Laparoscopic adjustable silicone gastric banding

Laparoscopic adjustable silicone gastric banding (LASGB) is a relatively new surgical procedure for the treatment of morbid obesity The most popular banding procedure is the vertical banded gastroplasty, however, there are risks involved in this procedure, including staple-line disruption and postoperative intractable vomiting. This article presents the advantages of using the LASGB device over former types of gastric banding.     

腹腔镜可调节性胃束带术治疗病态肥胖症的近期疗效

目的 了解腹腔镜可调节性胃束带术(laparoscopic adjustable gastric banding,LAGB)治疗病态肥胖症及伴发病的近期疗效. 方法 2006年10月至2007年12月,对50例病态肥胖症患者(其中伴发2型糖尿病11例、高血压3例、血脂异常15例、脂肪肝28例、睡眠呼吸暂停综合征1例和胆囊结石2例)行LAGB治疗,术后随访6～18个月,平均11.2个月,观察减重效果、伴发病变化及并发症发生情况.结果 术后9个月、12个月和18个月平均体质量指数由术前(39±6)ks/m2分别降至(31±4)kg/m2、(28±7)kg/m2和(27±7)kg/m2(P＜0.05);术后平均超重体重减重百分比分别为30%±11%、42%±13%和45%±13%;术后12个月和18个月超重体重减重百分比＞50%的人数分别达到20%和44%,66%～100%的患者术后12个月和18个月其肥胖相关伴发疾病得到完全缓解或好转.术后发生并发症4例,其中3例经保守治疗、1例经再次手术治疗痊愈.结论 LAGB是一种安全、有效和可行的治疗肥胖症及其相关伴发疾病的方法.     

Laparoscopic adjustable silicone gastric banding: complications

Laparoscopic adjustable gastric banding is a procedure that is now approved by the Federal Drug Administration for use in the United States to treat morbid obesity. Numerous complications can occur as a result of the device. These include both early technical complications as well as long-term problems such as esophageal dilatation and failed weight loss. While improvements in surgical technique may decrease early technical complications such as gastric prolapse, long-term follow-up studies will be required to determine the ultimate success of this device in controlling severe obesity.     

Laparoscopic adjustable gastric banding: surgical technique

Laparoscopic adjustable gastric banding is an effective and safe surgical treatment for morbid obesity. Initial experience with the Lap-Band system (Inamed Health, Santa Barbara, California) in the United States and Australia has demonstrated that surgical technique can affect outcomes in terms of weight loss, quality of life, and complication rates. Placement of the gastric band by means of the perigastric technique is associated with high rates of gastric prolapse, food intolerance, and weight loss failure that frequently lead to band explantation. In the pars flaccida technique, band placement higher on the stomach results in the formation of a smaller pouch and lower rates of gastric prolapse, which may contribute to greater weight loss and improved quality of life. This article describes the technical aspects of the pars flaccida approach in the laparoscopic placement of adjustable gastric bands.     

Laparoscopic adjustable gastric banding in severely obese adolescents

BACKGROUND: Severely obese adolescents are suffering all the consequences well known in adults. A decision was made to offer laparoscopic adjustable gastric band surgery to severely obese adolescents. METHODS: This retrospective study reviewed the outcomes of 41 adolescents aged 12-19 years (mean 15.6 years) who underwent laparoscopic adjustable gastric band surgery. At surgery, their mean weight was 125 +/- 9 kg (range 83-220), and the mean body mass index was 42.4 +/- 8.2 kg/m(2) (range 31-71). The comorbidities included 2 patients with diabetes, 1 with sleep apnea requiring continuous positive airway pressure, 2 with hypertension, and 1 with Perthe's disease of the hip. RESULTS: No operative or 60-day morbidity or mortality occurred. One patient was lost to follow-up, but returned at 3 years. The mean follow-up was 33.8 +/- 19 months (range 1-70). Eighteen patients have had a Lap-Band for at least 3 years. Compliance was excellent, with 12.2 visits per child (range 7-22) at 2 years. At 3 years, the mean body mass index had decreased to 29 +/- 6 kg/m(2) (range 23-47), which was maintained at 5 years. Of the 41 adolescents, 83% were no longer obese, with a BMI <30 kg/m(2). The estimated weight loss was 70% +/- 21% (range 37-101%) and was maintained at 5 years. CONCLUSION: Laparoscopic adjustable gastric band surgery is a valid option for the care of severely obese adolescents.     

Laparoscopic adjustable gastric banding: 1,014 consecutive cases

BACKGROUND: The purpose of this study was to examine 1,014 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 48 months of followup, including evolution and changes in surgical technique, learning curve issues, weight loss outcomes, and complications. STUDY DESIGN: Between October 2000 and December 2004, 1,014 consecutive patients (81.8% women, mean age 42.3 years, mean body mass index 47.7 +/- 8.6 kg/m(2)) underwent LAGB operation at our center. Perigastric dissection was used in the first 44 patients; pars flaccida technique was used for the latter 970 patients. Fluoroscopy-guided adjustments were performed and patients received intensive followup. RESULTS: Excess weight loss at 12, 24, 36, and 48 months was 40.5 +/- 17%, 52.9 +/- 19.5%, 62 +/- 20.9%, and 64.3 +/- 19%, respectively, with data available in > 85% of patients who had reached each of the time intervals. Patients with lower preoperative body mass index had higher excess weight loss initially, but this difference was not apparent at 3 and 4 years' followup. At 36 and 48 months, respectively, 73.5% and 75% of patients had > 50% excess weight loss. Perigastric dissection led to 9 of 44 (20.5%) slippages, compared with 14 of 970 (1.4%) with pars flaccida technique. Other complications included 2 erosions (0.2%), 5 tubing breaks (0.5%), 7 access port problems (0.7%), and 14 acute stoma obstructions (1.4%). Eight (0.8%) bands were explanted. No deaths occurred. CONCLUSIONS: LAGB can achieve effective and safe weight loss. Change from perigastric to pars flaccida technique reduced slippage rate. Preoperative body mass index alone was not found to be a predictor of effective weight loss in the longterm.     

Laparoscopic adjustable gastric banding: evolving clinical experience

Laparoscopic adjustable gastric banding (LAGB) was first introduced in the early 1990s as a potentially safe, controllable, and reversible method for achieving significant weight loss in the severely obese. It is timely to review the existing data on this procedure derived from European, Australian, and American studies and compare and contrast their results. Special emphasis is placed on clinical outcomes and reported complications of LAGB. In general, international studies support use of the LAGB procedure,while American studies are generally better designed but more equivocal in their results.     

Laparoscopic adjustable silicone gastric banding for morbid obesity

Background: Laparoscopic adjustable silicone gastric banding (LASGB) was used as the initial bariatric procedure for more than 36 months. The efficacy and safety of LASGB were studied. Methods: Patients were followed up prospectively in a multidisciplinary center for the perioperative and long-term courses, and for complications. Results: Between November 1996 and May 1999, 715 patients underwent surgery. The mean age was 34.6 years (range, 16-72) years, and the mean body mass index (BMI) was 43.1 kg/m2 (range, 35-66 kg/m2). The mean operative time was 78 min (range, 36-165 min), and the postoperative hospitalization time was 1.2 days (range, 1-8 days). There were six intraoperative complications (0.8%), eight early postoperative complications (1.1%), and no deaths. For follow-up evaluation, 614 patients (86%) were available. Late complications included band slippage or pouch dilation in 53 patients (7.4%), band erosion in 3 patients, and port complications in 18 patients. In 57(7.9%) patients, 69 major reoperations were performed. In patients with a follow-up period longer than 24 months, the average BMI dropped from 43.3 kg/m2 (range, 35-66 kg/m2) to 32.1 kg/m2 (range, 21-45 kg/m2). Conclusion: Laparoscopic adjustable silicone gastric banding is safe, with a lower complication rate than any other bariatric procedure. Most reoperations can be performed laparoscopically with low morbidity and short hospitalizations. On the basis of intermediate-term follow-up evaluation, it is an effective procedure for weight-reducing purposes.     

Laparoscopic adjustable gastric banding: initial Tasmanian experience

Background: The laparoscopic adjustable gastric band (LAGB) is a minimally invasive, adjustable and reversible bariatric pro­cedure. The present paper reports an initial 2 year experience at Royal Hobart Hospital, Tasmania. Methods: Between February 1999 and June 2001, 207 patients underwent LAGB insertion (176 female, 31 male). The mean age was 43 years (range: 16?74 years). Mean preoperative weight was 125 kg (range: 83?210 kg) and mean body mass index (BMI) was 45.9 (range: 32.6?67.0). The Bioenterics LAGB (Inamed, Chullora, NSW, Australia) was used in all cases. The average follow up was 17 months (range: 3?24 months). Three patients were lost to follow up (1.5%). Results: The average weight loss was 12.4 kg at 3 months, 25.3 kg at 1 year and 34.8 kg at 2 years. The average BMI was reduced from 45.9 preoperatively to 41.3 at 3 months, 36.9 at 1 year and 33.5 at 2 years. Reoperation for band slippage occurred in 24 patients (11%), and the injection reservoir required changes in 22 patients (11%). There were three perforations while inserting the LAGB, two non‐fatal pulmonary emboli (1%) and two cases of deep vein thrombosis (1%). There has been no mortality. Conclusions: Laparoscopic adjustable gastric banding is a safe and effective method of achieving significant (P < 0.0001) weight reduction in the morbidly obese.     

腹腔镜可调节捆扎带胃减容术治疗单纯重度肥胖症的临床应用

目的评价腹腔镜可调节捆扎带胃减容术(laparoscopicadjustablegastricbanding,LAGB)治疗单纯重度肥胖症的效果。方法对15例病态肥胖患者(平均年龄28岁,体重指数平均33.7kg/m2)施行LAGB,并观察其初步疗效。结果LAGB手术时间65～185(平均100)min,出血量10～60(平均29)ml。15例患者无手术死亡,术中、术后均未出现并发症。术后15例均获得25～43(平均31)周的随访,并根据需要调节捆扎带、控制减重速度。全组患者减重10.5～35.0(平均19.2)kg;无营养不良症状出现。结论LAGB治疗单纯重度肥胖症具有微创、安全等特点,近期减重效果满意,但其远期疗效仍需进一步观察。     

Laparoscopic gastroplasty (adjustable silicone gastric banding)

Until now, for treatment of morbid obesity in the long term, surgery remained as the final option. For 40 years, surgeons looked at the best procedure. Among the restrictive procedures (gastroplasty), the laparoscopic adjustable silicone banding is the least invasive surgical treatment of morbid obesity. Between October 1992 and January 1998, we performed this procedure on 652 patients. Median body mass index was 45 (range, 35-65). Median hospital stay was 3 days (range, 2-10 days). The mean operative time was 80 minutes (range, 40-240 minutes). Four patients (0.6%) presented early complications: bleeding (1 patient), gastric perforation (2 patients), and pneumonia (1 patient). Forty-seven (7.2%) patients presented late complications and needed to be reoperated. There is one case of mortality. Loss of mass body weight was 62% in 2 years. According to these results, laparoscopic adjustable silicone gastric banding seems to be a safe and efficient technique.     

Laparoscopic adjustable gastric banding in adolescents: short-term results

Purpose

Children and adolescents who fail to lose weight through diet and exercise programs have been offered weight loss surgery for several years. We report our early results on laparoscopic adjustable gastric banding (LAGB) in 100 teenagers.

Methods

Candidates for surgery underwent rigorous assessment for medical eligibility, compliance, and psychological well-being. Patients who met criteria and were approved by our team were offered LAGB. Postoperatively, patients were followed monthly until steady weight loss was achieved, then every 3 months thereafter.

Results

One hundred patients aged 14 to 19 years underwent LAGB. Preoperative average weight was 136.7 kg, and median body mass index was 48.7. Comorbid medical conditions were common. Five reoperations were performed for port site bleeding, hiatal hernia repair, possible intestinal obstruction, and port slippage. Eighty-seven patients were followed for a minimum of 6 months. Average weight loss at 6 months was 12.4 (range, 33.2 to 16.2) kg, and average change in body mass index was 4.4 (range, 11.8 to −5.6).

Conclusion

Laparoscopic adjustable gastric banding may be performed safely in adolescents, and short-term results suggest that LAGB may serve as an important tool to help them lose weight.     

Laparoscopic adjustable gastric banding in adolescent: safety and efficacy

Background

Obesity prevalence is rapidly increasing among children and adolescents worldwide. It is considered one of the most alarming public health issues facing the world today. The adult experience has demonstrated that surgery is the only effective means of achieving persistent weight loss in obese patients. However, little is known about bariatric surgery in children and adolescents. The aim of this study is to evaluate the safety and efficacy of laparoscopic adjustable gastric banding (LAGB) in this group of patients.

Methods

A retrospective review included all children and adolescents who underwent LAGB from January 2003 to December 2005.

Results

Fifty-one patients underwent LAGB. The mean age was 16.8 years (range, 9-19), and the mean body mass index was 49.9 kg/m² (range, 38-63). Mean excess weight loss was 42% at 6 months and 60% at 1 year follow-up. The most prevalent comorbidities were obstructive sleep apnea, limited physical activities, hypertension, and diabetes mellitus. Band adjustments were performed under fluoroscopic guidance in 5 patients and direct access as a clinic procedure in the remaining. One patient required port repositioning under fluoroscopic guidance. The mean follow-up was 16 months (range, 3-34). There was no mortality or significant postoperative complications.

Conclusion

The absence of significant nutritional deficiency, the continued adjustability, and potential reversibility of LAGB make it the safest, least invasive, and most effective bariatric surgery that can be offered to the young and adolescent population.     

Laparoscopic adjustable gastric banding in treatment of patients with obesity

Laparoscopic adjustable gastric banding (LAGB) has been fulfilled in 2958 patients in the period since 1998 through 2006 for treatment of different forms of obesity. The age of the patients was from 16 to 60 years (mean age 38 years). There were 80% of women (2366) and 20% of men (592). Mean preoperative body mass index was from 35 to 54 kg/m2, i.e 43+/-3.8 kg/m2, fluctuating from 35 kg/m2 to 54 kg/m2.The observation of 2485 (84%) patients operated in the terms in question showed the influence of LAGB on metabolic derangement, arterial pressure. Statistical data on possible early and late postoperative complications are presented. The operation of LAGB is one of minimally invasive methods for adjustable decreasing the excess body weight and its effectiveness exceeds other methods of restrictive interventions on the stomach, has a number of advantages compared with other bariatric interventions, it is relatively safe and completely reversible bariatric operation with all advantages of minimally invasive techniques.     

Laparoscopic adjustable gastric banding: essential role of psychological support

Background: A follow-up study of laparoscopic adjustable gastric banding (LAGB) in morbidly obese patients was conducted, with special emphasis on psychological aspects. Materials and Methods: 128 patients (98/30 females/males) underwent LAGB between October 1995 and March 2001. Age was 38±9 years, body mass index (BMI) 42.72±4.25 kg/m² and body weight 124±25 kg (mean±SD). Weight loss, early and late complications, band calibrations and difference between patients with and without psychotherapy were analysed. Psychological status was investigated before and during LAGB treatment using MMPI. Quality of life was investigated using MOS SF36. Results: Median BMI decreased from 42.7 preoperatively to 31.0 kg/m² after 12 months. Reduction of BMI was already significant (P<0.01) after 3 months. In the following 12 months, median BMI wavered between 31.0 and 29.5 kg/m². Best results were achieved in patients who followed psychotherapy. Conclusion: LAGB gave therapeutic success (progressive and significant weight loss). Psychotherapy was not only a simple support to diet but also an important part of the multidiscipline treatment. For best results, the team must care for patients individually and not just follow the same fixed protocol.