intervention, and a distinction was made between early and late complications. Early complications after AGB include prosthetic slippage or perforation; SG can be complicated early by staple line leak or fistula, and BPG by fistula, stenosis and postoperative hemorrhage. Delayed complications of AGB include intragastric migration of the prosthesis, late prosthetic slippage and infection, while SG can be complicated by gastro-esophageal reflux, and BPG by anastomotic ulcer and internal hernia. The analysis of available data allowed us to develop decisional algorithms for the management of each of these complications.
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Affiliation(s)
- N Contival
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - B Menahem
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - T Gautier
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - Y Le Roux
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
| | - A Alves
- Département de chirurgie digestive, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
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8
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Castagneto Gissey L, Casella Mariolo JR, Mingrone G. How to Choose the Best Metabolic Procedure? Curr Atheroscler Rep 2017; 18:43. [PMID: 27229936 DOI: 10.1007/s11883-016-0590-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bariatric/metabolic surgery has proven to be effective in inducing and maintaining diabetes remission-although with a percentage of patients undergoing hyperglycemia relapse-weight loss, and improvement of the cardiovascular risk. It is, however, associated with mortality, although low, and early and late complications. In particular, metabolic complications are related to vitamin deficiency due to the erratic absorption of the supplemented vitamins and to the unpredictable compliance of patients to vitamin and trace element supplementation. In addition, often, the general practitioners and even the specialists are unaware of the clinical effects of metabolic dysfunction following malabsorptive surgery. The choice of the surgical procedure should be the balance between benefits and risks. Our review addresses this important question trying to give some suggestions.
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Affiliation(s)
- Lidia Castagneto Gissey
- Department of General Surgery, University of Rome "La Sapienza", Rome, Italy. .,James Black Centre, King's College Hospital, Denmark Hill, SE5 9RS, London, UK.
| | - James Rossario Casella Mariolo
- Department of General Surgery, University of Rome "La Sapienza", Rome, Italy.,James Black Centre, King's College Hospital, Denmark Hill, SE5 9RS, London, UK
| | - Geltrude Mingrone
- Department of Internal Medicine, Catholic University, Rome, Italy.,Department of Diabetes, King's College London, London, UK
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9
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Long-term outcome of laparoscopic adjustable gastric banding (LAGB): results of a Swiss single-center study of 405 patients with up to 18 years' follow-up. Surg Obes Relat Dis 2017; 13:1313-1319. [PMID: 28602794 DOI: 10.1016/j.soard.2017.04.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/17/2017] [Accepted: 04/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND In the past, laparoscopic adjustable gastric banding (LAGB) seemed to be a promising bariatric procedure. However, many studies showed high rates of reoperation due to complications or insufficient weight loss. There is a lack of long-term studies with follow-up beyond 15 years. OBJECTIVE To conduct long-term follow-up of patients after LAGB and analyze their weight loss as a primary endpoint. SETTING Tertiary referral center for bariatric surgery, St. Claraspital, Switzerland. METHODS A retrospective analysis of prospectively collected clinical data in a cohort of 405 patients having undergone LAGB was performed. RESULTS A total of 405 patients (age 41±10 years, body mass index [BMI] 44.3±6 kg/m2) were treated with LAGB between 1996 and 2010. Mean follow-up was 13±3 years, with a follow-up rate of 85% (range 8-18 years), corresponding to 343 patients. One hundred patients exceeded 15-year follow-up. In 216 patients (63%), sleeve gastrectomy, gastric bypass, or biliopancreatic diversion with duodenal switch was performed as revisional surgery. Twenty-seven patients (8%) refused revisional surgery after band removal. Finally, 100 patients (29%) still have the band in place, with a mean BMI of 35±7 kg/m2, corresponding to an excess BMI loss of 48±27%. Among these, the failure rate was 25%, according to the Bariatric Analysis and Reporting Outcome System (BAROS); 50% had a good to excellent outcome. CONCLUSION More than 10 years after LAGB, 71% of patients lost their bands and only 15% of the 343 followed patients with the band in place have a good to excellent result, according to BAROS.
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10
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Arapis K, Tammaro P, Parenti LR, Pelletier A, Chosidow D, Kousouri M, Magnan C, Hansel B, Marmuse J. Long-Term Results After Laparoscopic Adjustable Gastric Banding for Morbid Obesity: 18-Year Follow-Up in a Single University Unit. Obes Surg 2016; 27:630-640. [DOI: 10.1007/s11695-016-2309-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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11
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Chiapaikeo D, Schultheis M, Protyniak B, Pearce P, Borao FJ, Binenbaum SJ. Analysis of reoperations after laparoscopic adjustable gastric banding. JSLS 2016; 18:JSLS.2014.00210. [PMID: 25392616 PMCID: PMC4154406 DOI: 10.4293/jsls.2014.00210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Laparoscopic adjustable gastric banding is considered the least invasive surgical option for the treatment of morbid obesity. Its initial popularity has been marred by recent long-term studies showing high complication rates. We sought to examine our experience with gastric banding and factors leading to reoperation. METHODS We reviewed retrospective data of 305 patients who underwent laparoscopic adjustable gastric banding between 2004 and 2011 at a single institution, 42 patients of whom required a reoperation, constituting 13.8%. Patients undergoing elective reoperations for port protrusion from weight loss as a purely cosmetic issue were excluded (n = 10). Patients' demographic data, weight loss, time to reoperation, and complications were analyzed. RESULTS Of 305 patients, 42 (13.8%) required reoperations: 26 underwent band removal (8.5%) and 16 underwent port revision (5.2%). The mean weight and body mass index for all patients who underwent reoperations were 122.6 kg and 45.0 kg/m(2), respectively. The most common complication leading to band removal was gastric prolapse (n = 14, 4.6%). The most common indication for port revision was a nonfunctioning port (n = 10, 3.3%). CONCLUSION Laparoscopic adjustable gastric banding was initially popularized as a minimally invasive gastric-restrictive procedure with low morbidity. Our study showed a 13.8% reoperation rate at 3 years' follow-up. Most early reoperations (<2 years) were performed for port revision, whereas later reoperations (>2 years) were likely to be performed for band removal. Laparoscopic adjustable gastric banding is associated with high reoperation rates; therefore bariatric surgeons should carefully consider other surgical weight-loss options tailored to the needs of the individual patient that may have lower complication and reoperation rates.
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Affiliation(s)
- David Chiapaikeo
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Molly Schultheis
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Bogdan Protyniak
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Paul Pearce
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Frank J Borao
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
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12
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Shen X, Zhang X, Bi J, Yin K. Long-term complications requiring reoperations after laparoscopic adjustable gastric banding: a systematic review. Surg Obes Relat Dis 2015; 11:956-64. [DOI: 10.1016/j.soard.2014.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 01/27/2023]
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13
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Giordano S, Tolonen P, Victorzon M. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic adjustable gastric banding in the super-obese: peri-operative and early outcomes. Scand J Surg 2015; 104:5-9. [PMID: 25623917 DOI: 10.1177/1457496914553148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Controversy exists between laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding in super-obese patients. METHODS This is a retrospective review of prospectively collected data. A total of 102 consecutive super-obese (body mass index >50) patients underwent laparoscopic Roux-en-Y gastric bypass (Group 1), and 79 consecutive ones underwent laparoscopic adjustable gastric banding (Group 2). Early complications and weight loss outcomes were evaluated. RESULTS No significant difference was found in operative mean (± standard deviation) time (93.5 ± 33 vs 87.7 ± 39 min, p = 0.29), hospital stay (2.68 ± 2.27 vs 2.75 ± 1.84 days, p = 0.80), or overall early postoperative morbidity (17.65% and 10.12%, p = 0.20). Intra-operative complications occurred in six patients (5.9%) in Group 1 and none in Group 2 (0.0%, p = 0.04). Mean excess weight loss percent at 6 and 12 months in Group 1 was 44.75% ± 11.84% and 54.71% ± 18.18% versus 26.20% ± 12.42% and 31.55% ± 19.79% in Group 2 (p < 0.001). CONCLUSION There seems to be no significant differences in early complications between laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding operations in the short term. Weight loss and excess weight loss percent at 6 and 12 months are significantly better after laparoscopic Roux-en-Y gastric bypass.
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Affiliation(s)
- S Giordano
- Department of Plastic and General Surgery, Turku University Hospital, Turku, Finland Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, Finland
| | - P Tolonen
- Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, Finland
| | - M Victorzon
- Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, Finland
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14
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Chiapaikeo D, Schultheis M, Protyniak B, Pearce P, Borao FJ, Binenbaum SJ. Analysis of reoperations after laparoscopic adjustable gastric banding. JSLS 2014. [PMID: 25516707 PMCID: PMC4266230 DOI: 10.4293/jsls.2014.002104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background and Objectives: Laparoscopic adjustable gastric banding is considered the least invasive surgical
option for the treatment of morbid obesity. Its initial popularity has been marred
by recent long-term studies showing high complication rates. We sought to examine
our experience with gastric banding and factors leading to reoperation. Methods: We reviewed retrospective data of 305 patients who underwent laparoscopic
adjustable gastric banding between 2004 and 2011 at a single institution, 42
patients of whom required a reoperation, constituting 13.8%. Patients
undergoing elective reoperations for port protrusion from weight loss as a purely
cosmetic issue were excluded (n = 10). Patients' demographic data,
weight loss, time to reoperation, and complications were analyzed. Results: Of 305 patients, 42 (13.8%) required reoperations: 26 underwent band
removal (8.5%) and 16 underwent port revision (5.2%). The mean
weight and body mass index for all patients who underwent reoperations were 122.6
kg and 45.0 kg/m2, respectively. The most common complication leading
to band removal was gastric prolapse (n = 14, 4.6%). The most common
indication for port revision was a nonfunctioning port (n = 10,
3.3%). Conclusion: Laparoscopic adjustable gastric banding was initially popularized as a minimally
invasive gastric-restrictive procedure with low morbidity. Our study showed a
13.8% reoperation rate at 3 years' follow-up. Most early reoperations
(<2 years) were performed for port revision, whereas later reoperations (>2
years) were likely to be performed for band removal. Laparoscopic adjustable
gastric banding is associated with high reoperation rates; therefore bariatric
surgeons should carefully consider other surgical weight-loss options tailored to
the needs of the individual patient that may have lower complication and
reoperation rates.
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Affiliation(s)
- David Chiapaikeo
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Molly Schultheis
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Bogdan Protyniak
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Paul Pearce
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Frank J Borao
- Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA
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15
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JOURNAL CLUB: Gastric Band Slippage: A Case-Controlled Study Comparing New and Old Radiographic Signs of This Important Surgical Complication. AJR Am J Roentgenol 2014; 203:10-6. [DOI: 10.2214/ajr.13.11650] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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De Palma GD, Forestieri P. Role of endoscopy in the bariatric surgery of patients. World J Gastroenterol 2014; 20:7777-7784. [PMID: 24976715 PMCID: PMC4069306 DOI: 10.3748/wjg.v20.i24.7777] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/31/2013] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
Obesity is an increasingly serious health problem in nearly all Western countries. It represents an important risk factor for several gastrointestinal diseases, such as gastroesophageal reflux disease, erosive esophagitis, hiatal hernia, Barrett’s esophagus, esophageal adenocarcinoma, Helicobacter pylori infection, colorectal polyps and cancer, non-alcoholic fatty liver disease, cirrhosis, and hepatocellular carcinoma. Surgery is the most effective treatment to date, resulting in sustainable and significant weight loss, along with the resolution of metabolic comorbidities in up to 80% of cases. Many of these conditions can be clinically relevant and have a significant impact on patients undergoing bariatric surgery. There is evidence that the chosen procedure might be changed if specific pathological upper gastrointestinal findings, such as large hiatal hernia or Barrett’s esophagus, are detected preoperatively. The value of a routine endoscopy before bariatric surgery in asymptomatic patients (screening esophagogastroduodenoscopy) remains controversial. The common indications for endoscopy in the postoperative bariatric patient include the evaluation of symptoms, the management of complications, and the evaluation of weight loss failure. It is of critical importance for the endoscopist to be familiar with the postoperative anatomy and to work in close collaboration with bariatric surgery colleagues in order to maximize the outcome and safety of endoscopy in this setting. The purpose of this article is to review the role of the endoscopist in a multidisciplinary obesity center as it pertains to the preoperative and postoperative management of bariatric surgery patients.
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Abstract
BACKGROUND Obesity is an important health problem affecting >500 million people worldwide. Esophageal dysmotility is a gastrointestinal pathology associated with obesity; however, its prevalence and characteristics remain unclear. Esophageal dysmotilities have a high prevalence among obese patients regardless of gastrointestinal symptoms. OBJECTIVE To identify the prevalence of esophageal dysmotility among obese patients. The secondary goals were to characterize these pathologies in obese patients and identify risk factors. METHOD A prospective study from January 2009 to March 2010 at the University of Montreal Hospital Centre (Montreal, Quebec) was performed. Every patient scheduled for bariatric surgery underwent preoperatory esophageal manometry and was included in the study. Manometry was performed according to a standardized protocol with the following measures: superior esophageal sphincter - coordination and release during deglutition; esophageal body - presence, propagation, length, amplitude and type of esophageal waves of contraction; lower esophageal sphincter - localization, tone, release, intragastic pressure and intraesophageal pressure. All reference values were those used in the digestive motility laboratory. A gastrointestinal symptoms questionnaire was completed on the day manometry was performed. Chart reviews were performed to identify comorbidities and treatments that could influence the results. RESULTS A total of 53 patients were included (mean [± SD] age 43 ± 10 years; mean body mass index 46 ± 7 kg/m; 70% female). Esophageal manometry revealed dysmotility in 51% (n=27) of the patients. This dysmotility involved the esophageal body in 74% (n=20) of the patients and the inferior sphincter in 11% (n=3). Mixed dysmotility (body and inferior sphincter) was found in 15% (n=4) of cases. The esophageal body dysmotilities were hypomotility in 85% (n=23) of the patients, either from insignificant waves (74% [n=20]), nonpropagated waves (11% [n=3]) or low-amplitude waves (33% [n=9]). Gastroesophageal symptoms were found in 66% (n=35) of obese patients, including heartburn (66% [n=23]), regurgitation (26% [n=9]), dysphagia (43% [n=15]), chest pain (6% [n=2]) and dyspepsia (26% [n=9]). Among symptomatic patients, 51% (n=18) had normal manometry and 49% (n=17) had abnormal manometry (statistically nonsignificant). Among asymptomatic patients (n=18), 44% (n=8) had normal manometry and 56% (n=10) had abnormal manometry (statistically nonsignificant). Furthermore, no statistical differences were found between the normal manometry group and the abnormal manometry group with regard to medication intake or comorbidities. CONCLUSION Esophageal dysmotilities had a high prevalence in obese patients. Gastrointestinal symptoms cannot predict the presence of esophageal dysmotility. Hypomotility of the esophageal body is the most common dysmotility, especially from the absence of significant waves.
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Long-term outcomes of laparoscopic adjustable silicone gastric banding (LAGB) in moderately obese patients with and without co-morbidities. Obes Surg 2014; 23:897-902. [PMID: 23529850 DOI: 10.1007/s11695-013-0877-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Overweight and obesity independently increase cardiovascular risk, while even modest weight loss can result in clinically significant improvements in cardiovascular risk and reduce long-term mortality. Lowering the body mass index (BMI) threshold for bariatric surgery to those with moderate obesity might be one way to lower the burden of this disease. The aim of this study was to evaluate the efficacy and safety of laparoscopic adjustable silicone gastric banding (LAGB) in moderately obese subjects with or without obesity-related co-morbidities. METHODS Thirty-four patients with BMI between 30 and 35 kg/m(2) (5 males/29 females, mean age 36 ± 10 years, mean preoperative weight 87.9 ± 7.1 kg, mean BMI 32.6 ± 1.6 kg/m(2) and mean percentage excess weight 48.7 ± 9 %) who underwent LAGB via pars flaccida between June 1, 2002 and August 31, 2010 were included. Good response was defined as BMI <30 kg/m(2) or percentage estimated weight loss (%EWL) >50. Poor response was defined as BMI >30 kg/m(2) or %EWL less than 50 after a minimum of 1 year. RESULTS Mean weight, BMI and %EWL were recorded at 1, 3, 5 and 7 years and were 77.4 ± 7.6, 69.9 ± 10.8, 70.9 ± 9.3 and 73.3 ± 12.0 kg; 28.8 ± 2.9, 26.4 ± 3.2, 26.5 ± 3.4 and 27.4 ± 5.0 kg/m(2); and 36 ± 23, 46.1 ± 33.8, 58.6 ± 31.5 and 45 ± 57, respectively (p < 0.01). Co-morbidities were diagnosed in 17/34 (50 %) patients at baseline and underwent remission or improvement in all cases after 1 year. CONCLUSIONS LAGB in a safe and effective procedure in patients with a BMI <35 kg/m(2).
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Le Page PA, Kwon S, Lord SJ, Lord RV. Esophageal dysmotility after laparoscopic gastric band surgery. Obes Surg 2013; 24:625-30. [PMID: 24258146 DOI: 10.1007/s11695-013-1134-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effect of the laparoscopic adjustable gastric band (LAGB) on the esophagus has been the subject of few studies despite recognition of its clinical importance. The aim of this study was to investigate the frequency and clinical effect of esophageal dysmotility and dilatation after LAGB. METHODS We undertook a retrospective analysis of 50 consecutive patients with no dysmotility on perioperative video contrast swallow who underwent primary LAGB operation. All patients had serial focused postoperative contrast studies for band adjustments at least 6 months post-LAGB. Clinical and radiological outcomes were assessed. RESULTS Median follow-up time was 18 months (range 7-39 months), and the median number of contrast swallows per patient was 5. The mean excess weight loss (EWL) overall was 47 % (standard deviation (SD) 22.3). Radiological abnormalities were recorded in 17 patients (34 %, 95 % confidence interval (CI) 21-49 %), of whom 15 had radiological dysmotility and 7 had esophageal dilatation (five patients had both dysmotility and dilatation). Of these 17 patients, six (35 %) developed significant symptoms of dysphagia, gastroesophageal reflux disease (GERD) or regurgitation requiring fluid removal. In comparison, 12 of 33 (36 %) patients without radiological abnormalities developed symptoms requiring fluid removal (p = 1.00). Patients with radiological abnormalities were significantly older than those without these abnormalities. Symptoms were alleviated by removing fluid in most patients. CONCLUSIONS The LAGB operation results in the development of radiological esophageal dysmotility in a significant proportion of patients. It is not clear if these changes are associated with an increased risk of significant symptoms. Fluid removal can reverse these abnormalities and their associated symptoms.
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Affiliation(s)
- Philip A Le Page
- Department of Upper Gastrointestinal Surgery, St. Vincent's Hospital, Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia,
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Ayloo SM, Fernandes E, Masrur MA, Giulianotti PC. Adjustable gastric banding: a comparison of models. Surg Obes Relat Dis 2013; 10:1097-103. [PMID: 24342037 DOI: 10.1016/j.soard.2013.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 05/06/2013] [Accepted: 05/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There are several models of adjustable gastric banding in use with little evidence for choosing a particular model. The objective of this study was to evaluate factors for selecting a particular type of band in terms of weight loss, complications, and co-morbidities. METHODS From July 2006 to May 2012, 222 patients underwent laparoscopic adjustable gastric banding (LAGB) by a single surgeon. Patient demographic characteristics, weight loss, body mass index (BMI), percentage of weight loss (%EWL), complications, and co-morbidities were retrospectively reviewed. Patients were grouped according to the band model into 6 categories: 27 LAP-BAND Adjustable Gastric Banding System VG, 25 Allergan-LAGB, 20 LAP-BAND AP(M) Standard, 18 LAP-BAND AP(M) Large, 34 Realize Band, and 98 Realize-C band. RESULTS At 60 months follow up, in the LAP-BAND VG Group, the mean %EWL was 41%, percentage of co-morbidity improvement was 66%, and percentage of complications was 14.3%; the same percentages in the Allergan-LAGB Group were 41%, 0%, and 52%, respectively; in the LAP-BAND AP Standard Group were 42%, 20%, and 40%, respectively; in the LAP-BAND AP Large group were 38% , 12.5%, and 27.8%, respectively (at 48 months); in the Realize Band Group were 37%, 60%, and 0%, respectively (at 48 months); and in the Realize-C Band Group were 48%,12.5%, and 12.2%, respectively (at 36 months). CONCLUSIONS In terms of weight loss and co-morbidities, no differences were found supporting the choice of one model over the others. Short-term and long-term band-related complications occurred without any clear predilection. The port-related complications were significantly lower in the Realize bands.
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Affiliation(s)
- Subhashini M Ayloo
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.
| | - Eduardo Fernandes
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Mario A Masrur
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Pier C Giulianotti
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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Koolwijk J, Schors M, el Bouazati S, Noordergraaf GJ. Airway management concerns in patient with gastric banding procedures. BMJ Case Rep 2013; 2013:bcr-2013-201009. [PMID: 24051151 DOI: 10.1136/bcr-2013-201009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Laparoscopic adjustable gastric band (LAGB) is considered a relatively safe and effective treatment for obesity. Even after weight loss patients with LAGB are at increased risk of pulmonary aspiration during induction of general anaesthesia, possibly due to LAGB-induced anatomical and functional changes. We present a case of aspiration in a patient with LAGB following significant weight loss and 14 h of preoperative fasting and review the literature. In the presence of LAGB we propose specific anaesthesia management at least consisting of anti-Trendelenburg positioning; avoidance of mask-ventilation; use of the local rapid sequence induction strategy with endotracheal intubation and fully awake extubation.
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Affiliation(s)
- Jasper Koolwijk
- Department of Anaesthesiology, St Elisabeth Hospital, Tilburg, The Netherlands
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Cobourn C, Degboe A, Super PA, Torre M, Robinson J, Jin J, Furbetta F, Bhoyrul S. Safety and effectiveness of LAP-BAND AP System: results of Helping Evaluate Reduction in Obesity (HERO) prospective registry study at 1 year. J Am Coll Surg 2013; 217:907-18. [PMID: 24035447 DOI: 10.1016/j.jamcollsurg.2013.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding has several distinctive features, including band adjustability, easy reversibility, and lack of malabsorption, which contribute to its widespread use. The LAP-BAND AP System (LBAP; Allergan, Inc.), a redesigned and improved version of the original device, was approved by the US Food and Drug Administration in 2006. Because of limited information on LBAP, this study prospectively assesses the efficacy and safety of LBAP in real-world settings at clinical centers located in North America, Europe, and Australia. STUDY DESIGN This interim report of the ongoing 5-year prospective, observational, international, multicenter registry, Helping Evaluate Reduction in Obesity (HERO) Study (NCT00953173), describes clinical efficacy and safety of LBAP in real-world settings at 1 year. RESULTS One thousand one hundred and six patients were implanted with LBAP and 1-year data were available from 834 patients for efficacy analysis. At 1 year, the mean (SD) percentage of excess weight loss was 39.8% (22.3%), of weight loss was 16.9% (9.0%), and the mean (SD) body mass index decreased to 37.7 (7.0) kg/m(2) from 45.1 (6.9) kg/m(2) at baseline. Patients with type 2 diabetes mellitus or hypertension showed significant improvements at 1 year post LBAP (both p < 0.005). The most common device-related complications were port displacement (n = 20 [1.8%]), pouch dilation (n = 12 [1.1%]), band slippage (n = 7 [0.6%]), and band erosion (n = 5 [0.5%]). Eighteen (1.6%) patients had the device explanted. CONCLUSIONS At 1 year post LBAP, progressive weight loss was associated with improvement and/or resolution of comorbid conditions and was safe and well tolerated. Patient follow-up continues.
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Affiliation(s)
- Chris Cobourn
- Surgical Weight Loss Centre, Mississauga, ON, Canada.
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23
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Fielding AA, Warren-Forward H, Baines SK. A Snapshot of Eating Behavior, Food Tolerance, and Dietary Intake after Laparoscopic Adjustable Gastric Banding. Bariatr Surg Pract Patient Care 2013. [DOI: 10.1089/bari.2013.9979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Alison A. Fielding
- School of Health Sciences, University of Newcastle, Callaghan, Australia
| | | | - Surinder K. Baines
- School of Health Sciences, University of Newcastle, Callaghan, Australia
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Elli EF, Masrur MA, El Zaeedi M, Galvani CA, Bozorgui N, Giulianotti PC. Four-year experience with outpatient laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2013; 9:693-5. [DOI: 10.1016/j.soard.2012.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/21/2012] [Accepted: 08/28/2012] [Indexed: 11/17/2022]
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Rodarte-Shade M, Barrera GT, Arredondo JFH, Diaz RR. Hybrid technique for removal of eroded adjustable gastric band. JSLS 2013; 17:338-41. [PMID: 23925033 PMCID: PMC3771806 DOI: 10.4293/108680813x13654754534279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A hybrid technique of laparoscopy and endoscopy can be successful in removal of eroded gastric bands. Background: Intragastric migration is a late and rare postsurgical complication in patients with gastric band placement. Gastric band erosion rate has previously been described to be 1.46%. In this report, we present the case of a 43-y-old male with gastric band erosion undergoing a laparoendoscopic retrieval of the gastric band, due to intragastric migration. Method: A hybrid procedure was performed to retrieve the gastric band. A laparoscopic approach was initially used to extract the connecting tube. Endoscopy was then performed to cut the gastric band with a specific cutter system and was subsequently extracted transorally. Results: The postoperative course was uneventful. Clear liquids were started on day 1, and the patient was discharged on day 2. Discussion: The purpose of this study was to describe a hybrid technique for the removal of an eroded gastric band, as a safe and feasible option in patients with band erosions. Conclusion: The laparoscopic approach enables safe extraction of the connecting tube, while endoscopy allows extraction of the band without creating a large incision in the stomach.
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Affiliation(s)
- Mario Rodarte-Shade
- Department of Surgery, Instituto Tecnologico y de Estudios Superiores de Monterrey, Mexico.
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26
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Caiazzo R, Pattou F. Adjustable gastric banding, sleeve gastrectomy or gastric bypass. Can evidence-based medicine help us to choose? J Visc Surg 2013; 150:85-95. [PMID: 23623562 DOI: 10.1016/j.jviscsurg.2013.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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27
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High Risks for Adverse Outcomes After Gastric Bypass Surgery Following Failed Gastric Banding. Ann Surg 2013; 257:279-86. [DOI: 10.1097/sla.0b013e3182683037] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Metabolic changes one year after laparoscopic adjustable gastric banding operation in morbidly obese subjects. Wideochir Inne Tech Maloinwazyjne 2012; 8:13-21. [PMID: 23630549 PMCID: PMC3627148 DOI: 10.5114/wiitm.2011.30828] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/24/2012] [Accepted: 08/28/2012] [Indexed: 01/14/2023] Open
Abstract
Introduction Laparoscopic adjustable gastric banding (LAGB) is effective for weight reduction in severely obese patients. However, the data about its effect on metabolic syndrome (MS) are limited. Aim To assess weight loss and changes of metabolic parameters 1 year after LAGB in a prospective, nonrandomized single center cohort study in morbidly obese subjects. Material and methods Physical examination, body weight (BW) parameters and metabolic profile were assessed at baseline and 1 year after LAGB in morbidly obese subjects. The incidence of MS was evaluated according to National Cholesterol Education Program Adult Treatment Panel III criteria. Results One year after the operation data from 90 patients out of 103 were available. Mean excess weight (EW) loss of 33.1% was associated with a significant improvement in all metabolic parameters: decrease of hypertension by 15.8%, hypertriglyceridemia by 42.6%, and hyperglycemia by 46.3%; and increase in high density lipoprotein cholesterol by 48.3%. This resulted in the resolution of MS in 44.2% of subjects. The significant change in the distribution of MS components was observed with the highest frequency of 4 components before and 2 components after surgery. Patients with MS at baseline lost 29.9% of EW compared to 44.3% in those without MS (p = 0.009). Conclusions The LAGB resulted in effective reduction of BW parameters in morbidly obese subjects 1 year after the operation. Along with the weight loss, resolution of MS and a significant shift towards decrease in the number of MS components was observed. Patients with MS were more resistant to the weight loss.
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Suzuki K, Jayasena CN, Bloom SR. Obesity and appetite control. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:824305. [PMID: 22899902 PMCID: PMC3415214 DOI: 10.1155/2012/824305] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 06/20/2012] [Indexed: 01/01/2023]
Abstract
Obesity is one of the major challenges to human health worldwide; however, there are currently no effective pharmacological interventions for obesity. Recent studies have improved our understanding of energy homeostasis by identifying sophisticated neurohumoral networks which convey signals between the brain and gut in order to control food intake. The hypothalamus is a key region which possesses reciprocal connections between the higher cortical centres such as reward-related limbic pathways, and the brainstem. Furthermore, the hypothalamus integrates a number of peripheral signals which modulate food intake and energy expenditure. Gut hormones, such as peptide YY, pancreatic polypeptide, glucagon-like peptide-1, oxyntomodulin, and ghrelin, are modulated by acute food ingestion. In contrast, adiposity signals such as leptin and insulin are implicated in both short- and long-term energy homeostasis. In this paper, we focus on the role of gut hormones and their related neuronal networks (the gut-brain axis) in appetite control, and their potentials as novel therapies for obesity.
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Affiliation(s)
- Keisuke Suzuki
- Section of Investigative Medicine, Imperial College London, Commonwealth Building, Du Cane Road, London W12 0NN, UK
| | - Channa N. Jayasena
- Section of Investigative Medicine, Imperial College London, Commonwealth Building, Du Cane Road, London W12 0NN, UK
| | - Stephen R. Bloom
- Section of Investigative Medicine, Imperial College London, Commonwealth Building, Du Cane Road, London W12 0NN, UK
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Abstract
Obesity is one of the major challenges to human health worldwide; however, there are currently no effective pharmacological interventions for obesity. Recent studies have improved our understanding of energy homeostasis by identifying sophisticated neurohumoral networks which convey signals between the brain and gut in order to control food intake. The hypothalamus is a key region which possesses reciprocal connections between the higher cortical centres such as reward-related limbic pathways, and the brainstem. Furthermore, the hypothalamus integrates a number of peripheral signals which modulate food intake and energy expenditure. Gut hormones, such as peptide YY, pancreatic polypeptide, glucagon-like peptide-1, oxyntomodulin, and ghrelin, are modulated by acute food ingestion. In contrast, adiposity signals such as leptin and insulin are implicated in both short- and long-term energy homeostasis. In this paper, we focus on the role of gut hormones and their related neuronal networks (the gut-brain axis) in appetite control, and their potentials as novel therapies for obesity.
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Prospective, multicenter, 3-year trial of laparoscopic adjustable gastric banding with the MIDBAND™. Obes Surg 2012; 22:572-81. [PMID: 21870049 DOI: 10.1007/s11695-011-0508-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although laparoscopic adjustable gastric banding (LAGB) is a popular metabolic/bariatric procedure, few prospective studies have assessed its outcomes. This study aimed to prospectively assess LAGB safety and effectiveness outcomes using the MIDBAND™ (MID, Dardilly, France). METHODS Between May 2005 and September 2006, 262 morbidly obese patients underwent primary gastric banding with pars flaccida technique in 13 French medical centers. Excess weight loss and change in body mass index (BMI, kilogram per square meter), percentage of patients with comorbidities, and obesity-related complications were recorded. Patients were followed at 6-month intervals for 3 years. A multivariable individual growth model was used to analyze weight change over time and determine potential predictors of weight loss. RESULTS The majority of patients were female (n = 233, 89%), with mean age of 36.4 ± 9.7 years. At 3 years, LAGB with MIDBAND resulted in significant decrease in mean BMI from 41.8 ± 4.2 to 30.7 ± 5.8 (p < 0.0001). Median excess weight loss and excess BMI loss were 61% and 68%, respectively. The prevalence of obesity-related comorbidities had significantly decreased from 71% to 15% (p < 0.0001). Complications were observed in 26 patients (10%); device-related complications occurred in 20 patients (8.2%), requiring band removal in 8 (3.3%), and port revision in 8 (3.3%). Individual growth analysis identified significant predictors of weight loss including the number of follow-up visits. CONCLUSION Prospective outcomes demonstrate the safety and efficacy of gastric banding over time using the MIDBAND. Individual growth modeling demonstrated that postoperative weight loss is strongly related to the frequency and consistency of follow-up visits.
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Pilone V, Mozzi E, Schettino AM, Furbetta F, Di Maro A, Giardiello C, Battistoni M, Gardinazzi A, Micheletto G, Perrotta N, Busetto L. Improvement in health-related quality of life in first year after laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2012; 8:260-8. [DOI: 10.1016/j.soard.2011.12.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 11/25/2011] [Accepted: 12/14/2011] [Indexed: 02/05/2023]
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34
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Ayloo SM, Buchs NC, Bianco FM, Giulianotti PC. Cost and validity of early postoperative contrast swallow after laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2012; 8:176-80. [DOI: 10.1016/j.soard.2011.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 11/26/2010] [Accepted: 02/02/2011] [Indexed: 11/17/2022]
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Laparoendoscopic single-site adjustable gastric banding: technical considerations. Surg Laparosc Endosc Percutan Tech 2012; 21:e295-300. [PMID: 22146175 DOI: 10.1097/sle.0b013e31823acd93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Recently, laparoendoscopic single-site surgery (LESS) has been proposed to minimize the invasiveness of laparoscopic surgery. We present our standardized technique of LESS adjustable gastric banding. METHODS Data of 25 patients who underwent LESS adjustable gastric banding between March 2009 and January 2010 was reviewed retrospectively. All procedures were performed with multiple low-profile trocars through a single incision using conventional laparoscopic instruments. RESULTS Mean operative time was 78 minutes. Mean blood loss was 8 mL and the median stay was 0.3 days (range, 0.1 to 3 d). No mortality was noted and there was 1 reoperation in the perioperative period due to stoma obstruction. CONCLUSIONS LESS adjustable gastric banding with traditional rigid instruments is feasible and safe but requires working with limited triangulation. Short-term outcomes are promising but long-term follow-up is needed in weighing in the potential benefits to the patient against the technical challenges that arise with this technique.
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36
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Ayloo SM, Buchs NC, Addeo P, Bianco FM, Giulianotti PC. Traditional versus single-site placement of adjustable gastric banding: a comparative study and cost analysis. Obes Surg 2012; 21:815-9. [PMID: 20809350 DOI: 10.1007/s11695-010-0259-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In bariatric surgery, laparoscopic adjustable gastric banding (LAGB) has proven effective in reducing weight and improving obesity-associated comorbidities. Recently, however, laparoendoscopic single-site (LESS) surgery has been proposed to minimize the invasiveness of laparoscopic surgery. The aim of this study is to compare the operative cost and peri-operative outcomes of these two approaches. We undertook a retrospective review of a prospectively maintained database of patients undergoing either LAGB or LESS between March 2006 and October 2009. The outcomes and cost of 25 LESS gastric bandings were compared to 121 standard LAGB. Costs included operative time, consumables, and laparoscopic tower depreciation. Both groups had similar patient demographics, body mass index, and comorbidities; with the exception of age (37 year for single site vs. 44 years for standard; P=0.002). There were no statistical differences for operative time (78 vs. 76 min, P=0.69), blood loss (8.4 vs. 9 ml, P=0.76), pain score (0.81 vs. 0.84 at 1 week, P=0.95) or complication rates (12% vs. 14%, P=1). Length of stay was shorter for the LESS group (0.5 day vs. 1.5 days, P=0.02). The mean operative cost for the LESS banding was $20,502/case vs. $20,346/case for the standard LAGB, with no statistically significant difference between the approaches (P=0.73). Operative costs and peri-operative outcomes of LESS gastric banding are comparable with those of the standard LAGB procedure. As a result, single-site surgery can be proposed as a valid alternative to the standard procedure with cosmetic advantage and comparable complication rate.
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Affiliation(s)
- Subhashini M Ayloo
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435 E, Chicago, IL 60612, USA.
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Burton PR, Brown WA. The mechanism of weight loss with laparoscopic adjustable gastric banding: induction of satiety not restriction. Int J Obes (Lond) 2011; 35 Suppl 3:S26-30. [PMID: 21912383 DOI: 10.1038/ijo.2011.144] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laparoscopic adjustable gastric banding (LAGB) has rapidly emerged as a popular bariatric procedure because of its safety, efficacy, durability and adjustability. Despite widespread use, there is limited understanding of how it induces weight loss. Previously, it has been classified as a restrictive procedure, physically limiting the patient to a small meal that subsequently slowly empties into the distal stomach. However, the tiny pouch of stomach created above the LAGB appears to be unable to accommodate even the smallest of meals. Therefore, the key mechanism has been hypothesized to be the induction of satiety via, as yet, undefined pathways. The critical question remains: what are the key physiological changes that lead to satiety and weight loss? In successful LAGB patients, a consistent intraluminal pressure at the level of the LAGB of 26.9 ± 19.8 mm Hg is observed. Studies using semi-solid swallows combined with intraluminal pressure recordings have demonstrated that semi-solid transit across the resistance of the LAGB is mediated by repeated esophageal peristaltic contractions (mean 4.5 ± 2.9) that produce episodic flow, interspersed by reflux events. Failed transit results in obstruction and regurgitation, whereas dilatation of the supraband stomach induces severe and intolerable reflux. Overall gastric emptying does not appear to be significantly altered following LAGB. Focused investigations have shown that the supraband stomach is empty of an ingested meal 1-2 min after intake ceases. Considerable progress has been made in understanding the mechanical physiological effects of the LAGB on esophageal and proximal gastric function. These have been correlated with patient outcomes and sensations. On the basis of recent data, it appears that the LAGB activates the peripheral satiety mechanism without physically restricting the meal size. Therefore, it should not be classified as a restrictive procedure. The precise mechanism of weight loss with the LAGB remains to be delineated.
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Affiliation(s)
- P R Burton
- Centre for Obesity Research and Education, Monash University, Melbourne, Victoria, Australia.
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Kinzl JF, Lanthaler M, Stuerz K, Aigner F. Long-term outcome after laparoscopic adjustable gastric banding for morbid obesity. Eat Weight Disord 2011; 16:e250-6. [PMID: 21613809 DOI: 10.1007/bf03327468] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study was performed to determine the long-term consequences of laparoscopic gastric banding on weight loss, body image, and life quality in morbidly obese patients. After a minimum follow-up of 9 years (mean follow-up 10 years; range 9-12 years) several questionnaires concerning weight loss, body image, and life quality were mailed to 180 morbidly obese patients following laparoscopic adjustable gastric banding. One hundred and twelve (62%) patients (92 females, 20 males) completed and returned the questionnaires. Of the entire sample, 73 (64.9%) patients still had the first band, 17 (15.3%) a second band, and in 22 (19.8%) probands the band had been removed for various reasons. Average weight loss, calculated as change in body mass index, was 13.9 kg/m². Average excess weight loss (EWL) was 30.6%. A total of 10% patients accounted for >50% of EWL. Half of the probands were completely satisfied with their weight loss and about half had reached their planned weight. Lowest post-operative weight was reached at different times, in nearly half of the probands after 2 years, in one-fourth after 4-5 years, and in about 20% at a later time. More than 90% of the probands experienced longer interruptions in weight loss; about half knew why. The findings indicate that overall quality of life was rated good to excellent by two-thirds of the probands, and fair to poor by one-third. A close correlation was seen between extent of weight loss and quality of life and body image. Despite some limitations, laparoscopic adjustable gastric banding is an effective and safe long-term surgical treatment for a majority of morbidly obese individuals, resulting in long-term weight loss and health-related quality of life. However, there is also a minority of morbidly obese subjects who do not benefit enough from this kind of bariatric surgery. Future research should investigate what kind of bariatric surgery is best for the particular obese individual in order to minimize unsatisfying post-operative results.
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Affiliation(s)
- J F Kinzl
- Department of Psychosomatic Medicine, Innsbruck Medical University Hospital, Anichstrasse 35, A-6020 Innsbruck, Austria.
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Suzuki K, Jayasena CN, Bloom SR. The gut hormones in appetite regulation. J Obes 2011; 2011:528401. [PMID: 21949903 PMCID: PMC3178198 DOI: 10.1155/2011/528401] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 07/25/2011] [Indexed: 12/12/2022] Open
Abstract
Obesity has received much attention worldwide in association with an increased risk of cardiovascular diseases, diabetes, and cancer. At present, bariatric surgery is the only effective treatment for obesity in which long-term weight loss is achieved in patients. By contrast, pharmacological interventions for obesity are usually followed by weight regain. Although the exact mechanisms of long-term weight loss following bariatric surgery are yet to be fully elucidated, several gut hormones have been implicated. Gut hormones play a critical role in relaying signals of nutritional and energy status from the gut to the central nervous system, in order to regulate food intake. Cholecystokinin, peptide YY, pancreatic polypeptide, glucagon-like peptide-1, and oxyntomodulin act through distinct yet synergistic mechanisms to suppress appetite, whereas ghrelin stimulates food intake. Here, we discuss the role of gut hormones in the regulation of food intake and body weight.
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Affiliation(s)
- Keisuke Suzuki
- Section of Investigative Medicine, Imperial College London, London W12 0NN, UK
| | - Channa N. Jayasena
- Section of Investigative Medicine, Imperial College London, London W12 0NN, UK
| | - Stephen R. Bloom
- Section of Investigative Medicine, Imperial College London, London W12 0NN, UK
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Changes in satiety, supra- and infraband transit, and gastric emptying following laparoscopic adjustable gastric banding: a prospective follow-up study. Obes Surg 2011; 21:217-23. [PMID: 21136303 DOI: 10.1007/s11695-010-0312-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Laparoscopic adjustable gastric banding (LAGB) induces and sustains weight loss, likely by activating the peripheral satiety mechanism. Recent data suggests that food is not retained above the optimally adjusted LAGB, suggesting that an alternate mechanism is inducing satiety. How transit and gastric emptying change following LAGB and correlate with satiety and weight loss have not been adequately defined. METHODS LAGB patients underwent preoperative and 12-month follow-up nuclear scintigraphic assessments of esophageal transit and gastric emptying. A new technique that allowed the calculation of emptying times and transit through the supra- and infraband compartments was used to assess emptying and transit patterns postoperatively. RESULTS Postoperatively, patients reported increased satiety both after a standard fast (3.7 ± 2.3 vs. 4.8 ± 2.1, p = 0.04) and following a standard semisolid meal (5.9 vs. 7.8 ± 1.7, p = 0.003). The mean percent excess weight loss was 48.5 ± 23.2%. The gastric emptying half-time (minutes) did not change significantly (63.5 ± 41.1 vs. 73.3 ± 26.8, p = 0.64). Semisolid transit into the infraband stomach was delayed briefly postoperatively in more patients (11 vs. 2, p = 0.001). There was minimal retention of the meal above the LAGB 2 min after commencing the gastric emptying study (median, 3%; interquartile range, 1.75-10); therefore, an emptying half-time of the supraband region could not be defined. CONCLUSIONS Weight loss, satiety, and early satiation following LAGB were associated with briefly delayed bolus transit into the infraband stomach. Retention of the semisolid meal above the LAGB was not observed. This is further evidence that suggests satiety develops following LAGB without physical restriction of meal size.
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Reynoso JF, Goede MR, Tiwari MM, Tsang AW, Oleynikov D, McBride CL. Primary and revisional laparoscopic adjustable gastric band placement in patients with hiatal hernia. Surg Obes Relat Dis 2011; 7:290-4. [PMID: 21130046 DOI: 10.1016/j.soard.2010.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 08/12/2010] [Accepted: 08/13/2010] [Indexed: 01/29/2023]
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Lanthaler M, Aigner F, Kinzl J, Sieb M, Cakar-Beck F, Nehoda H. Long-term results and complications following adjustable gastric banding. Obes Surg 2010; 20:1078-85. [PMID: 20496124 DOI: 10.1007/s11695-010-0190-3] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study was performed to assess our long-term results with laparoscopic gastric banding in patients with an observation period of at least 9 years calculated from the date of operation. Between January 1996 and December 2000, a total of 276 patients (83% female) underwent laparoscopic gastric banding at our institution. Mean preoperative body mass index (BMI) was 44 +/- 6 kg/m(2). BMI after 1, 5, 7, 9, and 10 years was 33 +/- 6, 30 +/- 6, 31 +/- 6, 32 +/- 7, and 31 +/- 7 kg/m(2), respectively. Mean excess weight loss after 1 year was 57.1 +/- 23.0% and after 5, 7, 9, and 10 years 73.2 +/- 29.6%, 65.9 +/- 29.3%, 61.8 +/- 32.8%, and 64.0 +/- 32.1%, respectively. Median completeness of follow-up was 80%. Of the study population, 146 (52.9%) patients had at least one complication requiring reoperation. Presently, only 148 (53.6%) patients still have their original band, 49 (17.8%) had their original band replaced with a new one, and 79 (28.6%) had their band removed. Thirty-three patients had no second bariatric operation, a Roux-en-Y gastric bypass was done in 39 patients, and six patients underwent sleeve gastrectomy. Our long-term results are good with regard to weight loss in those patients who still have their band in situ. This is accompanied by a high complication rate and a 29% band loss rate.
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Affiliation(s)
- Monika Lanthaler
- Department of Visceral, Transplantation and Thoracic Surgery, Centre for Operative Medicine, Innsbruck, Austria.
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Effects of Adjustable Gastric Bands on Gastric Emptying, Supra- and Infraband Transit and Satiety: A Randomized Double-Blind Crossover Trial Using a New Technique of Band Visualization. Obes Surg 2010; 20:1690-7. [DOI: 10.1007/s11695-010-0278-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Burton PR, Brown WA, Laurie C, Hebbard G, O’Brien PE. Predicting Outcomes of Intermediate Term Complications and Revisional Surgery Following Laparoscopic Adjustable Gastric Banding: Utility of the CORE Classification and Melbourne Motility Criteria. Obes Surg 2010; 20:1516-23. [DOI: 10.1007/s11695-010-0258-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Deveney CW, Martindale RG. Factors in selecting the optimal bariatric procedure for a specific patient and parameters by which to measure appropriate response to surgery. Curr Gastroenterol Rep 2010; 12:296-303. [PMID: 20556553 DOI: 10.1007/s11894-010-0117-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Bariatric operations are increasingly being used to induce weight loss and ameliorate or cure most of the morbidities that accompany obesity. These procedures not only produce substantial weight loss (>50% body weight), but they cure or ameliorate the comorbidities (diabetes type 2, hypertension, sleep apnea, hyperlipidemia) in the vast majority of patients. These procedures can usually be performed laparoscopically with a mortality of less than 0.5% and a hospital stay of 1 to 3 days. Presently they are the only effective treatment for weight loss in the extremely obese patient (body mass index >/= 35).
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Affiliation(s)
- Clifford W Deveney
- Division of General Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, L223A, Portland, OR 97239, USA.
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Hamza N, Abbas MH, Darwish A, Shafeek Z, New J, Ammori BJ. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Surg Obes Relat Dis 2010; 7:691-6. [PMID: 20688578 DOI: 10.1016/j.soard.2010.03.292] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 01/23/2010] [Accepted: 03/10/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is associated with obesity and results in considerable morbidity and mortality. Our objectives were to evaluate the effect of laparoscopic bariatric surgery on the control of T2DM in morbidly obese patients in a U.K. population and to determine the predictors of T2DM remission after bariatric surgery. The study was performed at teaching university hospitals and affiliated private hospitals. METHODS Of 487 patients who underwent laparoscopic bariatric procedures from 2002 to 2007, 74 patients (15.2%) had established T2DM. The results are presented as the mean values. Multivariate analysis was used to identify the factors predictive of remission of T2DM after bariatric surgery. RESULTS The body mass index before laparoscopic gastric bypass (LGB; n = 48) and laparoscopic adjustable gastric banding (LAGB; n = 26) were comparable (52 versus 51 kg/m(2), P = .508). At a mean follow-up of 16.9 months, 41% had remission and 59% had experienced improvement in T2DM. Although the duration of follow-up was significantly longer for the patients who had undergone LAGB than for those who had undergone LGB (23 versus 13.4 months, P = .001), the percentage of excess weight loss (%EWL) was significantly greater after LGB than after LAGB (59.4% versus 48.8%, P = .031), with an associated greater remission rate of T2DM (50% versus 24%, P = .034). Multivariate analysis revealed a greater %EWL and younger age to be independent predictors of postoperative remission of T2DM, and LGB, longer follow-up, and female gender were independent predictors of a greater %EWL. CONCLUSION The %EWL was the only predictor of remission of T2DM that was influenced by the choice of bariatric procedure. In our study, LGB offered greater weight loss and a chance of remission of T2DM compared with LAGB and within 2 years of surgery.
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Snyder B, Wilson T, Mehta S, Bajwa K, Robinson E, Worley T, Aluka K, Wolin-Riklin C, Wilson E. Past, present, and future: Critical analysis of use of gastric bands in obese patients. Diabetes Metab Syndr Obes 2010; 3:55-65. [PMID: 21437077 PMCID: PMC3047987 DOI: 10.2147/dmsott.s6935] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Adjustable gastric banding (AGB) is quickly becoming the most popular bariatric operation performed in the United States and Canada. Patients are particularly fond of the simplicity of the tool, the relatively low morbidity of the surgery, the quick recovery, and overall results. The gastric band has evolved over its 35-year history into a very successful adjustable tool used to restrict food consumption and limit caloric intake. The percent of excessive weight loss after banding can range from 30%-60% and depends on the time out from surgery. Along with weight loss, there is good resolution of the co-morbid conditions that are associated with excess weight and improvements in quality of life demonstrated after banding. Nutrition and follow up are extremely important after banding to ensure good compliance and adequate weight loss. Failure to follow the postoperative diet, exercise regiment, or mechanical failure of the band can lead to failure to lose adequate weight. While there are particular early and late complications associated with this surgery, the safety profile of the AGB is very appealing when compared to other bariatric operations. As we continue to reduce the morbidity of the procedure, the simple adjustable band concept has a lot of potential to remain a primary technique of maintaining long term weight loss. In conclusion, AGB has and continues to play an important role in the treatment of morbid obesity. It offers reasonably good weight loss results with very little morbidity, and the future of the adjustable band is bright.
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Affiliation(s)
- Brad Snyder
- Correspondence: Brad Snyder, University of Texas, Health Sciences, Center at Houston, TX, USA, Tel +1 713 500 7250, Fax +1 713 500 7268, Email
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Burton PR, Brown WA, Laurie C, Hebbard G, O'Brien PE. Mechanisms of bolus clearance in patients with laparoscopic adjustable gastric bands. Obes Surg 2010; 20:1265-72. [PMID: 20066500 DOI: 10.1007/s11695-009-0063-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 12/09/2009] [Indexed: 01/26/2023]
Abstract
BACKGROUND The components of esophageal function important to success with laparoscopic adjustable gastric banding (LAGB) are not well understood. A pattern of delayed, however, successful bolus transit across the LAGB is observed. METHODS Successful LAGB patients underwent a high-resolution video manometry study in which bolus clearance, flow, and intraluminal pressures were recorded. Liquid and semi-solid swallows and stress barium (a combination of semi-solid swallows and liquid barium) were performed. A new measurement, the lower esophageal contractile segment (LECS), was defined and evaluated. RESULTS Twenty patients participated (mean age 48.3 +/- 12.0 years, four men, %excess weight loss 65.6 +/- 18.0). During semi-solid swallows, two patterns of esophageal clearance were observed: firstly, a native pattern (n = 10) similar to that which is expected in non-LAGB patients; secondly, a lower esophageal sphincter-dependent pattern (n = 7), where flow only occurred when the intrabolus pressure increased during the lower esophageal sphincter (LES) aftercontraction. In both patterns, if there was incomplete bolus clearance, reflux was observed and was usually followed by another swallow. A mean of 4.5 +/- 2.9 contractions were required to clear the semi-solid bolus. Contractions with an intact LECS demonstrated longer flow duration: 7.1 +/- 3.8 vs.1.6 +/- 3.2 s, p < 0.005. During the stress barium, an intrabolus pressure of 44.5 +/- 16.0 mm Hg leads to cessation of intake. CONCLUSIONS In LAGB patients, normal esophageal peristaltic contractions transition to a LES aftercontraction, producing trans-LAGB flow. Repeated contractions are required to clear a semi-solid bolus. Incorporating measurements of the LECS into assessments of esophageal motility in LAGB patients may improve the usefulness of this investigation.
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Affiliation(s)
- Paul Robert Burton
- Centre for Obesity Research and Education (CORE), Monash Medical School, The Alfred Hospital, Commercial Rd, Prahran, 3181, Melbourne, Australia.
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Criteria for assessing esophageal motility in laparoscopic adjustable gastric band patients: the importance of the lower esophageal contractile segment. Obes Surg 2009; 20:316-25. [PMID: 20012706 DOI: 10.1007/s11695-009-0043-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Esophageal function appears critical in laparoscopic adjustable gastric band (LAGB) patients; however, conventional motility assessments have not proven to be clinically useful. Recent combined video fluoroscopic and high-resolution manometric studies have identified important components of esophageal function in LAGB patients. METHODS Successful and symptomatic LAGB patients, with normal or mildly impaired esophageal peristalsis, underwent a standardized, water swallow, high-resolution manometry protocol designed specifically to assess the lower esophageal contractile segment (LECS), in combination with conventional measures of esophageal motility. Differences in response to changes in LAGB volume were assessed. RESULTS There were 101 symptomatic and 29 successful patients. More symptomatic patients had a mild impairment in esophageal motility (39.6% vs. 3.4%, p < 0.005). Successful patients demonstrated an intact LECS during normal swallows more frequently than symptomatic patients (95% vs. 43%, p < 0.005). Absolute intraluminal pressures were not different between the groups. Removing all fluid from the LAGB revealed more hypotensive swallows in the symptomatic patients (30% vs. 17%, p = 0.002), an effect not observed when the LAGB volume was increased (8% vs. 5%, p = 0.21). Receiver operator characteristic analysis determined that an intact LECS in 70% of normal swallows defined normal motility in LAGB patients. CONCLUSIONS The LECS is a valuable measure of esophageal function in LAGB patients and complements conventional manometric criteria. Symptomatic patients have less normal swallows; however, these also frequently demonstrate a deficient LECS. Further information can be elucidated by performing swallows at differing LAGB volumes. High-resolution manometry, using these adapted criteria, is now a useful in the investigation in symptomatic LAGB patients.
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