To Band or Not to Band—Early Results of Banded Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) is the procedure with the fastest growing numbers worldwide. Although excellent weight loss can be achieved, one major obstacle of LSG is weight regain due to sleeve dilatation. Banded sleeve gastrectomy (BLSG) has been described as an option to counteract sleeve dilatation and ameliorate weight loss over time. In a retrospective study, we analysed 25 patients who underwent BLSG using a MiniMizer® ring. Twenty five patients who had previously undergone a conventional LSG were selected for matched-pair analysis. Patient follow-up was 12 months in both groups. Mean preoperative BMI was 56.1?±?7.2 kg/m² for BLSG and 57.0?±?6.3 kg/m² for LSG, P?=?0.522. Operative time was significantly shorter for BLSG (53?±?27 min vs. 68?±?20 min, P?=?0.0025). Excess weight loss (%EWL) was equal in both groups with %EWL at 12 months of 58.0?±?14.6 % for BSLG patients vs. 58.4?±?19.2 % for LSG patients. There was no procedure-related mortality in either group. At 12 months postoperative, vomiting was significantly increased in BSLG patients (OR 6.75, P?=?0.035). New onset reflux was equal in both groups (OR 0.67, P?=?0.469). Ring implantation does not increase the duration of surgery or early surgical complications. Weight loss in the first follow-up year is not influenced, but the incidence of vomiting is raised after 12 months when patients start to increase eating volume.     

Perioperative Comparison of the MiniMizer ® Extra Band with the Other Laparoscopic Gastric Bands

Background: Laparoscopic adjustable gastric banding is a widely used operation for morbid obesity. The most frequent complications of this operation are band migration and pouch dilatation (slippage). The use of the newly introduced MiniMizer^? Extra band with a unique gastric wall fixation system and a two-degree closure may decrease the postoperative complication rate. Very early (perioperative) results are hereby reported. Methods: From February 2005 through October 2005, 50 classical bands (Obtech-Ethicon, AMI, Midband, Inamed) and 10 MiniMizer^? Extra bands were inserted in our department. Bands were chosen randomly. Complications in the very early postoperative period were studied. Results: No statistically significant differences between surgery times were noted – classical bands mean 36 min (20-60), and MiniMizer^? Extra bands mean 34 min (25-55). No statistically different rates of perioperative complications were noted, with only 2 very minor intraoperative complications in the entire series. Conclusions: The absence of problems in the perioperative period allows the use of the MiniMizer^? Extra band as an alternative to classical bands for short- and long-term comparison.     

Congratulations to the publication of CJIIT

It is my great pleasure and honor to give my congratulations to the publication of Chinese Journal of Interventional Imaging and Therapy. I have always been greatly impressed by the recent rapid progress in the economy of China. The role of the Chinese Government in the political world has become greater and greater. There is no doubt that China will become one of the most influential nations in the medical world also, in particular in the field of interventional imaging and therapy. My personal interest is how the traditional Chinese medicine becomes harmonized with the modern western medicine.     

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.     

A Rodent Model of Adjustable Gastric Band Surgery—Implications for the Understanding of Underlying Mechanisms

Background  Bariatric surgery is currently the only anti-obesity therapy that can deliver weight loss of up to 20–30% of body weight. Laparoscopic adjustable gastric banding (LAGB) and Roux-en-y gastric bypass are the most commonly performed of these surgeries. The mechanisms by which LAGB initiates an increase in satiety remain completely unknown. The aim of this study is to establish a rodent model of adjustable gastric banding (AGB) that will enable investigation of these mechanisms. Methods  Sprague–Dawley rats were implanted with adjustable gastric bands immediately below the gastro-esophageal junction around the glandular stomach. This band, as in humans, can be inflated via an exteriorized port resulting in an incremental impact on the stomach. Results  Rats with an incremental inflation of the AGB showed a clear stepwise reduction in food intake and body weight. Normal food intake and body weight gain were restored with band deflation. Barium-assisted X-ray of the stomach showed the formation of a small gastric pouch proximal to the inflated band in a manner analogous to the human LAGB. Conclusions  This is the first animal model of the AGB that allows incremental inflation for optimal tightening of the band in the conscious animal with corresponding effects on food intake and body weight. This model will allow measurement of acute and chronic neural and hormonal changes following activation of the band in the conscious animal and will provide the potential to inform and improve surgical approaches that are at the forefront of obesity treatments.     

Does the fabella contribute to the reinforcement of the posterolateral corner of the knee by inducing the development of associated ligaments?

The fabellofibular (FF) and arcuate ligaments are closely colocated at the posterolateral corner of the knee. However, a bony fabella is often absent in Japanese subjects. We investigated these structures morphometrically using 212 knees. A thick FF ligament was found in 38.1% (40/105) of knees with a hard fabella. When identified histologically, a bony fabella accompanied a thick FF in 82.8% (24/29). Conversely, a thin or indefinite FF ligament and an elastic-textured fabella co-existed in 77.9% (60/70) of knees. There were no strong correlations between the morphology of the fabella and the arcuate ligament. Thus, a hard or bony fabella seemed to relate to thickening of the FF ligament. In contrast, the thicknesses of the FF and arcuate ligaments were negatively correlated. When the FF ligament was more than 5mm thick, indicating that it was as strong as the lateral collateral ligament, no arcuate ligament could be identified. Conversely, a thin or indefinite FF ligament often accompanied a well-developed arcuate ligament (61.9%, 96/155). Our observations suggest that these ligaments act in a complementary manner to stabilize the posterolateral corner. A possible common function is fixation of the popliteal tendon on the joint capsule and lateral meniscus, rather than direct stabilization against rotation stress.     

Adjustments and Leak Detection of the Adjustable Silicone Gastric Band (ASGB) and Lap-Band™ Adjustable Gastric Band (LAGB) System

Background: The detection of a leakage in the system of the adjustable silicone gastric band (ASGB) may be difficult. Gastrografin injection into the port should be avoided because it acts like a glue and blocks the system. Methods: A syringe containing saline and a syringe containing Thallium-201 chloride is connected to the 4-way stopcock which is connected to the needle. The needle is pushed into the port. The position is confirmed by injection and aspiration of saline. 2 ml of TL-201 chloride (74 MBp) is injected to locate the leakage in the system with planar images with a gamma camera (Elscint SP 6), 30 min, 2, 3, and 24 h after injection. Results: The original ASGB was provided with an injection reservoir which, in our series, was found to be leaking in four cases (3%). Conclusions: Our technique for adjustments and leak detection appears to be simple and effective. Band-related problems such as reservoir leak should disappear with improvement of the material.     

How to maintain the quality of laparoscopic surgery in the era of lack of hands?

Lack of personnel in the operating rooms is not a future problem, it is today's reality in many hospitals throughout the OECD countries. As studies anticipate that this situation will not change overnight (1), the issue of the quality of surgery within this new environment needs to be addressed on short notice. The problem is even more critical for laparoscopic surgeons, who have enjoyed proportionally more assistance since the emergence of minimally invasive surgery. After analyzing the tasks performed by OR assistants and nurses, we have looked at available techniques and tools (2) that could help laparoscopic surgeons, using the following criteria to assess their benefits : capability to address the shortage of assistance, impact on quality of surgery, economic affordability within the existing Belgian healthcare system.     

The foreword to the Chinese Journal of Traumatology

Today marks the birthday of Chinese Journal of Trau-matology(English Edition),which is the first English lan-guage publication on trauma in China.This is an occasionfor trauma researchers to celebrate.     

Is neoadjuvant therapy the answer to adenocarcinoma of the esophagus?

The conflicting results of randomized studies have led to confusion over the proper management of patients with esophageal adenocarcinoma. Although there is no firm evidence that neoadjuvant chemoradiation improves survival, because of the shortcomings of these trials, this method of treatment is practiced at many centers. Without the results of another multiinstitutional randomized trial, the true answer may never be known.