The technical approach in banding to avoid pouch dilatation

Outcome and Complications after Laparoscopic Swedish Adjustable Gastric Banding: 5-Year Results of a Prospective Clinical Trial

BACKGROUND

Bariatric surgery is currently the only effective treatment for morbid obesity in terms of inducing and maintaining satisfactory weight loss and decreasing weight-related co-morbidities. A study was conducted to assess the effects, complications and outcome after laparoscopic Swedish adjustable gastric banding (SAGB) to 5 years.

METHODS

Between June 1998 and December 2005, all patients with implantation of a SAGB were enrolled in a prospective clinical trial. Results were recorded and classified, with special regard to long-term complications and re-operation rate.

RESULTS

SAGB was performed in 128 patients (87 female, 41 male). Mean age was 40.2 +/- 5.3 years, with mean preoperative BMI 44.5 +/- 3.9 kg/m2. Overall mortality was 0%. Patient follow-up was 94.5%. BMI after 1, 2 and 5 years was 35.7 +/- 3.7 kg/m2 (P < 0.005), 33.7 +/- 3.8 kg/m2 (P < 0.001) and 31.8 +/- 3.8 kg/m2 (P < 0.001), respectively. Mean EWL after 1, 2 and 5 years was 33.3 +/- 6.8% (P < 0.005), 45.5 +/- 6.4% (P < 0.001) and 57.4 +/- 6.5% (P < 0.001), respectively. The nonresponder rate (EWL < 30%) after 2 and 5 years was 17.0% and 6.8%, respectively. The early complication rate (< 30 d) was 6.25% (8/128), with 5 minor and 3 major complications. Late complications (> 30 d) occurred in 10.9% (14/128), of whom 2 were minor and 12 were major complications. The overall re-operation rate was 11.7% (15/128).

CONCLUSIONS

At 5-year follow-up, laparoscopic SAGB is a safe and effective surgical treatment for morbid obesity. Our results appear to confirm that SAGB is a safer surgical treatment regarding rate and severity of complications compared with gastric bypass and malabsorptive procedures.

Retrospective study of laparascopic adjustable silicone gastric banding for the treatment of morbid obesity: results and complications in 127 patients

OBJECTIVES

Laparoscopic gastric banding is currently the most popular surgical technique for morbId obesity. This wIdespread use of surgery has been evaluated by a number of clinical studies, particularly on weight change.

METHODS

In a retrospective study of 127 obese patients operated between 1996 and 2000, data were collected for weight change, medical and surgical complications.

RESULTS

Of 127 patients, failures of gastric banding were noted during 2 surgical operations. The average follow-up period was 33 +/- 20 Months. Average weight loss in all patients was 19.9 +/- 5.3 kg (15.3 +/- 4.2%). No difference in weight loss was observed between diabetic and non-diabetic patients. During the follow-up, data were collected on 53 complications (42.4% of all gastric banding operations). 3 main types of complication were found: access port related complications (22.6% of the total), band slippage (20.7% of the total) and tubing related complications (16.9% of the total). No prognostic factor for these complications could be Identified from multivariate analysis.

CONCLUSIONS

Our results are very similar to those of other weight evolution studies. We found that there was a significant incIdence of surgical and medical complications during the follow-up because of the meticulous way all complications were recorded, even the most insignificant. This morbIdity must be borne in mind before surgery is performed.

Evolution of a paradigm for laparoscopic adjustable gastric banding

The first human laparoscopic adjustable gastric banding procedure, using the LAP-BAND device (INAMED Health, Santa Barbara, CA), was performed on September 1, 1993. Because of its minimal invasiveness, reversibility, and adjustability, it is considered a breakthrough in bariatric surgery. Placement of the LAP-BAND is the least invasive operative procedure that can be offered to patients with morbid obesity. The technique has evolved since it was first performed on humans. This evolution mainly concerns the band's position in relation to the gastric wall, which necessitated modifying the posterior dissection for band passage and placement. These technical changes have been aimed at reducing morbidity, especially the major complication, prolapse/slippage or pouch dilatation above the band. Based on personal experience and a review of the literature, the authors describe how the surgical technique has developed since the introduction of the LAP-BAND. The advantages of the LAP-BAND have contributed to its increasing use throughout the world. The authors believe that the approach represents a paradigm shift in bariatric surgery.