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.     

A 5-Year Experience of Laparoscopic Adjustable Gastric Banding in China

Background

Laparoscopic adjustable gastric banding (LAGB) has been our operation of choice for morbid obesity since 2003. The aim of this study was to review 5 years of LAGB procedures at a single institution in China.

Methods

All patients who underwent LAGB at our institution from June 2003 to November 2009 were analyzed retrospectively. A telephone survey of patients was conducted in 2010.

Results

This study included 188 Chinese patients, of which 69.7 % were female and 8 (4.3 %) were super-obese (body mass index (BMI) >50 kg/m²). The mean age of patients was 27.2?±?9.1 years (range, 14–55 years), mean weight was 106.8?±?24.7 kg (range, 67–230 kg), and mean BMI was 37.5?±?6.2 kg/m² (range, 26.1–61.7 kg/m²). The mortality rate was 0 %. Six bands were removed (four for slippage). One operation was converted to an open procedure. Ninety-eight patients were surveyed by telephone. The mean weight loss was 17.6?±?12.5 kg, and the mean follow-up time was 23.6 months. Percentage excess weight loss (%EWL) at 3 months, 6 months, 1 year, and 2 years was 27.8?±?16.4, 39.0?±?23.1, 44.1?±?27.3, and 43.1?±?28.4 %, respectively. The nonresponder rate (%EWL <30 %) at 2 years was 33.3 % (20/60). Weight regain of more than 10 kg from nadir was observed in 10 of the 98 patients (10.2 %).

Conclusions

LAGB is a relatively safe procedure with few major complications. However, a minority of morbidly obese patients did not benefit sufficiently from their surgery.     

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.     

Adjustable Silicone Gastric Banding and Band Erosion: Personal Experience and Hypotheses

Background: Adjustable silicone gastric banding (ASGB) has been advocated as a minimally invasive procedure that is completely reversible for the surgical treatment of morbid obesity. Band erosion (BE) is one of the possible complications of ASGB. The authors report their experience with BE and discuss its possible causes. Methods: Between February 1993 and February 1998, the authors performed 122 ASGB: 51 open and 71 laparoscopic procedures. Results: Two cases of BE occurred (1.6%). Conclusion: Band erosion is a possible complication of ASGB that is often not diagnosed immediately. Prevention is essential and consists primarily in correct placement of the band. There appears to be only one solution to BE: removal of the band. Placement of a new band after removal is possible; the minimum interval is not known.     

Laparoscopic Adjustable Gastric Band: 4-Year Experience and Learning Curve

Methods:A retrospective review of 156 patients who underwent laparoscopic adjustable gastric banding between October 2006 and May 2010 was performed. Patients were separated into 3 groups: group 1 comprised the first 50 patients; group 2 comprised the second 50 patients; and group 3 comprised the last group of patients, with a total of 56 patients.Results:The male-to-female ratio was 1:4 (33 male and 133 female patients). The mean age was 38 years (range, 17–62 years). The mean preoperative body mass index was 44.9 kg/m². The mean percent excess weight loss was 41.7% at the 1-year follow-up visit (153 patients, 98%), 49.7% at the 2-year follow-up visit (147 patients, 94%), and 50.2% at the 3-year follow-up visit (127 patients, 81%). The overall complication rate and major complication rate were 15.4% and 3.2%, respectively. There were no deaths. Percent excess weight loss, length of hospitalization (in days), and complication rates were compared among the 3 groups. No significant differences were noted among the groups except in the number of complications (P < .001), but all data were clearly improved in groups 2 and 3.Conclusions:The analyses in this study have documented one more time that laparoscopic adjustable gastric banding is an effective procedure for the treatment of morbid obesity, achieving >50% excess weight loss at 3 years. It is a procedure with certain complications even when performed by a surgeon with previous experience in laparoscopic surgery. According to our subset analysis, the learning curve is at least 50 procedures.     

Band Erosion after Laparoscopic Gastric Banding: Occurrence and Results after Conversion to Roux-en-Y Gastric Bypass

Background: Laparoscopic adjustable gastric banding is a popular bariatric operation. Unfortunately, long-term complications such as slippage, infection, and intragastric migration (erosion) may occur. With erosion, band removal is mandatory. Options to prevent weight regain are delayed implantation of a new band, or conversion to another bariatric procedure such as Roux-en-Y gastric bypass (RYGBP) or biliopancreatic diversion. We present our experience with band erosion and immediate or delayed conversion to RYGBP. Methods: With a multidisciplinary team approach and prospective data collection, a comparison was made between patients with and without band erosion. The patients who were converted to RYGBP for band erosion were analyzed. Results: Gastric banding was performed on 347 patients between 1995 and 2002. Median follow-up is 52 months. Band erosion developed in 24 patients (6.8 %).The latter were heavier before gastric banding (BMI 45.9 vs 43.3, P <0,01). No band had ever been overinflated. Band erosion was diagnosed after a mean of 22.5 months (3-51). At time of diagnosis, mean BMI of 33.5 kg/m² (22.5-48) and average excess weight loss (EWL) of 52.9% (25-97) did not differ from that of the remaining patients at the respective time interval. The band was removed in all cases. Conversion to RYGBP was performed at the same time in 11, and a few months later in 2 patients. Operative morbidity included 1 leak (reoperation) and 4 wound infections. All but 1 patient lost further weight after reoperation, or at least maintained their weight. At last follow-up, mean EWL in relation to the pre-banding weight was 65.1%, and 69.2% of the patients had an EWL >50%, which compares favorably with the results obtained after primary RYGBP. Conclusions: In our series with a median follow-up >4 years, band erosion was more common than usually reported. Band removal with immediate or delayed conversion to RYGBP is feasible with an acceptable morbidity, and prevents weight regain in most cases. These results support further use of this approach for band erosion.     

Gastric Bezoar Complicating Laparoscopic Adjustable Gastric Banding with Band Slippage

Gastric bezoars may develop in the proximal pouch after gastric restriction, eg. by laparoscopic adjustable gastric banding (LAGB). To date, only two centers have reported this rare complication. We report an additional case with band slippage, to emphasize that bezoars should be considered in the differential diagnosis in patients presenting with new onset nausea and vomiting after LAGB.     

Outpatient Laparoscopic Gastric Banding: Initial Experience

Background: Laparoscopic adjustable gastric banding (LAGB) has usually been performed as an inpatient procedure with an average hospital stay of 2-4 days. The aim of this study was to assess the feasibility of LAGB as an ambulatory procedure in selected patients. Methods: Potential candidates for ambulatory LAGB were recruited from patients consulting for obesity surgery. The main inclusion criteria were BMI >35 kg/m² with co-morbid conditions, living within a reasonable distance from the hospital, and adult company at home. The patients were admitted at 0700 hours on the day of surgery, underwent laparoscopic placement of a Lap-Band^? system and were discharged home that evening. Results: 9 women and 1 man underwent outpatient LAGB. Mean age was 36 (range 18-52) years and mean BMI was 38.4 kg/m² (range 35.1-43.3). Co-morbidities included functional dyspnea (6), osteoarthritis (4), arterial hypertension (4), type 2 diabetes (2) and dyslipidemia (1). 7 patients had undergone previous abdominal surgery: cesarian section (4), appendectomy (3), cholecystectomy (1) and hysterectomy (1). All patients had an American Society of Anesthesiologists (ASA) classification of II. The average operating time was 87 minutes (range 65-115). The mean time lapse between the end of the operation and discharge from hospital was 9.6 hours. There were no readmissions, and no complications were noticed at 1 month postoperatively. The patients' satisfaction with the ambulatory LAGB procedure was high. Conclusion: The present study demonstrates that LAGB for obesity may be performed on an ambulatory basis without complications.     

Thirty Months Experience with Laparoscopic Adjustable Gastric Banding

Introduction: Since June 1996 we performed laparoscopic adjustable silicone gastric banding (LASGB), because of low invasivity,absence of malabsorption, reversibility, and postoperative regulation. Materials and Methods: Criteria included body mass index (BMI) >40 or >35 with serious obesity-related conditions. 154 patients underwent LASGB. BMI ranged from 35 to 65.7 (mean 43.7±6.2). Results:The laparoscopic procedure was successfully completed in 150 patients (97.4%). One patient was converted to the laparotomic procedure because of hepatomegaly; 4 patients had to be converted for gastric laceration during the laparoscopic approach. In one of these patients, the band was removed 7 days later for sepsis, followed by an uneventful post-operative course. The mean length of postoperative hospitalization was 2.3±0.9 days. Per cent of excess weight loss was 42.5±22.4 after 1 year. Conclusions: LASGB was feasible and effective.     

Ten Years Experience with Laparoscopic Adjustable Gastric Banding

Background Gastric banding is a safe and efficient bariatric procedure. We report here the results of 591 consecutive gastric bandings in terms of excess weight loss with up to 10 years follow-up and the complications. Methods Between June 1996 and September 2006, 591 patients underwent laparoscopic adjustable gastric banding (LAGB) by the same surgeon (JB). Of these patients, 69.2% were women. Mean age was 33.6 years ± 10.7 and mean BMI was 41.95 kg/m² ± 8.7. Patients were reviewed monthly for the first 6 months, every 2 months for the next 6 months, and yearly thereafter. Excess weight loss was calculated at 6 months and 1, 2, 4, 6, 8, and 10 years. Results Six hundred eleven bands were implanted in 591 patients. Fifty-one patients (8.6%) had band removal due to a complication. Mean follow-up was 35 ± 2 months. Percentage of excess weight loss was 45.8% ± 27.4 at 6 months, 66.7% ± 30.3 at 1 year, 72.6% ± 28.8 at 2 years, 75.9% ± 27.4 at 4 years, 82.8% ± 32.6 at 6 years, 82.3% ± 25.1 at 8 years, and 82.7% ± 4.2 at 10 years. Complications encountered were band failure (9.3%), slippage (5.3%), erosion (4.6%), infection (2.4%), high band position (1.9%), and others (2.8%). Complication rate was 23.3% overall but dropped to 2.5% when calculated on the second half of the patients. Conclusion LAGB is a safe and efficient bariatric procedure. With experience, the complication rate drops to a very low level. Close follow-up can further increase its efficacy. Presented at 12th Annual Meeting of IFSO, Porto, Portugal, September 2, 2007.     

Band Erosion Following Gastric Banding: How to Treat It

Background Intragastric band migration is an unusual but major long-term complication of gastric banding: its frequency ranges from 0.5–3.8% and always requires removal of the band. Different laparoscopic, laparotomic or endoscopic methods are currently used for band removal. Methods 571 morbidly obese patients underwent adjustable gastric banding from February 1998 to July 2006. Band erosion occurred in 3 patients (0.52%). In addition, 6 such patients were referred to our Department from other hospitals. To remove the migrated band, in most patients we used an endoscopic approach with a device designed to cut the band: the Gastric Band Cutter (AMI, Agency for Medical Innovation). Results In 7 of the 9 patients, we used the gastric band cutter to remove the band endoscopically. It was able to cut the band successfully in all cases except one, where twisting of the cutting wire required conversion from endoscopy to laparoscopy. In another case, the band, after being cut, was locked in the gastric wall and required laparotomic removal. In 2 patients, we had to remove the band surgically – in one case for port-site infection with subphrenic abscess, and in the other case for complete band migration into the jejunum associated with acute pancreatitis, cholelithiasis and choledocholithiasis. Conclusion The Gastric Band Cutter, when used, was successful in dividing the band in all cases except one, although we could not always complete the procedure endoscopically. Endoscopic removal seems to be the procedure of choice for band erosion, because it allows earlier patient discharge and avoids a surgical operation. It is advisable to perform the endoscopic removal in the operating theater, because of possible complications of the procedure.     

Laparoscopic Adjustable Gastric Banding: A 10-Year Single-Centre Experience of 575 Cases with Weight Loss Following Surgery

Background

Laparoscopic adjustable gastric banding (LAGB) is one of the commonest bariatric procedures in the UK. This study reports our experience with this procedure over the last 10?years.

Methods

A prospectively maintained database of all the patients undergoing LAGB at our centre between March 2000 and August 2010 was analysed.

Results

Five hundred seventy-five patients underwent LAGB at our centre. There was no mortality in this series. Early (30-day) morbidity rate was 2.2?%. Late complications (20?%) comprised: 78 repositioning of the inflation port in 65 patients, repositioning of band in 24 patients (4?%), removal of band in 20 patients (3.4?%), conversion to bypass in 41 patients (7?%), diagnostic laparoscopy in 1 patient and subtotal gastrectomy in 1 patient. Median follow-up was 29?months. The median of percentage of weight loss (%WL) and excess body weight loss (EBWL) was 18.3 and 40?%, respectively, at ??5?years post-LAGB. Patients with body mass index (BMI) over 50?kg/m² were compared to those with BMI ??50?kg/m². No significant difference was noted in the weight loss between both of these groups. No significant difference was noted with regards to weight loss between patients <60 and >60?years of age.

Conclusions

In this cohort of patients, %WL and EBWL were 18.3 and 40?% ??5?years after LAGB, respectively, and early and late complication rates were 2.2 and 20?%, respectively. Majority of late complications were in the first 100 patients. Multifactorial causes included the surgical learning curve and patient selection process.     

Laparoscopic Gastric Banding Without Visible Scar: a Short Series with Intraumbilical SILS

Single-incision laparoscopic surgery has been developed with the aims of further reducing the invasiveness of traditional laparoscopy. The technique of lap-band placement from a single intraumbilical incision is described. Three patients underwent a single-incision laparoscopic surgery gastric banding (SILS-GB) for morbid obesity from May to September 2008. All interventions were uneventful and patients were discharged on first postoperative day, after an upper gastrointestinal series. SILS-GB is virtually scarless intervention and may be performed as a day-surgery procedure for the treatment of morbid obesity.     

Gastric Banding for Morbid Obesity: Initial Experience with a New Adjustable Band

A new adjustable gastric band was developed, consisting of a silicone balloon connected to a subcutaneous port in a closed system. The stoma diameter can be regulated within an extensive range (0-40 mm). The diameter is adjusted individually for each patient and weight loss can therefore be controlled and optimized. We evaluated the application of this new gastric banding procedure in terms of technical feasibility, complication rate and weight loss, and also the relationship between weight loss and pouch volume. Between January 1987 and April 1990 two preliminary studies of 18 and 24 patients respectively were carried out. In the first group there were technical problems resulting in insufficient weight loss. We therefore changed the procedure. In the second group the system thereafter worked as expected. In the second group mean preoperative weight was 132 kg, mean excess weight 60 kg, and mean BMI 45. The mean follow-up was in 21 months. At follow-up mean weight was 91 kg, mean weight loss 41 kg, and mean BMI 31. The mean postoperative stay was 6.0 days.     

Management of Gastric Perforations During Laparoscopic Gastric Banding

Background

Gastric perforations are one of the intraoperative complications of laparoscopic gastric banding (LAGB). Delayed diagnosis can increase the mortality and morbidity rates.

Methods

Retrospective analysis of surgery outcome and long-term follow-up of the patients with gastric perforations during primary LAGB and revisional band procedures was performed.

Results

Twenty-four patients with gastric perforations were identified during 15?years of LAGB surgeries. Half of these had primary LAGB and half had revisional procedures (five emergent and seven elective). Gastric tear was found at surgery in 19 patients; the band was preserved and LAGB was completed in 18 of these. Five patients had delayed diagnosis and underwent re-exploration 24?C72?h after surgery. During the surgery, 23 anterior, 8 posterior, 1 esophageal, and 1 small bowel tears were found. Laparoscopic repair was successful in 19 (83?%) cases. The mean surgery time and mean hospital stay were 56.3?min and 7.8?days, respectively. Morbidity and mortality rates were 25 and 4.1?%, respectively. Two patients underwent later band replacement following removal. Band erosion was observed in one patient. At least 17 patients had no complications during mean follow-up of 52.2?months.

Conclusions

Band preservation is recommended following primary repair of gastric tear. Early intra- and postoperative diagnosis of gastric tear in LAGB is essential for successful management of this iatrogenic injury and decreases occurrence of complications.     

Systematic Review of Erosion after Laparoscopic Adjustable Gastric Banding

Erosion of the laparoscopic adjustable gastric band (LAGB) into the lumen of the stomach is a recognised complication of this procedure. We undertook a systematic literature review of the incidence, clinical features and management of erosions occurring after LAGB. A systematic search of relevant medical databases for full-text original articles looking for LAGB patients and reported erosions was conducted. We focussed on incidence, aetiology, clinical presentation, treatment, complications and weight loss. Twenty-five studies of LAGB reported 231 erosions in 15,775 patients (overall incidence of 1.46%). The mean number of patients per study was 631 (±486), and the mean follow-up was 3.73 (±2.4) years. In four reports involving less than 100 patients, there were 27 erosions in a total of 270 patients (10%) compared with 180 erosions in 12,978 patients (1.386%) in the remaining 21 reports. Multiple regression analysis showed that erosion rate was significantly predicted by number of patients and number of years of surgeon experience (r ² = 0.186). Treatment was most commonly by removal of the band, repair of the stomach and later, band replacement. Other options were removal alone or conversion to another procedure. Weight loss was retained after treatment of the erosion with a mean weight loss at final follow-up of 50.34 ± 3.9 percent excess weight loss. Incidence of erosion after gastric banding is relatively low and can be related to surgeon experience. The most common treatment described in the literature is removal of the eroded band with delayed replacement. Replacement of the band is associated with maintenance of weight loss.     

Early Experience with Single-Access Transumbilical Adjustable Laparoscopic Gastric Banding

Background  

Laparoscopic adjustable gastric banding is the most common bariatric procedure performed worldwide; since FDA approval was granted for it in June 2001, the procedure has been steadily gaining popularity in the USA. We herein report our early experience with single-access transumbilical laparoscopic gastric banding. This approach to the procedure is performed mainly through a single incision in the umbilicus. This single incision is also utilized for the implantation of the port for subsequent band adjustments.     

Initial Experience with Laparoscopic Adjustable Gastric Banding in Hungary

Background: Laparoscopic adjustable gastric banding (LAGB) was started in Hungary in 1998. We used Lap-Band and SAGB devices. In this study we present our experience through the learning curve. Methods: From Jan 1999 to Dec 2002, 54 patients underwent laparoscopic surgery for morbid obesity in our department, using the Lap-Band? and SAGB. There were 33 men and 21 women, with median age 42 (range 20-64), and preoperative BMI 50 kg/m² (range 41-66). All underwent LAGB, except one patient who had laparoscopic vertical banded gastroplasty.The procedures used the 4-trocar technique. Results: The first patient required reoperation because of gastric rupture from drinking sparkling mineral water despite of our advice. Excluding this, we had no intraoperative or short-term postoperative complications. Mean operating time was 82 minutes (range 55-192), and hospital stay was 3 days. Followup ranges from 1 to 36 months. Mean weight loss was 47 kg at 12 months and 67 kg at 36 months. Mean BMI fell to 29 kg/m². Conclusion:With its safety and effectiveness, LAGB has been a good choice for handling morbidly obese patients in our early experience.     

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.     

Outcome and Complications after Laparoscopic Swedish Adjustable Gastric Banding: 5-Year Results of a Prospective Clinical Trial

BACKGROUND: Bariatric surgery is currently the only effective treatment for morbid obesity in terms of inducing and maintaining satisfactory weight loss and decreasing weight-related co-morbidities. A study was conducted to assess the effects, complications and outcome after laparoscopic Swedish adjustable gastric banding (SAGB) to 5 years. METHODS: Between June 1998 and December 2005, all patients with implantation of a SAGB were enrolled in a prospective clinical trial. Results were recorded and classified, with special regard to long-term complications and re-operation rate. RESULTS: SAGB was performed in 128 patients (87 female, 41 male). Mean age was 40.2 +/- 5.3 years, with mean preoperative BMI 44.5 +/- 3.9 kg/m2. Overall mortality was 0%. Patient follow-up was 94.5%. BMI after 1, 2 and 5 years was 35.7 +/- 3.7 kg/m2 (P < 0.005), 33.7 +/- 3.8 kg/m2 (P < 0.001) and 31.8 +/- 3.8 kg/m2 (P < 0.001), respectively. Mean EWL after 1, 2 and 5 years was 33.3 +/- 6.8% (P < 0.005), 45.5 +/- 6.4% (P < 0.001) and 57.4 +/- 6.5% (P < 0.001), respectively. The nonresponder rate (EWL < 30%) after 2 and 5 years was 17.0% and 6.8%, respectively. The early complication rate (< 30 d) was 6.25% (8/128), with 5 minor and 3 major complications. Late complications (> 30 d) occurred in 10.9% (14/128), of whom 2 were minor and 12 were major complications. The overall re-operation rate was 11.7% (15/128). CONCLUSIONS: At 5-year follow-up, laparoscopic SAGB is a safe and effective surgical treatment for morbid obesity. Our results appear to confirm that SAGB is a safer surgical treatment regarding rate and severity of complications compared with gastric bypass and malabsorptive procedures.