Risk of Gastric Pouch Enlargement With Adjustable Gastric Banding in Premenopausal Women: Sex Hormones May Play a Role

Safety and effectiveness of 1-stage conversion of adjustable gastric band-to-sleeve gastrectomy: a single-institution case-control study

BACKGROUND

Patients are increasingly referred for conversion of laparoscopic adjustable gastric band (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (SG). The safety of a 1- versus 2-stage approach to this revision is debated.

OBJECTIVES

We examined the safety and efficacy of 1-stage conversion of LAGB to SG at our institution.

SETTING

University hospital.

METHODS

An institutional database was used to retrospectively identify patients who underwent single-stage LAGB-to-SG conversion between 2010 and 2018. Patients were matched 1:1 for age, sex, and body mass index with primary SG patients during this same period. Primary endpoints were operative time, complication rate, length of hospital say, and weight loss 12 months from surgery.

RESULTS

Two-hundred and twenty-nine patients undergoing conversion of LAGB to SG were identified. Median postoperative length of hospital stay was 2 days. Two patients (.8%) developed surgical site infection. One patient (.4%) developed a postoperative myocardial infarction. There were 4 total readmissions (1.7%) and 1 reoperation within 30 days (.4%). There were no statistically significant differences in 30-day complication rates between groups. Weight loss at 12 months was significantly different: Median body mass index loss for conversion patients was 5.1 kg/m² compared with 8.85 kg/m² for patients in the primary SG group (P < .0001).

CONCLUSION

Single-stage conversion of LAGB to SG is safe and effective. Patients may not experience the same extent of weight loss as those with primary SG. Our findings represent the largest single-institutional experience to date and support a 1-stage approach whenever feasible.

Laparoscopic adjustable gastric banding: efficacy and consequences over a 13-year period

BACKGROUND

Laparoscopic adjustable gastric banding (LAGB) is a common bariatric surgery. Although it is a safe and effective method of weight reduction in short term, it may result in some problems in long term. The purpose of this study was to investigate the consequences of LAGB in long term among morbid obese patients.

METHODS

In this prospective study, 80 patients underwent LAGB using pars flaccida technique from 2001 to 2006. Long-term postoperative consequences and complications of these patients were recorded.

RESULTS

The preoperative mean values of weight and body mass index were 125.5 ± 22.5 kg and 44.5 ± 6.5 kg/m(2), respectively. Over the 13-year follow-up period, 56 patients (84.8%) experienced at least one complication. The most common complications were band erosion (20 patients) and weight regains (13 patients). Fifty-one patients (78.5%) required reoperation. The band of 48 patients (72.7%) was removed; of these, twenty patients (30.3%) underwent other bariatric surgeries. Percent of excess weight loss was 47.1% ± 30.1%, and the success rate was 48.7%.

CONCLUSIONS

LAGB is a successful method with low complications in short term; however, over long term, it results in various complications.

Autonomic control and bariatric procedures

The sudden improvement of metabolic profile and the remission of type 2 diabetes after bariatric surgery, well before weight loss, raise important new questions regarding glycemic control. Currently, various types of bariatric procedures target type 2 diabetes in obese and non-obese patients. Nevertheless, the origin of the dramatic metabolic improvements, including glucose homeostasis, is poorly understood, and the role of the gastrointestinal (GI) tract remains relatively speculative, as well as why these procedures are variably effective. One neglected explanation is that such interventions disrupt neural networks mediating GI-brain communication and could alter the autonomic output to the visceral organs, including the liver. Incretins, e.g., glucagon-like peptide 1 (GLP-1), have major influence on the central nervous system. Moreover, the level of GLP-1 is observed to significantly increase after bariatric surgery and could be a key factor in the weight-independent, anti-diabetic effect. Therefore, this review will evaluate the effect of GLP-1 on the central nervous system, with emphasis on the cellular effects of GLP-1, and will provide an overview of the autonomic control of the liver.