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.     

Long-term outcomes of laparoscopic adjustable gastric banding

Background

Laparoscopic adjustable gastric banding (LAGB) is an option for the treatment of severe obesity. Few US studies have reported long-term outcomes. We aimed to present long-term outcomes with LAGB.

A comparison of laparoscopic adjustable gastric banding in adolescents and adults

Background: Laparoscopic adjustable gastric banding (AGB) induces effective weight loss in adults, but its efficacy in adolescents has yet to be determined. Methods: Since 1996, data have been collected prospectively on all patients undergoing laparoscopic AGB procedures performed at our hospital by a single surgeon (G.F.). Patients <20 years old at surgery (adolescents) were compared with- patients >20 years old (adults) who were matched for sex and body mass index (BMI). Results: Seventeen adolescents with a median age of 17 years (range, 12–19) and a BMI of 42.2 kg/m² (range, 30.3–70.5) were compared to 17 adults with a median age of 41 years (range, 23–70) and a BMI of 41.8 kg/m² (range, 30.1–71.5). There were no significant differences between the adolescents and the adults in complications or weight loss. The BMI dropped to 30.1 kg/m² (range, 22.6–39.4) in adolescents and 33.1 kg/m² (range, 28.4–41.3) in adults at 2-month follow-up. Conclusion: Laparoscopic AGB is as effective in adolescents as it is in adults.     

腹腔镜可调节胃束带术后并发症及治疗

目的探讨腹腔镜可调节胃束带术（LAGB）后并发症及治疗方法。方法回顾性分析2005年9月至2011年6月天津市南开医院行LAGB随访2年以上的83例肥胖症患者的临床资料。腹腔镜下放置胃束带,使束带上方形成1个容量约20～30ml胃小囊,将注水泵埋于剑突下腹直肌前鞘浅面。在术后4周根据患者体质量变化、餐后症状及上消化道造影情况,对胃束带进行注水调节。采用门诊和电话方式进行随访,随访时间截至2013年7月。结果83例患者并发症发生率为44．6％（37／83）,其中早期并发症（1个月内）6例、远期并发症31例。早期并发症主要表现为进食后呕吐,5例患者通过减慢进食速度、减少进食量后缓解;1例患者症状严重,予禁食水并营养支持,5d后症状缓解。远期并发症中,25例患者发生束带腐蚀胃壁并向胃腔内移位（其中6例合并注水泵处感染）,通过腹腔镜手术（早期1例行开腹手术）将胃束带取出,并缝合胃壁穿孔处获得治愈;10例患者发生注水泵相关并发症（6例为上述注水泵感染者,4例为注水泵移位）,通过手术将注水泵取出;2例发生束带滑动移位,通过抽净注水泵内生理盐水,改为流质饮食,减少进食量后,1例患者束带位置恢复正常,另1例患者无变化,行腹腔镜手术取出胃束带。结论LAGB术后并发症发生率较高,并随着术后时间的延长而增高,远期并发症多数需要再次手术治疗。     

Comparative outcomes of laparoscopic adjustable gastric banding in adolescents and adults

Background

Obesity is a major health problem in all age groups. Morbidly obese adolescents often fail to lose weight with diet and exercise and, as adults, become candidates for surgical intervention.

Methods

We matched adolescents (14–19 yr) and adults (19–73 yr) retrospectively from university medical center-based adolescent and adult obesity surgery programs who had undergone laparoscopic adjustable gastric banding by gender and body mass index (n = 115).

Results

The most common co-morbid condition in adolescents was menstrual irregularity/polycystic ovary syndrome. Hypertension was the most common co-morbid condition in adults. The adults were nearly 9 times as likely to be diabetic as the adolescents. We analyzed patients with ≥6 months of follow-up for the percentage of excess weight loss at 6-month intervals for ≤24 months. Both groups demonstrated progressive weight loss that did not differ significantly in the initial 12 months; however, the data beyond 12 months were limited by the small numbers.

Conclusion

The presence of more serious co-morbidities in obese adults, coupled with the successful weight loss after laparoscopic adjustable gastric banding, in adolescents suggests that weight loss surgery might be indicated at a younger age for severely obese individuals.     

Gallbladder disease in patients undergoing laparoscopic adjustable gastric banding

BACKGROUND: Patients undergoing weight loss surgery may have an increased incidence of subsequent gallbladder disease. Management options include treatment of symptomatic disease only, preoperative ultrasonography and concurrent cholecystectomy in presence of stones, routine concurrent cholecystectomy, and choleretic therapy postoperatively. Here we report our approach to patients undergoing laparoscopic adjustable gastric banding (LAGB) and subsequent outcomes. METHODS: A retrospective review of all consecutive patients undergoing LAGB at our institution was performed. Only symptomatic patients were preoperatively evaluated for cholelithiasis and underwent concurrent cholecystectomy. No choleretics were used postoperatively. Weight loss data were collected when patients returned for band adjustments. All band adjustments were patient-driven and performed under fluoroscopic guidance. RESULTS: Between November 2001 and July 2004, 324 patients underwent LAGB. Mean starting weight was 143.6 kg (range, 92.3 to 250.5 kg), and mean body mass index was 50.5 kg/m(2) (range, 35.6 to 80 kg/m(2)). Fifty-six patients had undergone previous cholecystectomy, and 7 other patients underwent concurrent cholecystectomy. Average follow-up was 12.5 months (range, 1.3 to 31 months). Absolute weight loss for all patients ranged from - 2.7 to 102.3 kg. Of the remaining patients, 3 underwent subsequent uneventful laparoscopic cholecystectomy for symptomatic cholelithiasis. No independent predictors for post-LAGB gallbladder disease were identified. CONCLUSION: Despite significant weight loss, few patients require cholecystectomy after LAGB. Routine preoperative ultrasonography, empiric cholecystectomy, and choleretic therapy are of questionable value in LAGB patients. Considering the magnitude of weight loss in our patients, empiric cholecystectomy for all bariatric procedures may merit further investigation.     

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.     

Laparoscopic adjustable gastric banding in adolescents: short-term results

Purpose

Children and adolescents who fail to lose weight through diet and exercise programs have been offered weight loss surgery for several years. We report our early results on laparoscopic adjustable gastric banding (LAGB) in 100 teenagers.

Methods

Candidates for surgery underwent rigorous assessment for medical eligibility, compliance, and psychological well-being. Patients who met criteria and were approved by our team were offered LAGB. Postoperatively, patients were followed monthly until steady weight loss was achieved, then every 3 months thereafter.

Results

One hundred patients aged 14 to 19 years underwent LAGB. Preoperative average weight was 136.7 kg, and median body mass index was 48.7. Comorbid medical conditions were common. Five reoperations were performed for port site bleeding, hiatal hernia repair, possible intestinal obstruction, and port slippage. Eighty-seven patients were followed for a minimum of 6 months. Average weight loss at 6 months was 12.4 (range, 33.2 to 16.2) kg, and average change in body mass index was 4.4 (range, 11.8 to −5.6).

Conclusion

Laparoscopic adjustable gastric banding may be performed safely in adolescents, and short-term results suggest that LAGB may serve as an important tool to help them lose weight.     

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.

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     

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.     

Controversies in Bariatric surgery: Evidence-based discussions on laparoscopic adjustable gastric banding

Laparoscopic adjustable gastric banding (LAGB) is a surgical option that involves placing a silicone band circumferentially around the uppermost aspect of the stomach. The band creates a small proximal pouch that empties slowly resulting in early satiety and a decreased appetite. The band is attached to an access port that is secured to the rectus muscle and can be accessed percutaneously in the office with a needle. Injection of saline into the port results in tightening of the band. This is performed on an individual basis according to weight loss and appetite. Band adjustments are required approximately 5–6 times in the first year and 2–3 times in the second year. Weight loss is gradual, averaging 1–2 lb/week during the first 2 years after surgery.     

Treatment of massive super-obesity with laparoscopic adjustable gastric banding

BACKGROUND: Controversy exists concerning the optimal treatment of patients with massive super-obesity (body mass index >60 kg/m(2)). The ideal surgical operation must balance optimal weight loss with minimal morbidity and mortality. We report our results for this patient population undergoing laparoscopic adjustable gastric banding (LAGB). METHODS: We performed a retrospective review of all consecutive patients undergoing LAGB at our institution. Patients with a preoperative body mass index >60 kg/m(2) were identified and their charts were reviewed. Weight loss data were collected when the patients returned for band adjustments. All band adjustments were patient driven and performed under fluoroscopic guidance. RESULTS: Between November 2001 and October 2004, 352 patients underwent LAGB. Of these, 53 had a preoperative body mass index >60 kg/m(2) (15%). The mean absolute weight and body mass index was 186.6 kg (range 139.6-250.6) and 66 kg/m(2) (range 60.0-79.8), respectively. The average follow-up was 12.5 months (range 1.3-31). The most prevalent co-morbidities were obstructive sleep apnea (64%), hypertension (42%), and diabetes mellitus (42%). Postoperative complications included one band removal for chronic obstruction, one band revision for slippage, and one nonfatal pulmonary embolism. The mean percentage of excess weight loss was 15% (-1.1 to 27.4) with <6 months of follow-up, 28.1% (range 1.9-44.5) with 6-12 months of follow-up, 35.1% (range 8.8-84.9) with 12-18 months of follow-up, and 42.9% (range 15.7-80.1) with >18 months of follow-up. Compared with our cohort of nonmassive super-obese patients, massive super-obese patients required a longer period of follow-up to accomplish a similar percentage of excess weight loss. CONCLUSION: LAGB is an appropriate surgical option for the treatment of massive super-obesity. The procedure can be performed with minimal morbidity and mortality and leads to promising medium-term weight loss. Longer term follow-up of massive super-obese patients is necessary and may demonstrate even more successful results.     

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.     

腹腔镜可调节胃束带术减重疗效及高失访率原因分析

目的评估肥胖患者行腹腔镜可调节胃束带术（LAGB）的长期减重疗效,并探讨LAGB术后高失访率的原因。方法回顾性分析2003年6月至2007年6月间在第二军医大学附属长海医院行LAGB术的226例肥胖患者的临床及随访资料。结果随访至2010年6月,125例（55-3％）患者获得随访．随访时间为3-7年,其中115例（92．0％）患者术后体质量下降,60例（48．0％）减去了额外体质量。失访105例（44．7％）,失访患者年龄偏轻（P〈0．05）;而性别、体质量和BMI则与失访率无关（均P〉0．05）。结论LAGB术是减重手术中相对简单、安全性极高的一种术式;但其术后随访较繁琐．失访率较高,应加强其术后随访。     

Laparoscopic adjustable gastric banding in adolescent: safety and efficacy

Background

Obesity prevalence is rapidly increasing among children and adolescents worldwide. It is considered one of the most alarming public health issues facing the world today. The adult experience has demonstrated that surgery is the only effective means of achieving persistent weight loss in obese patients. However, little is known about bariatric surgery in children and adolescents. The aim of this study is to evaluate the safety and efficacy of laparoscopic adjustable gastric banding (LAGB) in this group of patients.

Methods

A retrospective review included all children and adolescents who underwent LAGB from January 2003 to December 2005.

Results

Fifty-one patients underwent LAGB. The mean age was 16.8 years (range, 9-19), and the mean body mass index was 49.9 kg/m² (range, 38-63). Mean excess weight loss was 42% at 6 months and 60% at 1 year follow-up. The most prevalent comorbidities were obstructive sleep apnea, limited physical activities, hypertension, and diabetes mellitus. Band adjustments were performed under fluoroscopic guidance in 5 patients and direct access as a clinic procedure in the remaining. One patient required port repositioning under fluoroscopic guidance. The mean follow-up was 16 months (range, 3-34). There was no mortality or significant postoperative complications.

Conclusion

The absence of significant nutritional deficiency, the continued adjustability, and potential reversibility of LAGB make it the safest, least invasive, and most effective bariatric surgery that can be offered to the young and adolescent population.     

Postoperative complications of laparoscopic adjustable gastric banding

Background: The primary aim was to determine the rate and nature of late postoperative complications in relation to the type of band used and the route through which it encircled the stomach in a retrospective review of postoperative complications that necessitated reoperation in 500 consecutive cases of laparoscopic adjustable gastric banding (LAGB) conducted over the past 48 months. Methods: The four study groups were: (A) Lap‐Band^® perigastric route, 186 cases; (B) Lap‐Band^® pars flaccida route 73 cases; (C) SAGB perigastric 70 cases, and (D) SAGB pars flaccida, 171 cases. There were 414 women and 86 men. The mean age was 39.2 ± 11.0 years (17–68). The mean weight was 126 kg, and mean BMI was 43.4 kg/m² prior to operation. Results: There were 32 cases of slippage (17%) in group A and five cases (7%) in Group B (P < 0.05). In group C there were 15 cases (21%) of slippage and in group D six cases (3%) (P < 0.05). There were no significant differences between Groups A and C or Groups B and D. Except for one case of band erosion in Group C, erosion, tube disconnection and aneurysmatic balloon dilatation occurred only in groups A and B. Band erosion occurred in 2% each in groups A and B, tube disconnection in 3% and 4%, respectively, and balloon dilatation in 2% in each of groups A and B. Conclusions: Slippage was primarily route dependent. Erosion, tube disconnection and aneurysmatic dilatation of the balloon were encountered almost exclusively in the high‐pressure system. We conclude that the pars flaccida route with the low‐pressure system is more effective in reducing the rate of complications necessitating reoperation.     

Laparoscopic adjustable gastric banding: initial Tasmanian experience

Background: The laparoscopic adjustable gastric band (LAGB) is a minimally invasive, adjustable and reversible bariatric pro­cedure. The present paper reports an initial 2 year experience at Royal Hobart Hospital, Tasmania. Methods: Between February 1999 and June 2001, 207 patients underwent LAGB insertion (176 female, 31 male). The mean age was 43 years (range: 16?74 years). Mean preoperative weight was 125 kg (range: 83?210 kg) and mean body mass index (BMI) was 45.9 (range: 32.6?67.0). The Bioenterics LAGB (Inamed, Chullora, NSW, Australia) was used in all cases. The average follow up was 17 months (range: 3?24 months). Three patients were lost to follow up (1.5%). Results: The average weight loss was 12.4 kg at 3 months, 25.3 kg at 1 year and 34.8 kg at 2 years. The average BMI was reduced from 45.9 preoperatively to 41.3 at 3 months, 36.9 at 1 year and 33.5 at 2 years. Reoperation for band slippage occurred in 24 patients (11%), and the injection reservoir required changes in 22 patients (11%). There were three perforations while inserting the LAGB, two non‐fatal pulmonary emboli (1%) and two cases of deep vein thrombosis (1%). There has been no mortality. Conclusions: Laparoscopic adjustable gastric banding is a safe and effective method of achieving significant (P < 0.0001) weight reduction in the morbidly obese.