Prevention of catheter disconnection after laparoscopic adjustable gastric banding

Long-term outcomes of laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass in the United States

BACKGROUND

Although laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most common bariatric procedures performed in the past decade, little is known about their long-term (>5 years) outcomes.

METHODS

A retrospective outcome study investigated 148 consecutive patients from a single practice who underwent LAGB from November 2000 to March 2002. The group was matched with 175 consecutive patients who underwent LRYGB from June 2000 to March 2005. Follow-up data for 5 years or longer was available for 127 LAGB patients (86%) and 105 LRYGB patients (60%).

RESULTS

After an initial 4 years of progressive weight loss, body mass index (BMI) loss stabilized at 5-7 years at approximately 15 kg/m(2) for the LRYGB patients and at about 9 kg/m(2) for the LAGB patients with band in place (P < 0.01). At 7 years, the excess weight loss (EWL) was 58.6% for LRYGB and 46.3% for LAGB with band in place (P < 0.01). By 7 years, 19 LAGB patients (15%) had had their bands removed, bringing the failure rate for LAGB (including patients with less than 25% EWL) to 48.3% versus 10.7% for LRYGB (P < 0.01). By 10 years, 29 (22.8%) of the bands had been removed, bringing the total LAGB failure rate to 51.1%. In 10 years, 67 LAGB (52.8%) and 43 LRYGB (41%) adverse events had occurred. However, over time, the LRYGB group experienced 9 (8.6%) serious, potentially life-threatening complications, whereas the LAGB group had none (P < 0.001). One procedure-related death occurred in the LRYGB group.

CONCLUSIONS

Over the long term, LRYGB had an approximate reduction of 15 kg/m(2) BMI and 60% EWL, a significantly better outcome than LAGB patients experienced with band intact. The main issue with LAGB was its 50% failure rate in the long term, as defined by poor weight loss and percentage of band removal. Nevertheless, LAGB had a remarkably safe course, and it may therefore be considered for motivated and informed patients.

Presentation and management of port disconnection after laparoscopic adjustable gastric banding

AIM

Laparoscopic adjustable gastric banding (LAGB) is a common and effective minimally invasive procedure in the treatment of morbid obesity. Port and connection tube complications are rarely reported. The aim of this study was to find presenting signs and predictors of tube disconnection from the access port that allow prompt diagnosis and appropriate treatment.

PATIENTS AND METHODS

A retrospective chart review was performed on the 29 patients who underwent 31 laparoscopic reconnections of the connecting tube following LAGB during a 10-year period.

RESULTS

Presenting signs were sudden lower-abdominal pain and free food passage following by weight gain and inability for band adjustment. Additional imaging was used to confirm diagnosis in the first three patients. Diagnostic laparoscopy for suspected acute appendicitis found tube disconnection from the port in one patient. Laparoscopic reconnection was successful in all patients. Access port exchange was done in 23 cases. Two patients had recurrent port disconnection. Band exchange was performed after second port reconnection.

CONCLUSION

Sudden onset of flank or abdominal pain, free eating, weight gain, and inability to adjust the band are signs of port disconnection after LAGB. Education and information for medical staff and patients can help in early recognition of this complication and avoid unnecessary investigations.