Partnership, sexuality, and sexual disorders in morbidly obese women: consequences of weight loss after gastric banding

Background: A study was performed to determine what consequences surgery for morbid obesity has on sexual attitudes and partnership in obese female patients. Method: Semi-structured interviews concerning sociodemographic data, sexuality and relationship were conducted on 82 female patients preoperatively and at least 1 year postoperatively. Results: Physical appearance played the main role in the decision to undergo weight reduction surgery in only 17% of the study patients. Postoperatively, half of the patients were satisfied with their physical appearance 1 year after surgery, the other half not. Preoperatively, 44% of the patients stated that sexuality with their partners was satisfying and the frequency of sexual intercourse was regular. Postoperatively, 63% of the patients stated that they enjoyed sex more, compared with 12% of the patients who enjoyed sex less than before surgery. Postoperatively, 20% of the patients reported that partnership had changed positively, 10% negatively. Conclusions: The results indicate that many of the sexual problems in obese individuals are the result of an underlying lack of self-esteem, unsatisfactory relationships, or collective stigmatization of obese individuals. Binge eating, often found in morbidly obese patients, seems to be less the result of or compensation for sexual problems but is more likely to stem from other psychosocial or psychological problems.     

Laparoscopic adjustable gastric banding: a prospective comparison of two commonly used bands

Background: Surgery for morbid obesity has increased since the introduction of the adjustable gastric bands (AGB), which can be placed laparoscopically. There are two AGB in wide use: the Swedish Adjustable Gastric Band (SAGB, Obtech), and the Lap-Band? (Inamed Health). We present the results of a comparative study between the 2 AGB. Methods: 101 patients with a minimal follow-up of 6 months were included. 49 patients received a Swedish Adjustable Gastric Band (SAGB), and the remaining 52 received the Lap-Band? (LB). Postoperative weight loss and complications were compared at set intervals of 3 months in the first postoperative year, and 6 months in the years following. Results: Mean follow-up was 9.9 months for the SAGB and 7.2 months for the LB. All but 5 procedures were performed laparoscopically. Mean operating-time was 102 minutes for the SAGB and 86 minutes for the LB. No significant difference in complications was noted between the 2 AGB. 1 SAGB was repositioned and 2 were removed, compared to 2 repositions and 2 removals of the LB.We excluded 5 patients with leakage of a SAGB due to technical failure. Mean preoperative weight kg/BMI of the SAGB patients was 133/45.3; in the LB patients 138/46.4. Mean weight loss at 6 months was 28 kg with the SAGB and 30 kg with the LB, and mean weight loss at 1 year 36 kg and 38 kg respectively. After 2 years, weight loss was 46 kg and 42 kg respectively. Conclusion:There was no significant difference in postoperative weight loss and complications between the SAGB and the LB.     

The Swedish Adjustable Gastric Band: Laparoscopic Technique and Preliminary Results

Background: The laparoscopic technique for the Swedish Adjustable Gastric Band (SAGB) has been developed based on the previously established open technique. Methods: From March 1996-June 1997, laparoscopic SAGB was attempted in 85 consecutive obese patients (77 women and 8 men). The average preoperative BMI was 44 (34-59). Results: All operations except one were completed by laparoscopy. One patient had to be converted because of unfavorable anatomic conditions. The average operating time was 40 minutes.There were no immediate perioperative complications. All patients were followed for 1 year. During this period 2 patients developed esophagitis and 3 patients experienced repeated vomiting. There were no other complications. At 1 year follow-up the average BMI was 33 (21-46).The excess weight loss was 54% (17-100%). Conclusion: Early results are encouraging. No significant complications related to the technique were registered. One-year weight loss was equal to what was achieved by open surgery. Laparoscopic SAGB will be established as an attractive alternative for surgical treatment of morbid obesity.     

Dermalipectomy for Body Contouring after Bariatric Surgery in Aegean Region of Turkey

Background: The only proven effective long-term treatment for morbid obesity is bariatric surgery. After surgery, additional problems may arise such as redundant hanging skin and a poor body image. The patient's quality of life and social acceptance may thus still be hindered. Body contouring operations remain the only hope here. Methods: Body contouring surgery was performed on 11 patients out of 38 who had had vertical banded gastroplasty. General self-consciousness, social self-consciousness of appearance and sexual and bodily self-consciousness of appearance were measured with a retrospective questionnaire. Results: Timing of body contouring surgery was determined according to the demand of the patient and stabilization of the patient's weight status. On average the first plastic surgery operation was performed after 17 (12-25) months. Mean age was 37.4 (34-65) and mean excess weight loss was 57.6 (37-129). In the 11 patients who underwent plastic procedures, a total of 23 such operations were performed, and 8 complications were encountered in these 23 operations. General self-consciousness and sexual bodily self-consciousness of appearance showed improvement after bariatric surgery and further improvement after the plastic surgery. Conclusion: For markedly redundant skin after massive weight loss, dermalipectomy is the only treatment. This improves the patient's general, sexual and bodily self-consciousness.     

A 6-year experience with the Swedish adjustable gastric band

Background In morbid obesity conservative therapy often fails to reduce overweight permanently. As a consequence, several bariatric surgical procedures have been developed to achieve permanent excess weight loss. Among these, the laparoscopic restrictive procedures seem to be the least invasive. The aim of this prospective study was to assess and analyze the effects, complications, and outcomes after the implantation of the Swedish adjustable gastric band (SAGB) in long-term follow-up.Methods All consecutive patients with implantation of a SAGB between August 1996 and August 2002 were prospectively investigated. The placement of the SAGB was done by laparoscopy in all cases. Success was rated by the reduction of body mass index (BMI) excess weight loss (EWL), and reduction of comorbidities. Nonresponders to SAGB were defined as <30% EWL after a 3-year follow-up. Band-related complications were recorded and classified. Patients outcome was assessed after 6 months and subsequently each year postoperatively.Results A total of 190 patients received a SAGB, 97% of whom could be followed up with a mean follow-up period of 39.4 months (duration of follow-up, 6–72). During follow-up, a significant reduction or improvement of BMI, EWL, and comorbidities were found. Nineteen percent of patients were identified as nonresponders. Early intraoperative and postoperative complications related to SAGB were one perforation of the gastric fundus (0.5%), one conversion (0.5%), one bleeding (0.5%), and two band infections (1.1%). The SAGB-related complications encountered during long-term follow-up were three port problems (1.6%), four band migrations (2.1%), five slipping/pouch dilatations (2.6%), and two band leakages (1.1%). All intra- and postoperative SAGB-related complications accounted for a total morbidity of 10.5%. Operative mortality was 0%. The overall reoperation rate was 8.5%.Conclusions In long-term follow-up, SAGB is safe and effective. Our results demonstrate a significant EWL of 50% during the first 24 months. However, patient selection has to be improved to reduce the nonresponder rate. SAGB leads to a significant reduction of obesity-related comorbidities. SAGB is an attractive alternative in the surgical treatment of morbid obesity.     

Quality of Life following Laparoscopic Adjustable Gastric Banding – the Swedish Band and the Moorehead-Ardelt Questionnaire

Background: Although weight loss is an important immediate outcome after gastric banding operations, quality of life (QOL) has been shown to be an equally important outcome measure. Methods: From 1996 to May 2002, 125 consecutive patients have been operated laparoscopically for morbid obesity at our institution with the Swedish Adjustable Gastric Band (SAGB). We compared the Moorehead-Ardelt QOL scores of the first 60 patients, operated at a median of 2 years earlier, with a group consisting of the following consecutive 65 patients, who answered the questionnaire preoperatively. Results: The QOL scores among the operated patients were significantly better (P<0.0001, unpaired t-test) on all domains of the Moorehead-Ardelt questionnaire compared to those not yet operated. Conclusions: Laparoscopic banding with the SAGB has been a safe procedure, with satisfactory weight loss and significant improvement in QOL scores 2 years postoperatively.     

Assessment of the Outcome of Laparoscopic Nonadjustable Gastric Banding and Stoma Adjustable Gastric Banding: Surgeon's and Patient's View

Background: The results of nonadjustable gastric banding (NAGB) and stoma adjustable gastric banding (SAGB) in the treatment of morbid obesity are compared. Of 300 patients operated laparoscopically with NAGB since 1993 and of 25 with SAGB since 1994, 65 in the NAGB and 11 in the SAGB group were available for a 3-year follow-up study. Methods: For assessment of the outcome of our laparoscopic approach in terms of weight loss, length of hospitalization, immediate and late postoperative wound complications, postoperative changes in the band and pouch area, were compared in patients from both groups. The patient's opinion on the outcome of the operation and the quality of postoperative digestion was recorded. Results: There was no significant difference in the length of hospital stay and wound complication rate in the two groups or the weight loss at 36 months after surgery. There was a statistically significant lower incidence of postoperative food intolerance and vomiting and a lower rate of immediate and long-term reoperation rate in the SAGB group. Conclusion: SAGB is a method with less postoperative complications in food intolerance and vomiting in comparison with NAGB.     

Laparoscopic Silicone Adjustable Gastric Band; Initial Experience in Finland

Background: The Swedish adjustable gastric band (SAGB) was introduced in 1985 and rapidly gained popularity.Today more than 21,000 gastric banding procedures have been performed in Europe. The reported results of gastric banding operations are mainly good, although the method is not without controversies and risks. We report here our initial experience with the SAGB. Methods: 60 patients (44 women, 16 men) were treated surgically for morbid obesity between the years 1996 and 1999, with SAGB. Median age of the patients was 44 years (range 21-64) and preoperative median Body Mass Index (BMI, kg/m2) was 45 (range 35-55). 3 patients were operated by an open approach, and the remaining 57 laparoscopically. Results:Operative time was 62-206 minutes (median 97 minutes). Only one operation was converted to open approach (1.8%), due to extensive adhesions. No intraoperative complications occurred. At 1 year follow-up, mean weight loss was 30 kg, mean excess weight loss was 50%, and median BMI was 35. 4 patients have been reoperated so far (6.7%) due to slippage of the band (2 patients), infection of the band (1 patient), and leaking of the filling system (1 patient). Median postoperative hospital stay was 3 days (range 2-53). Mortality was 0%. Immediate postoperative mor- bidity-rate was 12% (7/60), although serious morbidity occurred in only 1 patient (1.7%). Conclusions: Laparoscopically placed adjustable gastric band is a good option for the morbidly obese patient.     

Leakage of Adjustable Gastric Bands

Background: Surgery for morbid obesity has increased since the introduction of the adjustable gastric bands. Their advantage is the adjustability of the band, which can be inflated or deflated percutaneously according to weight loss without altering the anatomy of the stomach. We present 5 cases of leakage of the Swedish adjustable gastric band (SAGB) as a result of tearing of the balloon. Methods: In our series, 29 patients received an SAGB; the remaining 20 received the LapBand?. All but 4 procedures were performed laparoscopically. The adjustable gastric band (AGB) was inflated according to passage seen on gastro-esophagogram. According to weight loss or complaints of passage, the gastro-esophagogram was repeated, and the AGB was inflated or deflated. Results: No major complications were observed postoperatively. All but 5 patients showed weight loss and restriction of food intake after filling of the AGB. These 5 patients had all received an SAGB. High-pressure filling with contrast medium showed leakage of the SAGB. After removal the SAGB, 4 showed a tear at the site of fixation of the balloon to the band, and 1 showed a puncture of the balloon. The tears most probably occurred as a result of inadequate fixation while the SAGB was positioned around the stomach. Conclusion: To our knowledge, this complication has not been described before. The manufacturer of the SAGB has been notified, and consequently the fixation site has been reinforced.     

Treatment of Morbid Obesity with Adjustable Gastric Band: Preliminary Report

Background: The goal of surgery for morbid obesity is to achieve a good and durable loss of weight and improve health. Previous studies have demonstrated a significant weight loss for the Swedish adjustable gastric band (SAGB). Patients and Methods: Between November 1996 and April 1998, 18 morbidly obese patients underwent SAGB laparoscopically. Their mean age at surgery was 35 years. The mean preoperative weight was 128 kg (range 89-163), and the mean body mass index was 50.4 ± 9. Comorbidity was present in 13 patients. Results: One gastric perforation occurred, and in one patient it was not possible to create the pneumoperitoneum. Regarding late morbidity, one intragastric migration and one slippage of the band occurred. There was no mortality. Conclusion: The low morbidity, the good results with weight loss, and the improvement in comorbidity lead the authors to believe that Swedish adjustable gastric banding for the treatment of morbidly obese patients is a successful means of losing weight and improving general health.