Two Cases of Conversion of Vertical Ring Gastroplasty to Adjustable Silicone Gastric Banding

Background: Since May 1995, we have used laparoscopic adjustable silicone gastric banding (ASGB) as an alternative to silastic ring vertical gastroplasty (SRVG) to treat morbid obesity. Moreover, it seemed that ASGB was an appropriate procedure to use when SRVG had failed and no alternative procedure could be attempted again, which occurred in two patients. Because of adhesions, the laparoscopic approach was inappropriate in both cases. The size of the pouch and the staple-line were not obstacles to ASGB. Methods: Case 1 was a 53-year-old woman of 111 kg (BMI = 46) who had SRVG in July 1994. One year later, she had a 54 kg weight loss, but had continuing food intolerance, although malfunction of the pouch or ring could not be found. A removal of the ring was performed in October 1995, and a 10cm diameter silicone band placed. The band was not inflated until she had regained weight 5 months later. Case 2 was a 33-year-old woman of 100 kg (BMI = 40) who had SRVG in March 1994. Weight loss was 45 kg 18 months later; then she gained weight. Endoscopy and barium swallow showed both staple-line disruption and band erosion. Removal of the ring was performed in March 1996, and a 9.75-cm diameter silicone band placed, and inflated at the same time with 2 cc saline. Results: Both patients are doing well. Conclusions: ASGB appeared to be the best alternative when revising an SRVG in cases where a new stapling or the placement of a new ring could have had consequences more serious than the primary complications.     

The role of early radiological studies after gastric bariatric surgery

Background: The authors investigated early radiological findings after gastric surgery for morbid obesity to evaluate their usefulness in avoiding complications or facilitating treatment. Material and Methods: 413 patients underwent gastric bariatric surgery: 327 had vertical banded gastroplasty (VBG), 55 Roux-en-Y gastric bypass (RYGBP), 22 adjustable silicone gastric banding (ASGB), and 9 biliopancreatic diversion (BPD). A radiological upper gastrointestinal investigation employing water-soluble contrast medium was perform ed in each patient between the 2nd and 8th postoperative day. Several techniques were employed to assess different radiological findings related to the anatomic modifications after the bariatric surgery. Results: In VBGs, delayed emptying was found in 10 patients (3%), gastric leak in 3 patients (0.9%), vertical suture breakdown in 1 patient (0.3%), and a wide pouch in 4 patients (1.2%). In RYGBP, a leak was detected in 2 patients (3.6%), delayed emptying in 2 (3.6%), and a wide pouch in 5 (9.1%). ASGB required band enlargement for stomal stenosis in 6 patients (27.2%). Temporary delayed emptying from stomal stenosis was also observed in 2 BPDs (22.2%). Overall complications were 35/413 (8.2%). Two cases of gastric leak after VBG were reoperated. Stomal stenosis after ASGB was treated by percutaneous band deflation; other cases were medically treated until complete healing. Conclusions: Early radiological study after gastric bariatric surgery is advisable, since it detected post operative complications (gastric perforation, stomal stenosis, etc.) and modified the clinical approach. As the interpretation of these radiographs is often difficult, involving different projections or patient's positions or other technical managements, surgeons and radiologists must interact and be knowledgable.     

Use of Adjustable Silicone Gastric Banding for Revision of Failed Gastric Bariatric Operations

Background: Revision of gastric bariatric operations is sometimes technically difficult and may fail to achieve prolonged weight reduction. The use of the adjustable silicone gastric banding (ASGB) offers a new approach for these revisions. Methods: ASGB was performed as a revisional procedure on 37 patients whose initial bariatric operations were as follows: silastic ring vertical gastroplasty (21), gastric bypass (12), horizontal gastroplasty (3) and vertical banded gastroplasty (1). Results: The length of the procedure varied from 55 to 145 minutes (mean 83 minutes). Intraoperative complications included two fundic tears which were sutured without any postoperative sequelae. Five patients needed reoperation during the first postoperative year due to gastric volvulus (1), tubing tear (1) and development of postoperative ventral hernia (3). BMI fell from 44.8 ± SD 8.07 to 33.4 ± 6.9 kg/m² for patients operated with BMI higher than 35 kg/m² and from 29.2 ± 3.32 to 25.4 ± 2.8 kg/m² for patients operated with BMI lower than 35 kg/m². Conclusions: ASBG can be performed with revisions with an acceptable complication rate and post-operative weight reduction.     

Adjustable Silicone Gastric Banding: A Series with Three Cases of Band Erosion

Background: Among the various operations used for surgical treatment of morbid obesity, adjustable silicone gastric banding (ASGB) is the least invasive. Many good results have been described. During extended follow-up, however, serious complications may occur.We briefly describe our results with ASGB and will focus on three cases of band erosion. Methods: From January 1996 to December 1998, 91 patients underwent laparoscopic adjustable gastric banding in our clinic. Follow-up until now is 100%. Results: Body Mass Index (BMI) in this series decreased from 44.7 at time of operation to 34.8 at 18 months of follow-up (42 patients). Complications, minor and major, occurred in 27.5%. Three patients are described in which the gastric band migrated and had to be removed operatively. Conclusions: Satisfactory weight loss can be established by ASGB. However,serious and potentially lethal complications can occur. In view of the former Angelchik esophageal antireflux prosthesis,abandoned because of its notorious migration, we must be aggressive in evaluating band migration. Thus, we plead for international registration of adjustable silicone gastric banding.     

Biliopancreatic Diversion with Transitory Gastroplasty Preserving Duodenal Bulb: 3 Years Experience

Background: The authors have performed 521 bariatric surgery operations (319 restrictive procedures and 202 malabsorptive procedures). Methods: During the last few years we have introduced an evolution of biliopancreatic diversion (BPD): BPD with transitory gastroplasty, preserving the duodenal bulb (53 cases). From a technical point of view, the operation consists of a BPD, coupled with a gastroplasty which is transitory due to the use of a polydioxanone (PDS) band. In the last few cases, instead of a VBG (with PDS band) in order to make the operation completely reversible without any suture on the stomach, we made a gastric pouch by banding with PDS calibrated with the same tube as for the Lap-band (20 cc). We maintained completely the duodenal bulb (5 cm from the pylorus), making an end-to-side duodeno-ileal isoperistaltic anastomosis. Results: With this anastomosis, only 2% of patients developed an anastomotic ulcer. With this new procedure, results have been good in terms of weight loss (similar to that of BPD-AHS) and in nutritional complications. No patient has had hypoalbuminemia, diarrhea or halitosis. Conclusion: BPD with temporary gastric restriction has provided satisfactory results.     

42-Month Preliminary Follow-up of the Silastic Ring Vertical Banded Gastroplasty

Background: The authors review preliminary experience with silastic ring vertical gastroplasty (SRVG). Methods: Of 202 patients who underwent SRVG, 191 are more than 3 months postoperation and of these 165 were accessible for review. Results: Pouch volume could not be readily measured. The TA90BN stapler was occasionally difficult to apply exactly at the angle of His. There was one subphrenic abscess, one gastric bleed, and one dehiscence. Vomiting occurred in eight patients who required reoperation: ring removal, three; cholecystectomy, one; conversion to vertical banded gastroplasty, one; conversion to Roux-en-Y gastric bypass, three. There was no mortality. Weight loss has been satisfactory to 42 months. Conclusion: SRVG has been a relatively simple operation, with acceptable morbidity and weight loss thus far.     

Adjustable Silicone Gastric Banding vs Vertical Banded Gastroplasty: a comparison of early results

The Kuzmak adjustable silicone gastric band (ASGB; 33 patients) and the vertical banded gastroplasty (VBG; 91 patients) are compared for weight loss, complication rates, and patient satisfaction. The complexity of the two operations is also compared, using operative time, blood loss, and length of hospitalization. When these three parameters were evaluated, the operations were remarkably similar, although a significant percentage of the ASGB patients left the hospital earlier than the VBG patients. The ASGB group of patients lost 52% of their excess weight (34 kg) and the VBG group 63% (40 kg), with the maximum follow-up being 15 months. Mechanical problems (leaks in the system) occurred in four ASGB patients. This slowed their weight loss and caused dissatisfaction with the procedure. Sixty-four percent of the patients underwent adjustment of the silicone band atleast once during the 15 months. Complications included stomal stenosis in 9% of the ASGB patients vs 1.3% in the VBG patients. There was one staple-line leak, one subphrenic abscess (without a leak), and one retrogastric hematoma in the VBG patients. One death occurred in the ASGB group in a patient who was found at surgery to have unanticipated post-hepatitic cirrhosis. There were no deaths in the VBG group. The conclusion reached is that the ASGB compares favorably with the VBG as a bariatric surgical procedure.     

Perioperative complications of gastric restrictive operations

It has not been established which gastric restrictive operation produces the lowest postoperative morbidity. Of a total of 565 morbidly obese patients who underwent various operations, perioperative complications occurred in 70 patients who underwent gastric bypass with loop gastrojejunostomy, 192 patients who underwent Roux-Y gastrojejunostomy, 47 patients who had greater curvature gastroplasty, 226 who had gastrogastrostomy and 40 who had vertical banded gastroplasty performed on a total of 565 morbidly obese patients. Twenty (3.5 percent) of the patients had intraoperative complications that were not related to the specific procedure. The exception was splenic injury which should not occur with vertical banded gastroplasty. Twenty-five (4.4 percent) of the patients had general postoperative complications that were not related to differences in techniques of the five operations. Two postoperative deaths were caused by massive pulmonary embolism and one by cardiopulmonary arrest. When the complications specifically related to the five different operative techniques were compared, there was a 14.3 percent incidence with gastric bypass with loop gastrojejunostomy, a 14.5 percent incidence with Roux-Y gastrojejunostomy, a 23.4 percent incidence with greater curvature gastroplasty, a 10.2 percent incidence with gastrogastrostomy, and no incidence with vertical banded gastroplasty. The potentially most serious complication, leak from the stomach, was most common with the two types of gastric bypass operations but it also occurred with greater curvature gastroplasty and gastrogastrostomy. This study has indicated that vertical banded gastroplasty is the safest operation. Our 1 year follow-up findings indicate it is as effective as any of the other operations in helping patients lose weight.     

Laparoscopic Gastric Banding: preliminary series

Gastric banding as a laparoscopic procedure was performed on 40 morbidly obese patients. This operation matches the advantages of the gastric banding (efficacy, reversibility and low invasivity) with the advantages of the laparoscopic procedure (low surgical risk, short hospital stay and less complications in the short and long term). The maximum follow-up is 6 months and so far the weight loss results are the same as we obtained by the vertical banded gastroplasty of Mason. The greatest problem of laparoscopic gastric banding is to get the right tightness of the band for a stoma of 12-13 mm. In three patients the band was replaced due to stenosis, in two of them by a laparoscopic procedure. The adjustable band of Kuzmak should exclude the risk of stenosis and its use will be tried by the laparoscopic procedure.     

Long-term Follow-up on the Effect of Silastic Ring Vertical Gastroplasty on Weight and Co-Morbidities

Background Silastic ring vertical gastroplasty (SRVG) is a simple, effective and reproducible restrictive operation for the treatment of morbid obesity. Over the last years, it has lost its popularity due to the development of adjustable gastric banding systems performed laparoscopically. In order to evaluate the long-term effect of SRVG on weight loss and co-morbidities, we reviewed the results of SRVG operations in our institution. Methods We reviewed SRVG operations performed in our University-affiliated General Hospital. Data was collected from the patients’ in-patient records, their outpatient-clinic files, and from a telephone interview. Results Between 1989 and 2001, 162 patients were operated upon. Complete follow-up was obtained of 115 patients (71%). The mean follow-up was 7.1 ± 3 years (range 4 to 16 years). Mean preoperative BMI was 47 kg/m2 (range 34 to 69 kg/m²). Maximal weight loss was obtained within 1 year to a mean BMI of 29 kg/m², with a mean excess BMI loss of 67%. Subsequently, there was a small increase in BMI, which stabilized at 34 kg/m² up to 15 years after the operation. A rapid, significant improvement in obesity-related co-morbidities was observed regarding hypertension (81%), diabetes (100%), sleep disorders (90%), osteoarthritis (83%) and ischemic heart disease (75%). There was no peri-operative mortality. Early complication rate was 10%. Late complications included postoperative ventral hernia (18%), esophagitis (31%), ring stricture (19%), ring erosion (2 patients), failure of staple line (8%) and obstruction of the pouch with food (19%). 35 patients (30%) required another procedure, 8 of them were eventually converted to other bariatric operations, and 2 patients had the ring removed and refused another bariatric procedure. The overall satisfaction rate was 86%. Conclusions SRVG is a simple, safe and effective bariatric operation in selected patients with morbid obesity. It results in a rapid, excellent effect on obesity-related co-morbidities and good long-term effect in weight loss, which compares positively with other, more complicated bariatric operations.     

Endoscopic obesity surgery: gastric banding. A new trend without scientific basis?

Indication for operation in morbid obesity is a body mass index greater than 40 kg/m2. Various operative procedures such as vertical banded gastroplasty and gastric bypass are used for therapy. Since 1994 the laparoscopic performed gastric banding is an alternative to conventional techniques. The mortality rate of this technique is below 1%, summarizing data from the literature of 905 patients the complication rate ranged to 24%. These results are comparable to conventional operations. Regarding the weight loss the results are comparable to the vertical banded gastroplasty. 80% of the patients loss 60% of their excess weight at 12 months. The rate of conversion to open procedure is low and ranges to 2.4%. Especially in obese patients the laparoscopic approach offers the well known advantages of endoscopic procedures. Open questions are the long-term effects and complications of laparoscopic gastric banding.     

Bilio pancreatic diversion following failure of laparoscopic adjustable gastric banding

Background: This study examines the failure rate with laparoscopic adjustable gastric banding (LABG) and results of band removal with synchronous biliopancreatic diversion without (BPD) or with duodenal switch (BPDDS). Methods: Failure of LAGB was defined as removal of the band due to insufficient weight loss or a complication. Results: The band was removed in 85 of 1,439 patients (5.9%), most commonly for persistent dysphagia and recurrent slippage. The removal rate and slippage rate decreased from 10.8 and 14.2% to 2.8 and 1.3%, respectively, following introduction of the pars flaccida technique. Fifteen of 27 patients with previous open vertical banded gastroplasty (VBG) required removal of the band. Mean percentage excess weight loss 12 months following open BPD, laparoscopic BPD, open BPDDS, and laparoscopic BPDDS was 44, 37, 35, and 28%, respectively. Conclusion: LAGB fails in 6% of patients and removal of the band with synchronous BPD or BPDDS can be performed laparoscopically. Patients with failed primary VBG have a high failure rate with LAGB.     

Laparoscopic vertical banded gastroplasty

Background The commonest surgical procedure for management of morbid obesity in Europe is laparoscopic adjustable gastric banding (LAGB), even though laparoscopic vertical banded gastroplasty (LVBG) is still considered to be a gold standard restrictive option in bariatric surgery. A multicenter prospective study was designed to to assess the efficacy of LVBG in terms of weight loss and complication rates for obese patients who have indications for a restrictive procedure. Patients and methods Two-hundred morbidly obese patients (84.5% female) with a mean age of 41 years and mean body mass index (BMI) of 43.2 kg/m² underwent LVBG as described by MacLean. Five trocars were placed in standard positions as per laparoscopic upper gastrointestinal surgery. A vertical gastric pouch (30 ml) was created with circular (21 or 25mm) and endolinear stapling techniques, enabling definitive separation of the two parts of the stomach. The gastric outlet was calibrated with either a polypropylene mesh (5.5 cm in length and 1cm in width) or a nonadjustable silicone band. The median follow-up period was 30 months (range, 1–72 months). Results One case had to be converted to open surgery (gastric perforation) and there was one death secondary to peritonitis of unknown etiology. The morbidity rate was 24%, comprising the following complications: gastric outlet stenosis (8%); staple line leak (2.5%); food trapping (1.5%); peritonitis (1%); thrombophlebitis (1.5%); pulmonary embolism (0.5%); and gastroesophageal reflux (9%). The excess weight loss achieved was 56.7% (1 year), 68.3% (2 years), and 65.1% (3 years). Conclusions Laparoscopic vertical banded gastroplasty is an effective procedure for the surgical management of morbid obesity, especially for patients who present hyperphagia but are unable to manage the constraints of adjustable gastric banding. Laparoscopic vertical banded gastroplasty is safe, as demonstrated by an acceptable complication rate, of which gastric outlet stenosis, staple line leakage, and gastroesophageal reflux predominate.     

Evidence-based medicine: open and laparoscopic bariatric surgery

BACKGROUND: The aim of this study was to perform an evidence-based analysis of the literature on open and laparoscopic surgery for morbid obesity. METHODS: Human studies on surgery for morbid obesity were conducted. Multiple publications of the same studies, abstracts, and case reports were reviewed. Current Contents, MEDLINE, EMBASE, and Cochrane Library databases were investigated. RESULTS: Open Roux-en-Y gastric by pass (RYGB) for morbidly obese patients and long-limb RYGB for superobese patients are highly effective procedures. Randomized controlled trials comparing malabsorptive procedures with other bariatric operations are needed. The long-term efficacy of adjustable silicone gastric banding (ASGB) still is undetermined because of poor evidence. Laparoscopic RYGB is as safe as its open counterpart, although its long-term results are lacking. Laparoscopic ASGB is less invasive than open ASGB, although its efficacy cannot be determined because of poor evidence. Laparoscopic vertical banded gastroplasty (VBG) is becoming unpopular since the decreasing trend of open VBG. Laparoscopic biliopancreatic diversion with duodenal switch is feasible, but needs further studies. CONCLUSIONS: Randomized controlled trials comparing the various laparoscopic operations are strongly needed.     

Objective comparison of complications resulting from laparoscopic bariatric procedures

BACKGROUND: Several surgical treatment options for morbid obesity exist. Currently, there are no studies that objectively compare complication rates after laparoscopic bariatric operations performed at a single institution. We objectively classify and compare complications resulting from laparoscopic adjustable gastric banding (LABG), Roux-en-Y gastric bypass (RYGB), and biliopancreatic diversion (BPD) with duodenal switch (DS). STUDY DESIGN: A retrospective review of a prospective database of all patients undergoing laparoscopic bariatric operation was performed. Complications were categorized according to severity score using a well-described classification system and compared between procedures. RESULTS: From September 2000 to July 2003, 780 laparoscopic bariatric operations were performed: 480 LAGB, 235 RYGB, and 65 BPD+/-DS. There was one late death. Total complication rates were: 9% for LAGB, 23% for RYGB, and 25% for BPD+/-DS. Complications resulting in organ resection, irreversible deficits, and death (grades III and IV) occurred at rates of 0.2% for LAGB, 2% for RYGB, and 5% for BPD+/-DS. LAGB group had a statistically significant lower overall complication rate, both by incidence and severity, as compared with other groups (p < 0.001). After controlling for differences of admission body mass index, gender, and race, the LAGB group had an almost three and a half times lower likelihood of a complication compared with the RYGB group (odds ratio, 3.4; 95% CI, 2.2-5.3, p < 0.001) and had an over three and a half times lower likelihood of a complication compared with the BPD with DS group (odds ratio, 3.6; 95% CI, 1.8-7.1, p < 0.001). There was no statistically significant difference between complication rates of RYGB and BPD+/-DS. CONCLUSIONS: Bariatric operation complication rates range from 9% to 25%; very few complications are serious. Laparoscopic adjustable gastric banding is the safest operation in terms of complication rate and severity when compared with laparoscopic Roux-en-Y gastric bypass or laparoscopic malabsorptive operations.     

Massively Bleeding Gastric Pouch Ulcer after Silastic Ring Vertical Gastroplasty Successfully Treated Endoscopically: A Report of Two Cases

Two patients who developed massive bleeding from a gastric pouch ulcer are described. This rare complication occurred during the early postoperative course after silicone ring vertical gastroplasty (SRVG). In both cases the bleeding stopped after the ulcers were injected with epinephrine and alcohol. Both ulcers healed after 1 month of treatment with omeprazole (Losec?). The probable etiology of this rare complication is discussed.     

The Influence of a New Timing Strategy of Band Adjustment on the Vomiting Frequency and the Food Consumption of Obese Women Operated with Laparoscopic Adjustable Silicone Gastric Banding (LAP-BAND)

Objective: To evaluate the effects of a new timing strategy of band adjustment on the short-term outcome of obese women operated with adjustable silicone gastric banding. Subjects: The outcome of 30 women without binge-eating disorder operated with laparoscopic adjustable silicone gastric banding with a wider intraoperatory band calibration (LAP-BAND) was compared to that of 30 body mass index-matched women without binge-eating disorder previously operated with adjustable silicone gastric banding (ASGB) applied by laparotomy with the usual intraoperatory band calibration. The patients were evaluated 3, 6 and 12 months after surgery. Measurements: (1) weight loss; (2) total daily energy intake; (3) percent as liquid, soft or solid food; (4) vomiting frequency; (5) rate of postoperative percutaneous band adjustments; (6) rate of band-related complications. Results: Both the weight loss and the daily energy intake did not differ between patients with LAP-BAND and patients with ASGB. After surgery, the patients with LAP-BAND ate more solid food and less liquid food than the patients with ASGB. Vomiting frequency was higher in patients with ASGB than in patients with LAP-BAND. The total number of percutaneous band adjustments was higher in women with LAP-BAND than in women with ASGB. Band inflation because of weight stabilization was performed in six (20.0%) women with ASGB and in 19 (63.3%) women with LAP-BAND. Neostoma stenosis occurred in one women with ASGB, but in none of the women with LAP-BAND. One patient with LAP-BAND presented band slippage. Conclusions: The wider intraoperatory band calibration performed in patients with LAP-BAND did not reduce the short-term efficacy of adjustable silicone gastric banding. This new timing strategy of band adjustment required more postoperative percutaneous band inflations, but it improved the eating pattern of the patients (low vomiting frequency and high intake of solid food).     

Adjustable Gastric Banding: 5-Year Experience

Background: From 1993 to 1999, 172 patients underwent adjustable silicone gastric banding (ASGB) or laparoscopic adjustable silicone gastric banding (LASGB). In 109 patients the adjustable band was placed via laparoscopy; in the other patients it was placed via laparotomy (prelaparoscopic era, conversions from other bariatric operations, conversions for laparoscopic failure). The conversion rate from laparoscopy to laparotomy was 9.3%, occurring in the early part of our experience. Methods: Mean age was 37.9 years, weight 135 ± 14.8 kg (82-218) and BMI 46.3 ± 5.4 (35.1-69.5). All patients had multiple band adjustments, temporary antisecretive, electrolyte and vitamin therapy, and follow-up per routine. Results: Weight loss at 3 years was 30.2%; mean percent loss of excess weight was 62.5%.There was no mortality.The most important technical complications were: gastric pouch dilatation that required band replacement or removal (5.8 %); mild gastric pouch dilatation reversible with adequate dietary and pharmacological treatment (4.6%); intraoperative gastric perforation (2.3%); band migration (0.6%).The band was removed in 2.3%, with conversion to another bariatric procedure in 1.1%. Conclusions: Results have been satisfactory thus far.     

Safety and feasibility of revisional laparoscopic surgery for morbid obesity: conversion of open silastic vertical banded gastroplasty to laparoscopic adjustable gastric banding

Background: Since the 1980s, bypass operations have been largely replaced by gastric restrictive operations. One of the most commonly performed operations for gastric restriction is vertical banded gastroplasty (VBG). However, the results are often disappointing. Adjustable gastric banding (AGB) is a viable alternative to VBG, and the ability to perform this surgery laparoscopically makes it an attractive option for patients in need of revisional surgery. It allows for refashioning of the gastric pouch in patients with a dilation of the pouch or disruption of the staple line. Methods: A total of 48 patients were referred to our center due to post-VBG weight gain. All patients underwent preoperative evaluation to determine the cause for failure of the operation. All patients found suitable for revisional surgery underwent laparoscopic placement of an adjustable band. Results: All but one of the operations were completed laparoscopically; one patient required conversion to open surgery prior to band placement via laparoscopy. This patient needed a blood transfusion. Postoperative band erosion occurred in one patient; laparoscopy surgery was used successfully for removal of the band and suturing of the stomach. Conclusions: Our short-term results indicate that revisional operation for morbid obesity using laparoscopic AGB is a safe procedure when performed cautiously. It enables early patient mobilization and discharge with good functional results and fewer perioperative complications.     

Adjustable Silicone Gastric Banding (ASGB): the Italian experience

Adjustable silicone gastric banding (ASGB) is a recently introduced gastric restrictive procedure. From April 1990 to April 1992, 85 patients underwent ASGB at our Department. Patients' characteristics were: 65 females, 20 males, mean age 39.6 years (range 17-60 years); body weight (BW) 127.9 ± 23 kg; % ideal body weight (%IBW) 205 ± 29; body mass index (BMI) 46 ± 7; morbidly obese 68, super-obese 17. Mean follow-up is 353 days. Twelve months after the operation BW was 95.2 ± 23 kg, % loss of excess BW 52.1 ± 22, and %IBW 152.2 ± 30 (45 patients). Mortality rate was zero and postoperative morbidity was insignificant. As late morbidity, we experienced two slippages of the band and six stoma-stenosis with pouch dilatation. Therefore, a surgical revision without removal of the band was performed in eight patients. The band was removed in one patient because of band erosion. In conclusion, ASGB is a safe and effective bariatric procedure. The weight loss is comparable to that produced by more extensive operations. Moreover, ASGB is fully reversible and adjustable to the patients' needs.