Adjustable laparoscopic gastric banding for morbid obesity: imaging assessment and complications

A review of commonly performed bariatric surgeries: Imaging features and its complications

Obesity is a disease that has achieved the level that can be considered an epidemic. According to the National Center for Health Statistics data, the prevalence of obesity has increased from 30.5% in 1999-2000 to 42.4% in 2017-2018. During the same period, severe obesity has increased from 4.7% to 9.2%. With the growing prevalence of obesity, related conditions such as coronary artery disease, diabetes, and strokes have also become more prevalent. In the past few years, the need for bariatric surgeries such as laparoscopic Roux-en-Y gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric banding has increased considerably. With an increasing number of bariatric surgeries, multiple postoperative complications have become common. In this review, we have attempted to describe normal postsurgical anatomical findings after bariatric surgeries and pictorial review of a few common postoperative complications.

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

OBJECTIVE

The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists.

METHODS

Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts.

RESULTS

New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest).

CONCLUSIONS

Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

OBJECTIVE

The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to the American Association of Clinical Endocrinologists 2017 protocol for standardized production of CPG, algorithms, and checklists.

METHODS

Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts.

RESULTS

New or updated topics in this CPG include contextualization in an adiposity-based, chronic disease complications-centric model, nuance-based, and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current healthcare arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest).

CONCLUSIONS

Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence-based within the context of a chronic disease. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

Imaging following bariatric surgery: roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and sleeve gastrectomy

Morbid obesity is an increasing health problem, and bariatric surgery is a popular treatment option. Radiologists must be familiar with performing and interpreting studies in this patient population. The typical post-operative findings of the Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG) procedures on upper gastrointestinal (UGI) series and computerized tomography (CT) are presented. An overview of the potential complications is provided in addition to a description of potential pitfalls in interpreting these studies.

Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results

Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.

Multidetector CT imaging of bariatric surgical complications: a pictorial review

The prevalence of obesity is increasing, along with the number of bariatric surgical procedures performed to treat obesity. Laparoscopic sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and laparoscopic gastric banding (GB) comprise the vast majority of procedures with SG now the dominant procedure in the USA. Although multidetector computed tomography (MDCT) is not always the examination of choice for a particular suspected complication, many of these patients present with non-specific abdominal symptoms and undergo MDCT evaluation as an initial diagnostic test. This pictorial essay will review and discuss the normal post-surgical bariatric appearance on MDCT, and the appearance of common and uncommon complications associated with the common bariatric procedures on MDCT with correlative imaging. SG complications include leak/abscess, hemorrhage, splenic injury, and portomesenteric thrombosis. RYGB complications include leak/abscess, gastrogastric fistula, small bowel obstruction, internal hernia, and intussusception. Although GB is waning in popularity, radiologists continue to see the legacy of these patients and complications include gastric prolapse, band erosion, and port/tubing mechanical failures. Awareness of the characteristic findings of bariatric complications on MDCT is critical, allowing for earlier recognition and prompt intervention.

Dysphagia revisited: common and unusual causes

Dysphagia is a common clinical problem whose prevalence is increasing with the aging population in the United States. The term dysphagia is commonly used to describe subjective awareness of swallowing difficulty during the passage of a bolus from the mouth to the stomach or the perception of obstruction during swallowing. Dysphagia may be further classified as oropharyngeal or substernal, depending on the location of this sensation. It can be due to benign or malignant structural lesions, esophageal motility abnormalities, oropharyngeal dysfunction (including aspiration), neuromuscular disorders, or postsurgical changes and is also associated with gastroesophageal reflux disease. Pathologic conditions of the oral cavity, pharynx, esophagus, and proximal stomach can manifest with dysphagia. Imaging remains the preferred method for evaluating patients with dysphagia, and dysphagia is an increasingly encountered indication for radiologic evaluation. Fluoroscopic studies, including the modified barium swallow and esophagography in particular, are often used in the assessment of patients with dysphagia, and the techniques used for these studies should be tailored to the patient's needs. Fluoroscopic studies can be used to evaluate the esophagus for structural abnormalities (eg, webs, diverticula, strictures, masses) and to assess function (eg, the swallowing mechanism and esophageal motility). Knowledge of the imaging spectrum of disease entities that may cause dysphagia and thorough radiologic assessment with a tailored approach may help avoid misdiagnosis.

[Gastric band erosion: Alternative management]

BACKGROUND

Obesity is a public health problem, for which the prevalence has increased worldwide at an alarming rate, affecting 1.7 billion people in the world.

OBJECTIVE

To describe the technique employed in incomplete penetration of gastric band where endoscopic management and/or primary closure is not feasible.

MATERIAL AND METHODS

Laparoscopic removal of gastric band was performed in five patients with incomplete penetrance using Foley catheterization in the perforation site that could lead to the development of a gastro-cutaneous fistula.

CLINICAL CASES

The cases presented include a leak that required surgical lavage with satisfactory outcome, and one patient developed stenosis 3 years after surgical management, which was resolved endoscopically. In all cases, the penetration site closed spontaneously.

DISCUSSION

Gastric band erosion has been reported in 3.4% of cases. The reason for inserting a catheter is to create a controlled gastro-cutaneous fistula, allowing spontaneous closure.

CONCLUSIONS

Various techniques have been described: the totally endoscopic, hybrid techniques (endoscopic/laparoscopic) and completely laparoscopic. A technique is described here that is useful and successful in cases where the above-described treatments are not viable.

A Challenging Misleading Diagnosis in a Patient with Suspicion of Gastric Banding Slippage and Strangulation: Diagnosis and Laparoscopic Treatment

A 51-year-old female (height 160 cm, weight 89 kg, BMI 34.8) presented at the emergency department complaining of sudden onset of sharp abdominal pain in the epigastrium, colicky in nature, dysphagia, nausea, and repeated retching with non-productive vomiting. She has had an adjustable gastric banding implanted laparoscopically 11 years earlier. Since then, she reported to have had only a moderate weight loss (initial BMI 44), although she was closely followed up and the reservoir properly filled by her obesity surgeon. A gastrografin was performed and showed no clear signs of slippage of the gastric band nor of gastric strangulation/ischemia. Nonetheless, the passage of the contrast through esophagogastric junction was slightly slow and restricted suggesting a moderate stenosis from the band. Two cubic centimeters of saline were aspirated from the reservoir to loosen the gastric band. However, on the following minutes, no significant relief of the sharp pain was observed. NSAIDS and morphine were repeatedly given without significant pain relief, and after a few hours, the pain was more intense and diffused to the upper abdomen. I.V. contract CT scan showed a large amount of free fluid, with severe small bowel distension and suspected volvulus and a transition point at the port site of the reservoir, suggesting a strangulated incisional hernia on this site and/or strangulating band adhesion. Urgent surgery was planned, and a laparoscopic approach was chosen. A large amount of free bloody fluid was found, and a long segment of small bowel was twisted around a strangulating band adhesion on the port site of the reservoir, incarcerated within an incisional hernia on the same port site. The strangulating band was cut, and the strangulated bowel was released. Gradual reversion of bowel ischemia was observed, and the gastric banding was removed according to the patient's preoperative request.

Imaging of bariatric surgery: normal anatomy and postoperative complications

Obesity is a disease that has reached epidemic proportions in the United States and around the world. During the past 2 decades, bariatric surgery has become an increasingly popular form of treatment for morbid obesity. The most common bariatric procedures performed include laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic sleeve gastrectomy. Fluoroscopic upper gastrointestinal examinations and abdominal computed tomography (CT) are the major imaging tests used to evaluate patients after these various forms of bariatric surgery. The purpose of this article is to present the surgical anatomy and normal imaging findings and postoperative complications for these bariatric procedures at fluoroscopic examinations and CT. Complications after Roux-en-Y gastric bypass include anastomotic leaks and strictures, marginal ulcers, jejunal ischemia, small bowel obstruction, internal hernias, intussusception, and recurrent weight gain. Complications after laparoscopic adjustable gastric banding include stomal stenosis, malpositioned bands, pouch dilation, band slippage, perforation, gastric volvulus, intraluminal band erosion, and port- and band-related problems. Finally, complications after sleeve gastrectomy include postoperative leaks and strictures, gastric dilation, and gastroesophageal reflux. The imaging features of these various complications of bariatric surgery are discussed and illustrated.

Three-year experience of pouch dilatation and slippage management after laparoscopic adjustable gastric banding

PURPOSE

Pouch dilatation and band slippage are the most common long-term complications after laparoscopic adjustable gastric banding (LAGB). The aim of the study is to present our experience of diagnosis and management of these complications.

MATERIALS AND METHODS

The pars flaccida technique with anterior fixation of the fundus was routinely used. All band adjustments were performed under fluoroscopy. We analyzed the incidence, clinico-radiologic features, management, and revisional surgeries for treatment of these complications. We further presented the outcome of gastric plication techniques as a measure for prevention of these complications.

RESULTS

From March 2009 to March 2012, we performed LAGB on 126 morbidly obese patients. Among them, 14 patients (11.1%) were diagnosed as having these complications. Four patients (3.2%) had concentric pouch dilatations, which were corrected by band adjustment. Ten (7.9%) had eccentric pouch with band slippage. Among the ten patients, there were three cases of posterior slippage, which were corrected by reoperation, and seven cases of eccentric pouch dilatation with anterior slippage. Three were early anterior slippage, which was managed conservatively. Two were acute anterior slippage, one of whom underwent a revision. There were two cases of chronic anterior slippage, one of whom underwent a revision. The 27 patients who underwent gastric plication did not present with eccentric pouch with band slippage during the follow-up period.

CONCLUSION

The incidence of pouch dilatation with/without band slippage was 11.1%. Management should be individualized according to clinico-radiologic patterns. Gastric plication below the band might prevent these complications.

Gastric bands: what the general radiologist should know

Obesity in the UK is increasing, it is estimated that in England 24% of men and 25% of women are obese.(1,2) In recent years bariatric surgery has become increasingly common and is effective in producing long-term weight loss.(4,5) The most popular form of bariatric surgery in Europe is laparoscopic adjustable gastric banding (LAGB).(6) Radiologists play a key role assessing the normal function of bands, adjusting their filling under fluoroscopic guidance, and in recognizing and managing complications. This review will describe the general principles of LAGB; how they are assessed, how to recognize the most common complications, an overview of the appearances of the bands used in the UK, and novel developments in their use and design.

Pre- and postoperative imaging of adolescents undergoing laparoscopic adjustable gastric banding surgery

BACKGROUND

As childhood obesity rates rise, laparoscopic adjustable gastric banding (LAGB) is being investigated as a bariatric surgical option in adolescents.

OBJECTIVE

To examine pre- and postoperative imaging in adolescents undergoing LAGB, describe the most common abnormal preoperative imaging findings, and illustrate the typical appearance and variants on postoperative upper-gastrointestinal (UGI) examinations.

MATERIALS AND METHODS

A retrospective chart review was performed of all adolescents from 2008 to 2010 undergoing LAGB at a single tertiary-care pediatric hospital. The picture archiving and communication system was queried for all imaging obtained before and after surgery. Postoperative UGI studies were analyzed for common patterns.

RESULTS

Twenty-seven obese adolescents who underwent LAGB were identified. Twenty-five had preoperative imaging, most commonly a UGI study (81.5%). Eight UGI studies were abnormal but did not impact surgery. Preoperative chest and neck radiographs were also common. Intraoperative imaging was rare. Seventy-three postoperative UGI studies were performed on 22 children (range, 2-12 studies). A common postoperative imaging pattern was observed in 19/22 (86%) children. No complications were observed.

CONCLUSION

The most common pre- and postoperative imaging studies in adolescents undergoing LAGB are UGI studies. Pediatric radiologists should be familiar with the imaging of LAGB as this procedure becomes increasingly common.

Medical management of postsurgical complications: the bariatric surgeon's perspective

Bariatric surgery remains the only effective method to initiate and sustain massive weight loss in morbidly obese patients. Along with the advent of minimal access surgery, its popularity has not only resulted in an exponential increase in number of cases but also a subsequent increase in number of complications. Although most postsurgical bariatric complications are managed surgically, it is imperative that all physicians be aware of the unique potential complications to effectively communicate and optimize the medical management in this emergent set of patients.

The surgical management of obesity with emphasis on the role of post operative imaging

The role of surgery in the morbidly obese is becoming more prominent. There are a variety of surgical approaches which can be used and radiology plays a crucial role in post operative follow up, particularly in the management of complications. Many general radiologists remain unfamiliar with both the normal and abnormal appearances after bariatric surgery and this pictorial review aims to bridge this gap.

Past, present, and future: Critical analysis of use of gastric bands in obese patients

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.

Routine postoperative upper gastrointestinal fluoroscopy is unnecessary after laparoscopic adjustable gastric band placement

BACKGROUND

Laparoscopic adjustable gastric banding (LAGB) has become an accepted procedure for weight loss surgery, particularly due to fewer early complications and decreased mortality in comparison to other bariatric procedures. Many centers use postoperative upper gastrointestinal fluoroscopy (UGI) to ensure stomal patency and gastric integrity at the banding site. However, UGI increases cost and may increase length of stay due to availability. The purpose of this study is to determine whether routine UGI after LAGB is necessary for detection of early complications.

METHODS

A prospective database of 200 LAGBs performed by a single surgeon over 3 years was reviewed retrospectively. All patients underwent UGI 2-24 h after surgery.

RESULTS

Mean age was 43, mean BMI was 45, and mean operative time was 44 min. Forty-four percent of patients stayed overnight. All postoperative UGI results were normal. Six percent underwent intraoperative instillation of methylene blue due to procedural difficulty with no leaks identified. These patients on average were 5 years older ( p< 0.01) and had an operative time 23 min longer (p < 0.01). Differences in gender and BMI were not statistically significant. One patient (0.5%), who had a normal methylene blue test and normal UGI, returned within 2 days with a gastric perforation requiring band explant and gastric repair.

CONCLUSIONS

We conclude that routine UGI after LAGB is not necessary based on a 0% stomal obstruction rate and detection of not a single gastric leak. Elimination of routine postoperative UGI will decrease cost and length of hospital stay. We suggest a selective approach for those patients at increased risk of early postoperative complications, including those having intraoperative methylene blue instillation, increased length of operation, and increased age.

Surgeon-performed fluoroscopy conducted simultaneously during all laparoscopic adjustable gastric band adjustments results in significant alterations in clinical decisions

BACKGROUND

Little data exists regarding filling regimens for laparoscopic adjustable gastric bands (LAGB). In addition to patient symptoms and weight changes, we have instituted surgeon-performed, real-time fluoroscopic evaluation in our clinical decision making during all band adjustments.

OBJECTIVE

Our hypothesis is that surgeon-performed, real-time contrast fluoroscopy conducted routinely during all LAGB adjustment results in significant deviations in clinical care.

SETTING

The study is set at the Academic Referral Center, United States

METHODS

Fifty-two consecutive patients who underwent LAGB and presented for adjustment were given a questionnaire evaluating obstructive symptoms. The patient's weight loss history was also reviewed. Each patient underwent real-time fluoroscopy performed by the surgeon during adjustment. Data were recorded and compared to final decision to fill, make no adjustment, or remove fluid.

RESULTS

Patients were, on average, at post-operative visit 5. Sixty-three percent of patients received a fill, 31% had no change, and 6% had fluid removed. On the questionnaire, 15% of patients noted reflux, 10% had dysphagia, and 8% had regurgitation. Eighty percent of patients requested a fill. Thirty-one percent had an abnormality noted on fluoroscopy. Fifteen percent of patients demonstrated esophageal dilation, 15% had a delay of greater than 5 s, 19% had reflux of contrast. Three patients had band displacements on imaging. Additionally, six patients (12%) were not filled based on fluoroscopic findings alone, not predicted by either the survey or historical weight loss.

CONCLUSION

Surgeon-performed, real-time, fluoroscopy during LAGB adjustment results in significant changes in clinical care that are not predicted by history and weight loss alone. Routine fluoroscopic imaging altered the course of management in 12% of patients and identified three asymptomatic displaced bands.

Imaging of morbid obesity procedures and their complications

Surgery for morbid obesity has become commonplace in the United States. Any radiologist who reads abdominal films, body CT, or does gastrointestinal fluoroscopy should be familiar with the surgical procedures and their imaging. Included in this update will be discussions of the vertical banded gastroplasty, Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and biliopancreatic diversion with duodenal switch.

International multicenter study of safety and effectiveness of Swedish Adjustable Gastric Band in 1-, 3-, and 5-year follow-up cohorts

BACKGROUND

No long-term, international, multicenter studies of the effectiveness and safety of the SAGB in morbid obesity have been previously published. The objective of this study was to assess the effectiveness and safety of the Swedish Adjustable Gastric Band (SAGB) at 6 bariatric centers in Australia, Europe, and Brazil, with < or =5 years of follow-up; the effect on patient covariates; and changes in co-morbidity.

METHODS

A 2-phase study design was used, involving both retrospective and prospective data. SAGB was implanted by way of the pars flaccida 1, 3, and 5 years previously. The retrospective phase entailed a review of the records. The prospective phase included a subset of eligible patients who agreed to undergo additional clinical assessments. The percentage of excess weight loss (%EWL), patient level predictors, change in co-morbidities, and complications were analyzed.

RESULTS

A total of 481 patients in 3 mutually exclusive follow-up cohorts (1 yr, n = 200; 3 yr, n = 184; 5 yr, n = 97) participated in the present study. Of these 481 patients, 339 (1 yr, n = 139; 3 yr, n = 131; 5 yr, n = 69) underwent prospective evaluations. The mean %EWL was 43.5% + or - 21.8%, 57.7% + or - 25.9%, and 49.8% + or - 27.6% and the mean change in body mass index was -7.64, -10.75, and -9.52 in the 1-, 3-, and 5-year cohorts, respectively (P <.001). Gender and age did not predict the %EWL; however, a greater preoperative body mass index was inversely related to the %EWL. Longer postimplantation times were associated with greater improvement in co-morbidities and with greater frequencies of reoperation. Fewer than 15% of the patients in the 5-year cohort had undergone band removal and 10% required band revisions. No fatal or life-threatening complications occurred.

CONCLUSION

SAGB is safe and effective in inducing weight loss and improvement of co-morbidities in morbidly obese patients at international bariatric centers at 1, 3, and 5 years postoperatively.

Adjustable laparoscopic gastric banding: demonstrated on multidetector computed tomography with multiplanar reformation and 3-dimensional imaging

Laparoscopic adjustable gastric banding (LAGB) is a widely performed surgical procedure for morbid obesity in Europe and Australia. An upper gastrointestinal examination is usually used to assess for band placement and possible complications. Computed tomography (CT) is not used routinely but may be beneficial to evaluate LAGB and possible complications. Also, LAGB may be incidentally demonstrated on CT. We report 2 patients with LAGB that was well demonstrated on multidetector CT with multiplanar reformation and 3-dimensional imaging.

Radiological assessment of complications after laparoscopic suprabursal adjustable gastric banding for morbid obesity

BACKGROUND

The purpose of this study was to investigate the clinical impact of radiological assessment on delivery of therapy in patients with laparoscopic adjustable gastric banding for morbid obesity who have developed gastroesophageal symptoms or have inadequate excess weight loss.

METHODS

Institutional review board approval and informed consent were obtained from all patients. Suprabursal banding was performed in 373 patients who underwent 869 upper gastrointestinal series. The control group comprised 59 asymptomatic subjects from the study population with satisfactory weight loss at follow-up.

RESULTS

There were no intra-operative deaths or gastric perforations. A small gastric pouch was found above the band in 13 (22.03%) of the 59 control subjects; the upper limit of the gastric pouch volume was 9.85 ml (mathematical formula for a sphere used). The main postoperative complications included: 21 of 373 (5.63%) gastric portions above the band with a mean volume of 137.98 ml and narrowed stoma of 0.99 mm; 15 of 373 (4.02%) gastric portions above the band with a mean volume of 33.27 ml and open stoma of 4.95 mm; and 16 of 373 (4.28%) tubing disconnection and displacement into the peritoneal cavity. Twenty-one of 21 narrowed-stoma and eight of 15 open-stoma gastric portions underwent repeat surgery, upward herniation of the stomach (from below the band) being found in all 29 cases.

CONCLUSION

Our main findings following the use of the suprabursal approach for surgical band positioning suggest that repeat surgery may be worthwhile for all gastric upper portions >10 ml in patients with gastroesophageal symptoms or inadequate excess weight loss.