Management of slipped adjustable gastric bands

BACKGROUND: A small percentage of patients undergoing laparoscopic adjustable gastric banding (LAGB) experience band slippage that might require subsequent surgical intervention. We present our experience with band slippage in 660 consecutive LAGBs performed since November 2001 in order to determine the optimal management for slipped gastric bands. METHODS: The treatment options for patients with slipped bands include band removal, gastric reduction and reapplication of the original band, and band replacement. Data from electronic medical records, as well as telephone interviews, were collected and tabulated. The original weight and body mass index, weight and body mass index before the revisional procedure, and the most recent weight, body mass index, and percentage of excess weight loss are presented. RESULTS: Of the 660 LAGB patients, 34 (5%) experienced band slippage and required 40 subsequent operative procedures. Of the 34 patients, 6 underwent multiple procedures for their slipped band. Overall, 10 removals, 13 gastric reductions, and 17 replacements were performed (40 total procedures). Of the 34 patients, 28 (82%) were available for follow-up. This group of 28 patients underwent 34 operative procedures (7 removals, 11 gastric reductions, and 16 replacements). No complications were associated with these 34 operations. Of the 11 patients with gastric reduction, 6 (55%) had subsequent recurrence of band slippage, resulting in 6 additional operations (5 replacements and 1 removal). CONCLUSION: After band slippage, all 3 management options result in maintenance of most of the lost weight. However, because a large number of patients who undergo gastric reduction experience repeated slippage and require additional surgical intervention, gastric reduction should not be routinely performed in this population. Given the overall experience with revisional surgery after band slippage, additional investigation of the etiology of band slippage and its prevention is warranted.     

Laparoscopic Adjustable Gastric Banding: A Prospective 4-Year Follow-up Study

Background: A body mass index of ≥40 kg/m² represents clinically severe obesity and warrants operative treatment if requested. The adjustable silicone gastric band and the Swedish adjustable gastric band are recently produced laparoscopic gastric restrictive devices. The aim of this study was to assess all complications linked to both the available gastric bands in a long-term follow-up. Methods: In a prospective study, the effects, complications, and outcomes of this procedure were analyzed. The complications found were divided into early and general complications, and complications correlated to the bands. The technique of laparoscopic adjustable gastric banding is described. Follow-up was performed by the operating team. Results: Between July 1994 and August 1998, the authors operated on 158 patients and performed 102 adjustable silicone gastric bandings and 54 Swedish adjustable gastric bandings. The mean age at surgery was 36 years (range 17-72). The mean preoperative weight was 136 kg (89-230). Of 158 patients who underwent laparoscopic procedures, 156(98%) could be followed up (mean 28 months; duration of follow-up, 6 weeks to 46 months). In early postoperative complications that required operation, one trocar wound hematoma (0.6%) and one wound infection of the port site (0.6%) were observed. The late complications that required reoperation were two pouch dilatations (1.3%), three band leakages (2%), one band migration (0.6%), and one late infection of the port (0.6%). A debanding operation was necessary in one patient because of esophageal dysmotility disorder. No early or late postoperative mortality was registered. The overall reoperation rate is currently about 7%. Conclusion: The operation is safe and effective. Moreover, adjustable gastric banding is fully reversible and is adjustable to the patient's needs. This study verifies the importance of correct operating technique. The authors' study and experience clearly indicate that laparoscopic adjustable gastric banding is an attractive alternative in the surgical treatment of morbid obesity.     

Outcomes after laparoscopic adjustable gastric band repositioning for slippage or pouch dilation

BACKGROUND: Slippage and pouch dilation are the most common surgical complications after laparoscopic adjustable gastric banding, yet few reports have described the specific outcomes after band repositioning for these complications. The objective of this study was to examine the intermediate outcomes of our patients who underwent band repositioning for slippage or pouch dilation. METHODS: From October 2000 to December 2005, 1275 patients underwent laparoscopic adjustable gastric banding at our center. Of these, we retrospectively reviewed the data of the first 40 consecutive patients (92.5% women, mean age 41.7 years, mean preoperative weight 123.3 kg [range 86.2-180.5], mean body mass index 44.8 kg/m2 [range 34.6-66.4]) who presented with anterior slippage (52.5%), posterior slippage (20%), or pouch dilation (27.5%, 7 with associated hiatal hernias) that required band repositioning (95%) or explantation (5%). RESULTS: The average time between laparoscopic adjustable gastric banding and reoperation was 22.9 months. Before band repositioning, the mean weight was 91.5 kg, mean body mass index was 33.2 kg/m(2), and mean percentage of excess weight loss was 49.4% (range 1-79.8%). One patient had a recurrent anterior slippage that required a second band repositioning. Two bands were explanted, one for intraoperative gastric perforation and one at the patient's request. The mean percentage of excess weight loss after band repositioning was 48.1% (range 18.2-77.4%) at an average follow-up of 17.6 months (range 6-36). To date, 38 (95%) of the 40 patients have functioning bands. Co-morbidity resolution was seen in 3 (60%) of 5 patients with diabetes, 13 (65%) of 20 with hypertension, and 8 (72%) of 11 with sleep apnea. CONCLUSION: Laparoscopic band repositioning can result in preservation of most of the initial weight loss and co-morbidity resolution.     

Preoperative upper endoscopy is useful before revisional bariatric surgery.

BACKGROUND AND OBJECTIVES: We hypothesized that patients who have previously had bariatric surgery and are undergoing revision to laparoscopic Roux-en-Y gastric bypass would have abnormal findings detected by upper endoscopy that could potentially influence patient management. The procedures that are being revised include vertical banded gastroplasty, laparoscopic adjustable gastric bands, nonadjustable gastric bands and previous Roux-en-Y gastric bypass (open and laparoscopic). METHODS: We conducted a retrospective chart review of patients who previously had undergone vertical banded gastroplasty or nonadjustable gastric banding. We preoperatively performed an upper endoscopy on all patients. The endoscopy reports were reviewed and the findings entered into a database. RESULTS: Eighty-five percent of 46 patients undergoing revisional bariatric surgery had an abnormal upper endoscopy. Eleven percent had a gastrogastric fistula. Gastritis and esophagitis were noted in 65% and 37%, respectively. Eleven percent of patients had band erosion, 2 from a nonadjustable band, and 5 from vertical banded gastroplasties. Based on our findings, 65% of our patients required medical treatment. CONCLUSIONS: Preoperative upper endoscopy provides valuable information before revisional laparoscopic bariatric surgery. In addition to identifying patients who need preoperative medications, the preoperative upper endoscopy also provided valuable information regarding pouch size and anatomy. Preoperative upper endoscopy should be performed by the operating surgeon on every patient undergoing revisional bariatric surgery.     

Early Results with a New Telemetrically Adjustable Gastric Banding

Background It has already been demonstrated that laparoscopic adjustable gastric banding (LAGB) is a safe and effective alternative to other permanent bariatric surgery techniques. Although clinical complications have been managed through improvements in surgical techniques, port-related complications and adjustment process inefficiencies have persisted. To reduce and manage these issues, a new type of gastric band has been developed which uses telemetric technology to eliminate the use of hydraulic ports and simplify the overall gastric band adjustment procedure. Methods From June 2005 to October 2005, 37 patients were implanted in two German academic centers with the Easyband? telemetrically adjustable gastric band (Endoart S.A., Lausanne, Switzerland), using standard gastric banding laparoscopic technique. Prospective data was collected and analyzed for a minimum of 6 months on all morbidly obese patients who underwent laparoscopic telemetrically adjustable gastric banding. Results Data on 37 patients was analyzed.The mean percent excess weight loss was 10.2% at 1 month, 21.6% at 3 months, and 29.4% at 6 months. In 12 hypertensive patients, the systolic blood pressure decreased from 143 ± 24 mmHg at baseline to 131 ± 10 mmHg after 6 months. Diastolic pressure did not change significantly. In all 5 patients with diagnosed type 2 diabetes, the fasting blood glucose normalized after 6 months (135 mg/dl at baseline, 81 mg/dl at month 6). Conclusion These early results of the new telemetrically adjustable gastric banding device indicate clinical safety and efficacy comparable to that achieved by other commercially available gastric bands. Additional multi-center studies with long-term followup are recommended to confirm the benefits of telemetrically adjustable gastric banding.     

Migration of adjustable gastric banding from a cohort study of 4236 patients

Background Experience was gained management of intra-gastric migration of adjustable gastric banding.Methods From July 1996 to January 2003, 4236 patients who underwent laparoscopic adjustable gastric banding were proposed for routine follow-up. Gastrograms were performed in case of band adjustment. Radiological controls and endoscopy were performed according to symptoms.Results A total of 45 cases of band migration (1.6%) were diagnosed during follow-up. All but one of the migrated bands were removed laparoscopically either by a dissection outside the stomach or through a short gastrotomy. Mortality was 0% and morbidity 8% (n = 4).Conclusion The risk of an intragastric band migration remains low in the literature but could grow on account of the longer follow-up of patients. The retrieval of the band is the gold standard and must be planned promptly or delayed according to symptoms.     

Single-incision laparoscopic placement of an adjustable gastric band versus conventional multiport laparoscopic gastric banding: a comparative study

Single-incision laparoscopic surgery (SILS) is rapidly becoming the focal point of attraction for early adopters of minimally invasive surgery nationwide. Having achieved a rapid crossover to the realm of advanced surgical procedures, SILS has shown remarkable versatility and adaptability, making it no longer limited to basic laparoscopic procedures. We report our experience performing laparoscopic placement of gastric bands with an emphasis on comparison of the single-incision laparoscopic approach with the conventional multiport laparoscopic approach. From December 2008 to September 2009, 27 patients underwent laparoscopic placement of an adjustable gastric band at Michigan State University/Kalamazoo Center for Medical Studies. This included 15 patients who underwent single-incision laparoscopic gastric banding and 12 patients who underwent conventional multiport laparoscopic gastric banding procedures. The overall pain score was found to be significantly less in the SILS group than that for the conventional multiport laparoscopic gastric banding group with a statistically significant P value of 0.012. The operating time was found to be significantly less in the multiport group with a P value of 0.000. Differences in immediate postoperative pain scores, analgesia, and the overall length of hospital stay were found to be statistically insignificant. Single-incision laparoscopic gastric banding is associated with significantly less overall postoperative pain than the conventional laparoscopic approach; in addition, it provides improved cosmetic outcome despite a modest increase in operative time.     

Bariatric Surgery at the 1st Surgical Department in Prague: History and Some Technical Aspects

Background: Obesity has been increasing in the Czech Republic over the last 20 years. In 1983 we were one of the first surgical departments in the country which performed bariatric surgery on a regular basis. Methods: From 1983 to 1986 we performed vertical banded gastroplasty (VBG). Because of a high rate of various complications arising both from the stomach and the wound, we switched in 1986 to ‘less aggressive’ nonadjustable gastric banding (GB). In 1993 we performed the first laparoscopic nonadjustable banding, and in 1994 we started laparoscopic placement of adjustable gastric bands. Results: In the group of 52 patients who underwent VBG and were followed-up, acceptable weight loss results (−40.5 kg) were achieved in the 24 months following surgery. The postoperative complications were high; 17.3% gastric staple-line disruption and 15.3% wound complications (incisional hernias, discharge, etc.). Since 1986, we have performed nonadjustable GB in 150 patients and achieved weight loss of -38.4 kg in the 24 months following surgery. There was no change in the wound complication rate, but the complications arising from the stomach and the band decreased to 6.3%. Since June 1993, we have performed 268 procedures laparoscopically, either with nonadjustable bands or, since 1994, with the adjustable bands. The wound complication rate decreased to 0.9%, and one complication (6.6%) was related with the adjustable band. Conclusions: Because of the high rate of post-operative complications in our experience with VBG, we started GB in 1986. Since then the number of complications arising from the stomach has decreased substantially. With the laparoscopic technique, there was a further decrease in wound healing problems. With the adjustable GB, a significant decrease in the stomach-related complications occurred. Shorter hospital stays were possible with the laparoscopic technique. Long-term weight loss results have not been significantly different among the above mentioned procedures.     

11-cm Lap-Band<Superscript>®</Superscript> System Placement after History of Intragastric Migration

Background: Intragastric migration (erosion) of the band after laparoscopic adjustable silicone gastric banding (LAGB) is a serious late complication. It requires removal of the entire system. Subsequent recurrence of obesity can be treated by laparoscopic placement of a larger band: the 11-cm Lap-Band^? System. Methods: In 727 laparoscopic gastric bandings using the 9.75 Lap-Band^?, 10 cases presented with intragastric migration of the band. The same complication was encountered in an additional 4 patients who had previously been implanted with an Obtech band in another hospital. Laparoscopic removal of the band was performed in all cases. In 9 cases, after a delay of 6 months, a new gastric band was placed using the 11-cm Lap-Band^?, because of uncontrollable recurrence of obesity. Results: No complication was observed during the laparoscopic removal of the system. The placement of a new band required conversion to laparotomy in 1 patient who had previously received an Obtech band which had been placed using the pars flaccida technique. After a mean follow-up of 21 months, no intragastric migration of the new bands was noted. Conclusions: Laparoscopic placement of an 11-cm Lap-Band^? in patients with a history of intragastric migration is a safe procedure. It allows effective control of recurrent obesity. The laparoscopic procedure was easier in patients initially operated using the perigastric technique.     

Band slippage after laparoscopic adjustable gastric banding: etiology and treatment

Background Laparoscopic adjustable gastric banding is a safe and effective procedure for the management of morbid obesity. However, band slippage is a common complication with variable presentation that can be rectified by a second laparoscopic procedure.Methods We studied case series of 125 consecutive patients who suffered from band slippage between November 1996 and May 2001 from a group of 1,480 laparoscopic adjustable gastric banding procedures performed during this time. The decision of whether to remove or replace/reposition the band was made prior to the operation, although the specific method used when replacement or repositioning was deemed suitable was determined by the operative findings. A laparoscopic approach was used in all but three patients.Results A total of 125 patients (8.4%) suffered band slippage (posterior slippage, 82.4%; anterior slippage, 17.6%). In 70 patients (56%), the band was removed, whereas in 55 patients (44%) it was repositioned or replaced immediately. Of these 55 patients, six underwent later removal, five due to recurrent slippage and one due to erosion. Fourteen patients suffered complications, including gastric perforation (n = 8), intraoperative bleeding (n = 1), postoperative fever (n = 3), aspiration pneumonia (n = 1), upper gastrointestinal bleeding (n = 1), and pulmonary embolism (n = 1).Conclusion Band slippage is not a rare complication after laparoscopic adjustable gastric banding. The decision to remove or replace the band or convert to another bariatric procedure should be made preoperatively, taking both patient preference and etiology into consideration. Short-term results indicate that band salvage is successful when the patient population is chosen correctly.     

Surgical revision after failure of laparoscopic adjustable gastric banding

BACKGROUND: This paper reports the outcome of surgical revision for complications following laparoscopic placement of an adjustable silicone gastric band (AGB) to treat morbid obesity. METHODS: Seventy-three (19.1 per cent) of 382 patients who underwent laparoscopic AGB placement between January 1996 and March 2001 presented with complications within 6 years after operation. Revision was carried out with the intention of reinstating the functional device in all patients. RESULTS: Successful surgical revision or gradual balloon deflation was performed in 53 patients (29 port-related complications, 14 pouch dilatations, 12 band leakages, three oesophageal dilatations, two symptomatic hernias, one late migration, one intracerebral bleed). Of these patients, 51 (96.2 per cent) had a successful outcome according to the Bariatric Analysis and Reporting Outcome System following significant additional postinterventional weight loss. AGB removal was carried out in 20 patients (13 early or late migrations, five pouch dilatations, three port-related complications, two psychiatric disorders, one band leakage). The final failure rate for complicated AGB procedures was 30.1 per cent. CONCLUSION: AGB placement is associated with a variety of complications. In most cases surgical complications can be treated with minimally invasive surgery, which should allow further weight loss and improvement of quality of life during long-term follow-up. Alternative bariatric procedures should be reserved for patients with poor outcome after surgical revision of the AGB.     

Efficacy of surgery in the management of obesity-related type 2 diabetes mellitus

BACKGROUND: It is estimated that up to 80% of persons with diabetes mellitus type 2 are overweight and in these patients it is recognized that effective weight control can lead to improvement or even resolution of their diabetes (Colagiuri et al.). All currently carried out operations for morbid obesity have been shown to improve diabetes, but there appears to be a variable response to surgery depending on several surgical and patient factors. METHODS: In this prospective review, we analysed the change in the diabetic status in 72 patients undergoing three different bariatric procedures in a single institution over 30 months. A review of the published work comparing the efficacy of the various procedures in achieving improvement or resolution of diabetes was also carried out and correlated to our findings. RESULTS: At an average follow up of 13 months, 50% of patients who had placement of laparoscopic adjustable gastric band had an improvement or resolution of their diabetes, compared with 95% of patients who had had laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass. Two of 12 (17%) laparoscopic adjustable gastric band patients had normal blood glucose levels off all diabetic medications compared with 7 of 21 (33%) laparoscopic sleeve gastrectomy and 27 of 39 (69%) Roux-en-Y gastric bypass patients. There was no significant association between the amount of weight lost and the return to euglycaemia. CONCLUSION: Direct comparison has shown a significant difference in the effects of different forms of bariatric surgery on type 2 diabetes, this is in keeping with evidence that surgery can lead to improvement in diabetes additional to that obtained by weight loss alone.     

Barrett’s Esophagus: A Late Complication of Laparoscopic Adjustable Gastric Banding

Laparoscopic adjustable gastric banding has become a popular bariatric restrictive procedure in the USA. The increasing popularity of the laparoscopic adjustable gastric band procedure could, in part, be related to the lower cost and lower morbidity compared with laparoscopic gastric bypass. Although its placement is related to a lower number of perioperative complications compared with laparoscopic gastric bypass, its morbidity may be substantial. Barrett’s esophagus or esophageal intestinal metaplasia is a known complication of chronic gastro-esophageal reflux disease that, in rare occasions, progresses to dysplasia and esophageal adenocarcinoma. Barrett’s esophagus, after laparoscopic adjustable gastric banding placement, is a rare but not unexpected complication after gastric band placement. The incidence of Barrett’s esophagus after adjustable gastric banding is not known. We present a case of Barrett’s esophagus as a result of laparoscopic adjustable gastric banding placement due to a chronically and highly restrictive gastric band in a former morbidly obese patient.     

Pancreas transplantation after bariatric surgery

Obese transplant candidates are at increased risk for perioperative and postoperative complications. In many transplant programs, morbid obesity is considered to be an exclusion criterion for transplantation. The only potential option that would grant these patients access to transplant is weight loss. Non-operative weight loss strategies such as behavioral modifications, exercise, diet, or medication have only very limited success in achieving long-term weight loss. In contrast, bariatric surgery was shown to achieve not only more excessive weight loss, but more importantly, this weight loss can be sustained for longer periods of time. Therefore, bariatric surgery presents an attractive option for weight loss for morbidly obese transplant candidates. We report our experience with four patients who underwent bariatric surgery prior to successful pancreas transplantation. Even though gastric bypass and laparoscopic adjustable gastric band present as equivalent alternatives for weight reduction, we believe that in the population of morbidly obese diabetic patients who are possible candidates for pancreas transplantation, laparoscopic adjustable gastric band placement is the more suitable procedure.     

Follow-up of Lap-Band® Complications

Background: Proximal gastric pouch dilation (PGPD) and band dislocation (BD) are the most frequent complications of laparoscopic adjustable silicone gastric banding (LASGB). Methods: Conservative treatment of PGPD and BD was attempted in all patients by deflation of the band. In the case of failure, laparoscopic exploration was performed. Results: From January 1996 to July 1998, 8 of 40 patients who underwent LASGB experienced PGPD (n = 7) or BD (n = 1). Debanding was performed in 3 patients with PGPD, while in 4 the pouch dilation was successfully treated with deflation of the band. Two patients (PGPD and BD) were treated with band repositioning. Weight loss was not influenced in patients treated conservatively, compared with patients who did not experience complications. Conclusions: PGPD and BD are not always responsible for band failure in LASGB. Conservative treatment can be successful, and repositioning of the band is feasible in selected cases.     

Physical Principles of Available Adjustable Gastric Bands: How they Work

Background: Commonly used adjustable gastric bands function on two different physical principles: low pressure-high volume and high pressure-low volume system. Methods: A study was carried out to investigate the theoretical and clinical levels of adjustable band volume-pressure features and their possible influence on band-related complications. The theoretical study had two objectives: to define physical principles of impact of the band balloon on the gastric wall at the stoma region, and to apply a physical formula for calculating this data. The objectives of the clinical part of the study were to construct a simple reliable measuring device, enabling data collection on an out-patient basis from patients who had undergone gastric banding with the two band systems, to support or refute the theoretically calculated results. Results: A physical formula calculated the pressure applied by the different band systems on the gastric wall in the stoma region. Calculations revealed a >100% difference in pressure caused by the respective bands. Invasive pressure measurements in 35 patients with the different balloon systems agreed with the calculated data, and found a >100% difference in pressure affecting the stoma wall both at rest and during meals. Conclusions: Differences in pressure on the gastric wall related to the physical system on which the bands operate may be a partial explanation for long-term complications of respective bands.     

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.     

Gastric prolapse with pseudocysts following laparoscopic adjustable gastric banding

Introduction:

Laparoscopic adjustable gastric banding (LAGB) is a reversible method of surgical gastric restriction. Following LAGB, the adverse event most commonly necessitating subsequent reoperation is prolapse of the gastric corpus or fundus above the band. A review of the medical literature reveals no reports of nonpancreatic pseudocysts being associated with this adverse event. Nonpancreatic pseudocysts, encountered during revisional bariatric surgery should be considered a cause of irreducible gastric prolapse.

Case Report:

We report the case of a 41-year-old Caucasian female who underwent laparoscopic surgery to revise an adjustable gastric band and to repair an anterior gastric prolapse. Intraoperatively, 2 pseudocysts were found on the gastric fundus above the band in association with the gastric prolapse. The pseudocysts were resected, the gastric prolapse was reduced, and the band was left in place. The patient recovered uneventfully.

Conclusion:

Nonpancreatic pseudocysts may be associated with gastric prolapse in patients who have undergone LAGB. These pseudocysts can often be excised laparoscopically without violating the gastric lumen. This atypical presentation of gastric prolapse may pose a diagnostic and therapeutic challenge as these patients may present to an outpatient clinic or emergency room with nonspecific symptoms.     

Conversion to a laparoscopic biliopancreatic diversion with a duodenal switch for failed laparoscopic adjustable silicone gastric banding

BACKGROUND: Initial data indicate that long-term weight loss for patients who have undergone laparoscopic adjustable silicone gastric banding (LASGB) may be inadequate. It is anticipated that many of these patients will require revision in the next few years. The procedure of choice for such a revision is unknown. PATIENTS AND METHODS: Two LASGB patients, who underwent a laparoscopic gastric band removal with a conversion to a biliopancreatic diversion with a duodenal switch (BPD/DS), are presented. RESULTS: Their procedures were completed without intraoperative complications. Significant weight loss over 12 and 13 months was achieved. CONCLUSION: The BPD/DS, as opposed to the Roux-en-Y gastric bypass (RGB), is well suited for LASGB revision, as its proximal anastomosis is at the duodenum, away from the gastric band scar tissue. Our experience performing laparoscopic BPD/DS has yielded satisfactory weight loss results without the need for revision.     

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.