Is gastro-gastric fixation suture necessary in laparoscopic adjustable gastric banding? A prospective randomized study

A Novel Auxiliary Device for Preventing Band Slippage After Laparoscopic Adjustable Gastric Banding: Infra-Band Fixation Using S-Loop

BACKGROUND

Band slippage is known to be a troublesome complication of laparoscopic adjustable gastric banding (LAGB), often requiring surgical intervention. To prevent band slippage, a new auxiliary device "S-loop" was developed.

METHODS

From July 2010 to January 2014, a total of 814 LAGBs were performed by a single surgeon. The patients were divided into two groups based on the application of S-loop: conventional LAGB group (n = 378) and S-loop group (n = 436). The operative outcomes were compared between the two groups.

RESULTS

The mean operative time and the length of hospital stay were significantly longer in the conventional LAGB group than in the S-loop group (64.3 minutes versus 57.1 minutes; P < .001 and 5.0 hours versus 3.6 hours; P < .001, respectively). The complications occurred in 7.1% of the conventional LAGB group and 1.6% in the S-loop group (P < .001). Slippage was the most common complication: 13 cases were observed in the conventional LAGB group, whereas no slippage was observed in the S-loop group.

CONCLUSION

Infra-band fixation using S-loop is a simple and effective method for preventing band slippage compared with the conventional LAGB.

Prospective, double center, 1-year results of adjustable gastric banding with MIDBAND (gastro-gastric suture vs. non-gastro-gastric suture)

Purpose

Although laparoscopic adjustable gastric banding (LAGB) is a popular bariatric procedure, few comprehensive studies have been investigated on the use of non-gastro-gastric sutures (NGGSs) for decreasing postoperative complications. This study aimed to assess and compare the safety and effectiveness of MIDBAND with or without gastro-gastric sutures (GGSs).

Methods

Between February 2013 and March 2014, 41 severely obese patients underwent primary LAGB using pars flaccid technique at double center in South Korea. Excess weight loss, operative time and postoperative complications were assessed and compared between a GGS group (group 1) and a NGGS group (group 2), and patients were followed monthly for 1 year.

Results

Mean body mass indices in groups 1 and 2 were 38.4 ± 4.7 and 38.9 ± 5.0 kg/m², respectively, and mean percentage excess weight losses (%EWLs) were 59.9% ± 28.4% and 50.9% ± 20.0%, respectively, at 6 months, and 75.8% ± 26.6% and 72.5% ± 27.5%, respectively, at 12 months, and these intergroup differences of %EWL were not significant (P = 0.256 and P = 0.704, respectively). Mean operative time (57.2 minutes) was shorter in group 2 than in group 1 (79.2 minutes) (P < 0.001). In terms of complications, pouch dilatation rates were similar in the 2 groups, and no case of gastric band erosion was encountered.

Conclusion

Operative time was shorter in the NGGS group, and pouch dilatation rates and %EWL were similar in the 2 groups. We conclude NGGS using MIDBAND is both straightforward and effective. A long-term prospective comparative study is needed to demonstrate the safety and efficacy of NGGS.

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.