腹腔镜可调节捆扎带胃减容术治疗单纯重度肥胖症的临床应用

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

Preoperative esophageal manometry and outcome of laparoscopic adjustable silicone gastric banding

Background Laparoscopic adjustable silicone gastric banding (LASGB) for morbid obesity has been reported to provide long-term weight loss with a low risk of operative complications. Nevertheless, esophageal dilation leading to achalasia-like and reflux symptoms is a feared complication of LASGB. This study evaluates the clinical benefit of routine preoperative esophageal manometry in predicting outcome after LASGB in morbidly obese patients. Method A review of prospectively collected data on 77 patients who underwent routine esophageal manometry prior to LASGB for morbid obesity from February 2001 to September 2003 was performed. Aberrant motility, abnormal lower esophageal sphincter (LES) pressures, and other nonspecific esophageal motility disorders noted on preoperative esophageal manometry defined patients of the abnormal manometry group. Outcome differences in weight loss, emesis, band complications, and gastroesophageal reflux disease (GERD) resolution or improvement were compared between patients of the abnormal and normal manometry groups after LASGB. Analysis of variance (ANOVA) and chi-square tests were performed to determine the significance of these outcomes. Results Of the patients tested, 14 had abnormal esophageal manometry results, whereas 63 had normal manometry results before LASGB. There was no significant difference in percent excess weight loss (%EWL) at 6 and 12 months between the groups after gastric banding. Severe postoperative emesis occurred more frequently in patients with abnormal manometry results than in those with normal manometry results. There were two band-related complications, both of which occurred in patients of the normal manometry group. Conclusions Preoperative esophageal manometry does not predict weight loss or GERD outcomes after LASGB in morbidly obese patients. Postoperative emesis was more common in patients with abnormal manometry findings, but such symptoms were manageable and did not lead to poor weight loss or to band removal or increased band-related complications. Presented at the 2004 Resident and Fellow Scientific Session of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Denver, CO, March 31–April 3, 2004 Received a Poster of Distinction Award at the 2004 Scientific Session of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Denver, CO, March 31–April 3, 2004     

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.     

Laparoscopic adjustable gastric band versus laparoscopic Roux-en-Y gastric bypass

Background In the United States, the most frequently performed bariatric procedure is the Roux-en-Y gastric bypass (RYGB). Worldwide, the most common operation performed is the laparoscopic adjustable gastric band (LAGB). The expanding use of LAGB is probably driven by the encouraging data on its safety and effectiveness, in contrast to the disappointing morbidity and mortality rates reported for RYGB. The aim of this study was to evaluate the results of LAGB versus RYGB at a single institution. Methods Between November 2000 and July 2004, 590 bariatric procedures were performed. Of these, 120 patients (20%) had laparoscopic RYGB and 470 patients (80%) had LAGB. A retrospective review was performed. Results In the LAGB group, 376 patients (80%) were female, and the mean age was 41 years (range, 17–65). In the RYGB group, 110 patients (91%) were female, and the mean age was 41 years (range, 20–61). Preoperative body mass index was 47 ± 8 and 46 ± 5, respectively (p = not significant). Operative time and hospitalization were significantly shorter in LAGB patients (p < 0.001). Complications and the need for reoperation were comparable in both groups. Weight loss at 12, 18, 24, and 36 months for LAGB and RYGB was 39 ± 21 versus 65 ± 13, 39 ± 20 versus 62 ± 17, 45 ± 25 versus 67 ± 8, and 55 ± 20 versus 63 ± 9, respectively. Conclusions The current study demonstrates that LAGB is a simpler, less invasive, and safer procedure than RYGB. Although mean percentage excess body weight loss (%EBWL) in RYGB patients increased rapidly during the first postoperative year, it remained nearly unchanged at 3 years. In contrast, in LAGB patients weight loss was slower but steady, achieving satisfactory %EBWL at 3 years. Therefore, we believe that LAGB should be considered the initial approach since it is safer than RYGB and is very effective at achieving weight loss.     

Laparoscopic gastric banding for morbid obesity

Background: Morbid obesity occurs in 2–5% of the population of Europe, Australia, and the United States and is becoming more common. Open surgical techniques, such as vertical banded gastroplasty and other divisional procedures in the stomach, have led to long-term weight reduction as well as an amelioration of the attendant medical problems in approximately two-thirds of patients. Materials and methods: A total of 335 patients with a median age of 41 years underwent gastric banding. We emphasized the need for long-term maintenance and follow-up. The indications for surgery comprised a body mass index >35, a stated desire to undergo the procedure, and a full understanding of all possible complications. Results: All patients have needed band adjustments of 1–4 ml over the course of their follow-up. No patient had increased his or her weight during the follow-up, and only three patients have not enjoyed sustained weight loss. Conclusions: Laparoscopic gastric banding has much to recommend it. Certainly in the short term, its results in terms of effectiveness of weight loss are at least as good as those of any open procedure. Longer follow-up will show whether this weight loss is maintainable. The procedure is technically demanding, and the major prerequisite of satisfactory performance of this surgery is laparoscopic experience. Received: 12 May 1998/Accepted: 12 February 1999     

Laparoscopic adjustable silicone gastric banding in the treatment of morbid obesity

A first approach to laparoscopic placement of the adjustable silicone gastric band (ASGB) was begun in our institution in 1992. This work started on an animal model first. In the animal lab, details of laparoscopic dissection around the stomach have been defined. A new prototype of the adjustable silicone band for laparoscopic use has been devised. Four voluntary patients underwent this operation on the 1st, 2nd, and 3rd of September 1993. All the patients were female and the average weight was 116 kg (102–120 kg). The mean body mass index was 43 kg/m² (36–49 kg/m²). No major operative difficulty was encountered. Immediate postoperative outcome was uneventful.     

Anesthetic management of laparoscopic adjustable gastric banding in Japanese patients with morbid obesity

Laparoscopic adjustable gastric banding (LAGB) is a common type of bariatric surgery worldwide, though not so in Japan. Here we report the anesthetic management of LAGB in ten Japanese patients with morbid obesity. General anesthesia was induced with propofol, fentanyl, and vecuronium bromide and maintained with sevoflurane in oxygen and air (or nitrous oxide in some cases). In a limited number of patients, perioperative epidural analgesia was performed, with fentanyl injected intravenously for analgesia in the remaining patients. Although some special considerations were needed, in perioperative management, including thromboprophylaxis, there were no severe complications in any of the patients.     

Esophageal dilation after laparoscopic adjustable gastric banding

BACKGROUND: Esophageal dilation can occur after laparoscopic adjustable gastric banding (LAGB). There are few studies in the literature that describe the outcomes of patients with esophageal dilation. The aim of this article is to evaluate weight loss and symptomatic outcome in patients with esophageal dilation after LAGB. METHODS: We performed a retrospective chart review of all LAGBs performed at Columbia University Medical Center from March 2001 to December 2006. Patients with barium swallow (BaSw) at 1 year after surgery were evaluated for esophageal diameter. A diameter of 35 mm or greater was considered to be dilated. Data collected before surgery and at 6 months and 1, 2 and 3 years after surgery were weight, body mass index (BMI), status of co-morbidities, eating parameters, and esophageal dilation as evaluated by BaSw. RESULTS: Of 440 patients, 121 had follow-up with a clinic visit and BaSw performed at 1 year. Seventeen patients (10 women and 7 men) (14%) were found to have esophageal dilation with an average diameter of 40.9 +/- 4.6 mm. There were no significant differences in percent of excess weight lost at any time point; however, GERD symptoms and emesis were more frequent in patients with dilated esophagus than in those without dilation. Intolerance of bread, rice, meat, and pasta was not different at any time during the study. CONCLUSIONS: In our experience the incidence of esophageal dilation at 1 year after LAGB was 14%. The presence of dilation did not affect percent excess weight loss (%EWL). GERD symptoms and emesis are more frequent in patients who develop esophageal dilation.     

A novel technique for fascial fixation of laparoscopic adjustable gastric band ports

Access port dislodgement after laparoscopic adjustable gastric banding is a recurring problem that often requires operative revision. Securing the port to the abdominal wall fascia in the traditional way with standard instruments is challenging in obese patients due to a thick abdominal wall. Therefore, we have devised a novel and simple technique for access port fixation using the EndoStitch device.     

Safety and effectiveness of REALIZE adjustable gastric band: 5-year prospective study

BackgroundThe long-term safety results of the REALIZE (Ethicon Endo-Surgery, Inc., Cincinnati, OH) adjustable gastric band collected in this prospective, multicenter study in patients with morbid obesity are presented.ObjectivesTo determine the reoperation rate, including band revisions, replacements, and explants, resulting from a serious adverse device-related event through years 4 and 5. Various efficacy measures were also assessed as secondary objectives.SettingNine academic and/or private institutions.MethodsThe participating institutions enrolled 303 patients, who were then assessed on an annual basis, with 231 patients completing 5 years of follow-up. The study parameters included reoperation rates, changes in percentage of excess weight loss (%EWL), and changes in body mass index (BMI), as well as parameters of diabetes and dyslipidemia. Quality of life was assessed using the Short Form (SF)-36 and the Impact of Weight on Quality of Life-Lite questionnaires.ResultsThe reoperation rate due to a serious adverse event in this population at 5 years after implantation with the REALIZE gastric band was 8.9%. The most common serious adverse event was band slippage, which affected 6.9% of the study population. The mean %EWL was 35.6% ± 26.84%, and the decrease in mean BMI was ?7.01 ± 5.45 kg/m² at 5 years. Patients experienced improvements in mean glycated hemoglobin and serum lipid levels, in addition to improvements in the quality of life measures.ConclusionNo new safety concerns were identified during the 5 years of follow-up. Although the results of this study did not meet the predefined safety criteria of 8% or less, the safety profile and long-term effectiveness observed in this study are consistent with those in the current literature.     

Benchmarking hospital outcomes for laparoscopic adjustable gastric banding

Background Since the Food and Drug Administration (FDA) approval of laparoscopic adjustable gastric bands (LAGB) in June 2001, the number LAGB procedures performed in the United States has increased exponentially. This study aimed to benchmark the authors’ initial hospital experience to FDA research trials and evidence-based literature. Methods Over a 2-year period, 87 consecutive patients with a mean age of 43 years (range, 21–64 years) and a body mass index of 45.6 kg/m² (range, 35–69 kg/m²) underwent an LAGB procedure at the authors’ institution. The authors conducted a retrospective review of the outcomes including conversion, reoperation, mortality, perforation, erosion, prolapse, port dysfunction, excess weight loss, and changes in comorbidities, then compared the data with published benchmarks. Results Gender, age, and body mass index were comparable with those of other series. Perioperative adverse events included acute stoma obstruction (n = 1) and respiratory complications (n = 2). Delayed complications included gastric prolapse (n = 4) and port reservoir malposition (n = 4). Five bands were explanted. The mean follow-up period was 14 months (n = 79). The mean percentage of excess weight loss was 30% (range, 4.7–69%) at 6 months, 41% (range, 9.6–82%) at 12 months, and 47% (range, 14–92%) at 24 months. Comorbidities resolved included diabetes (74%), hypertension (57%), gastroesophageal reflux disease (55%) and dyslipidemia (38%). Conclusions The short-term outcomes for LAGB were comparable with published benchmarks. With adequate weight loss, most patients achieve significant improvement in obesity-related illnesses. With new bariatric accreditation standards and mandates required for financial reimbursement, hospitals will need to demonstrate that their clinical outcomes are consistent with best practices. The authors’ early experience shows that LAGB achieves significant weight loss with low mortality and morbidity rates. Despite a more gradual weight loss, most patients achieve excellent weight loss with corresponding improvement of comorbidities within the first 2 years postoperatively. Poster Presentation at Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meeting, Dallas, TX 2006     

Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases

Background: Kuzmak's gastric silicone banding technique is the least invasive operation for morbid obesity. The purpose of this study was to analyze the complications of this approach. Methods: Between September 1992 and March 1996, 185 patients underwent laparoscopic gastroplasty by the adjustable silicone band technique. A minimally invasive procedure using five trocars was performed. Results: In 11 patients exposure of the hiatus was impeded because of hypertrophy of the left liver lobe which led to conversion in eight patients and abortion of the procedure in three other patients. Anatomical complications: We observed two gastric perforations and one band slippage at the early stage, one infection and three rotations of the access port. Functional complications: There were eight (4%) cases of irreversible total food intolerance resulting in pouch dilation and eight cases (4%) of esophagitis. One fatality on the 45th day in a patient with a Prader-Willi syndrome. Conclusion: The most disturbing complications of gastric banding technique are gastric perforation and pouch dilation. Their incidence may be reduced by improving the technique and by considering pitfalls of the procedure. Received: 28 May 1996/Accepted: 25 July 1996     

Laparoscopic Adjustable Gastric Banding in a Morbidly Obese Patient with Situs Inversus Totalis

Laparoscopic adjustable gastric banding is a commonly performed bariatric operation worldwide. The presence of an anatomical variation like situs inversus demands preoperative assessment and preparedness on the part of the surgeon. We report a laparoscopic gastric banding performed on a morbidly obese patient with situs inversus totalis in the Kingdom of Saudi Arabia.     

Laparoscopic cardiomyotomy for achalasia after failed balloon dilatation

Background: This study was designed to determine the feasibility and outcome of laparoscopic cardiomyotomy in patients with achalasia who have persistent or recurrent dysphagia following balloon dilatation. Methods: Ten patients who had undergone a minimum of two (range, two to seven) previous balloon dilatations underwent a single anterior cardiomyotomy extending from the gastroesophageal junction onto the esophagus proximally for 6 cm. Four patients had a Toupet fundoplication. Patients were analyzed using pre- and postoperative DeMeester symptom scores for dysphagia, regurgitation, and heartburn (0 = none–3 = maximal) and esophageal manometry. Results: Mean operating time was 90 min. Periesophagitis was noted in some patients but was rarely troublesome. Submucosal fibrosis was present in all patients and made dissection more difficult particularly around the cardioesophageal junction. As a result, three patients had mucosal perforations that required repair by laparoscopic suturing. There were no subsequent postoperative complications. Median (IQR) postoperative stay was 3 (2–4) days. At 3-month reassessment, there was a reduction in the median dysphagia score from 3 to 0, and also in the regurgitation score from 3 to 0. At last follow-up (median, 22 months), one patient had developed recurrent dysphagia (grade 2), which improved with dilatation. Overall success of the laparoscopic procedure was therefore 90%. Only one patient developed new symptoms of reflux (mild, grade 1) after surgery. Conclusions: Laparoscopic cardiomyotomy provides good control of the symptoms of dysphagia and regurgitation without the morbidity of a laparotomy or thoracotomy incision. Although technically more difficult, the technique can be extended to those who have had previous balloon dilatation with complication and success rates similar to published results in patients who have not undergone previous dilatation. Received: 7 January 1998/Accepted: 22 June 1998     

U.S. experience with 749 laparoscopic adjustable gastric bands: intermediate outcomes

Background: Laparoscopic adjustable gastric band (LAGB) has consistently been shown to be a safe and effective treatment for morbid obesity, especially in Europe and Australia. Data from the U.S. regarding the LAGB has been insufficient. This study reveals our experience with 749 primary LAGB over a 3-year period in a U.S. university teaching hospital. Methods: All data was prospectively collected and entered into an electronic registry. Characteristics evaluated for this study include preoperative age, BMI, gender, race, conversion rate, operative time, hospital stay, percent excess weight loss (%EWL) and postoperative complications. Annual esophagrams were performed Results: From July 2001 through September 2004, 749 patients (531 females, 218 males) underwent LAGB for the treatment of morbid obesity. There were 630 Caucasians, 61 African-Americans, and 49 Latin Americans, with a mean age of 42.3 (range 18, 72 years) and mean BMI of 46.0 ± 7.0 (range 35, 91.5 kg/m²). There was one conversion to open (0.1%). Median operative time and hospital stay were 60 minutes and 23 hours, respectively. The mean %EWL at 1 year, 2 years, and 3 years was 44.4 (±17.8), 51.8 (±20.9), and 52.0 (±19.6), respectively. There were no mortalities. Postoperative complications occurred in 12.8% of patients: 1.5% acute postoperative band obstruction, 0.9% wound infection, 2.9% gastric prolapse (“slip”), 2.0% concentric pouch dilatation (without slip), 0.8% aspiration pneumonia, 2.4% port/tubing problems, 0.3% severe esophageal dilatation/dysmotility (reversible), and 1.5% overall band removal. Conclusion: These American results substantiate the data from abroad that LAGB is a safe and effective treatment for morbid obesity. Presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting, Fort Lauderdale, FL, USA, 14 April 2005     

Large series examining laparoscopic adjustable gastric banding as a salvage solution for failed gastric bypass

Background

The Roux-en-Y gastric bypass (RYGB) has long been considered the gold standard of weight loss procedures. However, there is limited evidence on revisional options with both minimal risk and long-term weight loss results.

Studies of Swedish adjustable gastric band and Lap-Band: systematic review and meta-analysis

BACKGROUND: This is the first systematic review and meta-analysis of the large body of data describing the Swedish adjustable gastric band (SAGB) and Lap-Band (LB). METHODS: A systematic review was performed that included screening of studies published in any language (January 1, 1998 through April 30, 2006) identified through MEDLINE, Current Contents, or the Cochrane Library. Studies with > or =10 SAGB or LB patients reporting > or =30-day efficacy or safety outcomes were eligible for review; the data were extracted from the accepted studies. A weighted means analysis and random-effects meta-analysis of efficacy outcomes of interest were conducted. RESULTS: A total of 4592 bariatric surgery studies met the initial criteria. Of these studies, 129 (28,980 patients) were accepted (33 SAGB and 104 LB studies); most had a retrospective single-center design. For 4273 patients (36 treatment groups) in 33 SAGB studies and 24,707 patients (111 groups) in 104 LB studies, the mean baseline age (39.1-40.2 yr), body mass index (43.8-45.3 kg/m2), and gender (women 79.2-82.5%) were similar. A laparoscopic technique was used in > or =88% and a pars flaccida technique in > or =41% of both groups. Early mortality was equivalent for SAGB/LB (< or =.1%). The 3-year mean SAGB and LB excess weight loss (56.36% and 50.20%, respectively) and body mass index reduction (-11.99 and -11.81 kg/m2, respectively) from baseline were statistically significant (P <.05), as was the resolution of diabetes (61.45% and 60.29%, respectively) and hypertension (62.95% and 43.58%, respectively). Although scant and inconsistently reported data precluded direct statistical comparisons, the complication rates for the 2 devices appeared comparable. In 8 directly comparative studies, meta-analysis found a significantly greater absolute weight loss (P <.05) with the SAGB at 2 years (48.4 versus 41.9 kg, mean difference -4.84, 95% confidence interval -9.47 to -0.22), although no difference was found in the percentage of excess weight loss or change in body mass index. CONCLUSION: In a systematic review of the published world SAGB and LB data, at 1, 2, and 3 years, the weight loss, resolution of diabetes and hypertension, and complications appeared comparable.     

Laparoscopic adjustable gastric banding for the treatment of adolescent morbid obesity in the United States: a safe alternative to gastric bypass

Background

Morbid obesity (MO) has reached epidemic proportions and is a major health problem in developed nations. In the adolescent with MO, early intervention can minimize obesity-related comorbidities, avoid premature mortality, improve quality of life, and prevent obesity-related diseases as these patients mature into adulthood. The primary surgical treatment of adolescent patients meeting National Institutes of Health criteria for bariatric surgery has been the gastric bypass (GB). Although GB has led to weight loss and improvement of comorbid conditions, concerns remain over the high incidence of postoperative complications and life-style-altering long-term sequelae of gastrointestinal tract reconstruction. Based on the excellent results from international adult series as well as the authors' own experience of more than 300 adult patients, laparoscopic adjustable gastric banding (LAGB) as an alternative to GB to eligible adolescents was offered.

Methods

After medical, psychologic, and nutritional screening, 4 patients (ages 17-19 years) with a body mass index of 40 or more (range, 40-61) who failed medical attempts at weight loss were selected for LAGB.

Results

The operative time was 40 to 90 minutes. All patients were discharged on the day of surgery. There were no early complications. One patient had cholecystitis 6 months after surgery requiring laparoscopic cholecystectomy. For the 4 patients, the amount of excess weight loss was 57% at 30 months, 34% at 12 months, 87% at 7 months, and 15% at 4 months, respectively.

Conclusions

In this preliminary series of the US experience in the use of LAGB for the management of adolescents with MO, the lack of operative morbidity, short operative time/hospital stay, and encouraging initial weight loss mirror the adult experience and illustrate that the LAGB is a safe and effective alternative to GB. These encouraging results support further evaluation of LAGB as a surgical option in a comprehensive adolescent weight loss program.     

Laparoscopic sleeve gastrectomy versus laparoscopic adjustable gastric banding for the treatment severe obesity in high risk patients

Background:

Laparoscopic sleeve gastrectomy (LSG) has emerged as an alternative restrictive bariatric procedure to the most popular laparoscopic adjustable gastric banding (LAGB). We analyze and compare the clinical and weight loss outcomes of LSG versus LAGB for the treatment of severe obesity in high-risk patients.

Methods:

Forty severely obese veterans (20/group) received either LSG or LAGB and were followed prospectively for 2 years. Outcome measures included operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), morbidity, mortality, reoperations, readmission rates, and weight loss over time.

Results:

The cohort primarily comprised high-risk and older male veterans. Patient''s baseline demographics were similar between groups. LSG was associated with prolonged OR time (116±31 vs. 94±28min), higher EBL (34±28 vs. 17±19mL), and LOS (2±.9 vs. 1±.4days) when compared with LAGB. Minor morbidity and readmissions were similar between groups, while no major morbidity, reoperations, or mortality occurred. Total weight and BMI decreased significantly after surgery in both groups (LSG: 302±52 to 237lbs and 45±5 to 36±5kg/m² vs. LAGB: 280±36 to 231±29lbs and 43±5 to 36±5kg/m², respectively). Total weight loss was superior in the LSG vs. LAGB group at 2 years (TWL=65±24 vs. 49±28 lbs (P=.03); %EWL=51±20 vs. 46±23%; %EBMI loss=48±22 vs. 45±23%, and %BWL = 21±8 vs. 17±9%, respectively).

Conclusion:

In severely obese and high-risk patients, laparoscopic sleeve gastrectomy provides superior total weight loss at 2 years.     

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.