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

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

Laparoscopic Roux-en-Y gastric bypass for morbid obesity.

Surgery is currently the only effective treatment for morbid obesity. The two most commonly accepted operations are the Roux-en-Y gastric bypass and vertical banded gastroplasty. Although multiple authors have reported on a laparoscopic approach to gastric banding, the Roux-en-Y gastric bypass is a complex operation to be replicated using laparoscopic techniques. In this article, we describe our technique of the Roux-en-Y gastric bypass using a laparoscopic approach in four cases.     

Bariatric Surgery: Asia-Pacific Perspective

Background: There is a world-wide epidemic of overweight, obesity and morbid obesity. Bariatric surgery today, as the only effective therapy for morbid obesity, is expanding exponentially to meet the global epidemic of morbid obesity. Bariatric surgeons in the Asia-Pacific region had founded the Asia-Pacific Bariatric Surgery Group (APBSG) at Seoul, Korea on October 6, 2004. Methods: E-mail requests for information were sent to the national bariatric surgery leaders. These requests were followed, if necessary, by second e-mail requests and communications seeking clarification. The summary data was also discussed at the 1st Asia-Pacific Bariatric Consensus Meeting held in Taipei, February 27, 2005. Results: 11 countries or areas in Asia had started bariatric surgery and responded to the general questions. In 2004, 636 bariatric operations were performed by 61 bariatric surgeons. The earliest data for starting bariatric surgery was in 1974 in Taiwan. Following the development of gastric partition, Taiwan performed the first case in 1981, Japan in 1982 and Singapore in 1987. In 2004, 11 countries have started bariatric surgery. The APBSG was founded in 2004. In 2004, 12.1% of operations were open and 87.9% laparoscopic. The 6 most popular operations were: laparoscopic adjustable banding 42.3%; laparoscopic gastric bypass 34.2%; open vertical banded gastroplasty 7.5%; laparoscopic vertical banded gastroplasty 6.3%; laparoscopic sleeve gastrectomy 6.3%; open gastric bypass 4.2%. Pooling open and laparoscopic procedures, relative percentages were gastric banding 42.3%; gastric bypass 38.4%; vertical banded gastroplasty 13.8%. The APBSG consensus meeting recommended bariatric surgery in Asian patients with BMI >37 or >32 with diabetes or two other obesity-related co-morbidities. Conclusions: Bariatric surgery is expanding rapidly in Asia to meet rapidly increasing obesity. The modification of the indications for bariatric surgery in the Asian is proposed.     

Prospective randomised comparison of adjustable gastric banding and vertical banded gastroplasty for morbid obesity.

OBJECTIVE: To compare the clinical results of adjustable gastric banding and vertical banded gastroplasty for morbid obesity. DESIGN: Prospective randomised trial. SETTING: University hospital, Sweden. PATIENTS: 59 morbidly obese patients, listed for obesity surgery. INTERVENTIONS: Adjustable gastric banding (n = 29) or vertical banded gastroplasty (n = 30). MAIN OUTCOME MEASURES: Weight loss, complications, need for revisional surgery, reflux symptoms and the patient's own evaluation. RESULTS: Five years after surgery the mean (SEM) weight reduction for adjustable gastric banding was 43 (3.0) kg and for vertical banded gastroplasty 35 (4.8) kg. One patient in each group died of unrelated causes during follow-up and 3 and 2 patients, respectively, were lost to follow-up. One patient in the vertical banded group required reoperation for an anastomotic leak on the third postoperative day. A total of 3 patients in the adjustable group required reoperation and 11 in the vertical banded group. CONCLUSIONS: Adjustable gastric banding carries a smaller risk of reoperation than vertical banded gastroplasty and the weight reduction is in the same order of magnitude.     

The state of the art in bariatric surgery for weight loss in the morbidly obese patient

Bariatric surgery is a safe and effective method for achieving durable weight loss for patients with morbid obesity. Gastric restrictive procedures include vertical banded gastroplasty and gastric banding. Malabsorptive procedures include long-limb gastric bypass, biliopancreatic diversion, and biliopancreatic diversion with duodenal switch. The gastric bypass has features of both restriction and malabsorption. The laparoscopic approach to bariatric surgery has substantially improved postoperative recovery. Careful patient selection and preoperative work-up are extremely important. A number of medical comorbidities are improved after surgically-induced weight loss.     

Bariatric Surgery Worldwide 2003

Background: There is a world epidemic of overweight, obesity, and morbid obesity, encompassing 1.7 billion people. Bariatric surgery today is the only effective therapy for morbid obesity. Methods: E-mail requests for information were sent to the presidents of the national societies of the 31 International Federation for the Surgery of Obesity (IFSO) nations, or national groupings, plus Sweden. Responses were tabulated; calculation of relative prevalence of specific procedures was done by weighted averages. Results: Responders were 26 of 32 (81%) for the general questions and 24 of 32 (75%) for the question on specific operative percentages. In the year 2002-2003, 146,301 bariatric surgery operations were performed by 2,839 bariatric surgeons; 103,000 of these operations were performed in USA/Canada by 850 surgeons. The earliest start date for bariatric surgery was 1953 in the USA; IFSO was founded in 1995. In the year 2002-2003, 37.15% of operations were open; 62.85% laparoscopic. The 6 most popular procedures by weighted averages were: laparoscopic gastric bypass, 25.67%; laparoscopic adjustable gastric banding, 24.14%; open gastric bypass, 23.07%; laparoscopic long-limb gastric bypass, 8.9%; open long-limb gastric bypass, 7.45%; and open vertical banded gastroplasty, 4.25%. Pooling open and laparoscopic procedures, relative percentages were: gastric bypass, 65.11%; gastric banding, 24.41%; vertical banded gastroplasty, 5.43%; and biliopancreatic diversion/duodenal switch, 4.85%. Categorizing into restrictive/malabsorptive, purely restrictive, and primarily malabsorptive, the relative distribution of procedures was 65.11%, 29.84%, and 4.85%, respectively. The number of countries performing gastric banding was 23 (95%), gastric bypass 21 (88%), vertical banded gastroplasty 19 (79%), and biliopancreatic diversion/duodenal switch 16 (67%). Purely restrictive procedures were performed in 24 (100%) of the countries, restrictive/malabsorptive in 21 (88%), and primarily malabsorptive in 18 (75%). Conclusions: Bariatric surgery is expanding exponentially to meet the global epidemic of morbid obesity. Operative procedures in bariatric surgery are in flux and specific geographic trends and shifts are evident. Yet, of the patients qualifying for surgery, only about 1% are receiving this therapy – the only effective treatment currently available.     

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.     

Obesity Surgery in Russia

Background: In Russia, 40% of the population are overweight, and 26% are obese. As was mentioned at the IFSO Symposium in Cancun, very little is known about obesity surgery in Russia. Methods: The authors undertook a literature search and interviewed surgeons who are known to perform bariatric procedures. Results: Jejunoileal bypass (JIB) was used in the 1970s but has been abandoned by most surgeons. Since 1977, 334 JIBs, of a total of 360 bariatric operations, have been performed at I Saint Petersburg Medical University. The remaining 26 operations included 14 gastric bandings, 6 horizontal and 4 vertical gastroplasties, and 2 gastric bypasses. Since 1984, 545 gastric banding procedures have been done at the Moscow Medical Academy, where the current approach is the lap-band type of gastric banding. The laparoscopic technique of adjustable gastric banding is beginning to be used. Vertical banded gastroplasty (VBG) was begun in the early 1990s. At the Russian Research Center of Surgery in Moscow, 48 Mason VBGs have been done. The other group in Moscow reported 28 VBGs without the creation of a window and including covering the stoma by polypropylene mesh. There are only a few known cases of gastric bypass procedures. No data on biliopancreatic diversion were found. Conclusions: Obesity surgery is not being performed enough to satisfy the requirements of the Russian population. Simple operations are more common than complex ones. The use of the laparoscopic approach has begun and probably will increase.     

Laparoscopic vertical banded gastroplasty

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

History and Technical Aspects of Bariatric Surgery in the Czech Republic

Background: Central Europe and the Czech Republic are specific in the prevalence of obesity which has increased by 10-40% during the last 10 years. Methods: In the Czech republic there is 30 years of experience of a comprehensive approach to obesity treatment which includes: dietary treatment; exercise; behavioral modification; drug treatment; and bariatric surgery. Each of these approaches has its place in complex obesity management. Since 1983 bariatric surgery has been established in the Czech Republic for the treatment of morbid obesity. Vertical banded gastroplasty (VBG), gastric banding, laparoscopic nonadjustable and adjustable gastric bandings have been used over the years. Since 1993 laparoscopic gastric banding has been the only method used in our department. Results: The comprehensive approach for obesity treatment in the Czech Republic has resulted in the development of obesity management and research centers, regional obesity units, obesity out-patients clinics and weight reduction clubs. The surgical treatment is a well-established part of this system and the long-term results of surgical treatment are acceptable both in terms of weight loss and complication rate. There has been no statistical difference in weight loss results following VBG and laparoscopic gastric banding, but there is a significant decrease in morbidity, and shorter hospital stay associated with laparoscopic gastric banding. Conclusions: The surgical approach in obesity treatment has an important place in the comprehensive care of obese patients. Laparoscopic gastric banding in the hands of an experienced surgeon is a method with low morbidity, short hospital stay and long-term weight loss results which are fully comparable with the results of other surgical approaches.     

Evidence-based medicine: open and laparoscopic bariatric surgery

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

Cost-Effective Restrictive Bariatric Surgery: Laparoscopic Vertical Banded Gastroplasty Versus Laparoscopic Adjustable Gastric Band

Background  

Among bariatric restrictive operations, the procedure of choice is still controversial. The aim of this study is to compare the cost of two gastric restrictive procedures: laparoscopic vertical banded gastroplasty (LVBG) and laparoscopic adjustable gastric banding (LAGB).     

手术治疗肥胖症及糖尿病——在共识与争议中发展

肥胖症已经成为现今社会所面临的最严重的公共健康问题之一,手术治疗是使肥胖症病人获得长期而稳定的减重效果的唯一手段。自从20世纪50年代出现第一例减肥手术的报道以来,胃肠外科手术治疗肥胖症在全球范围内获得了很大的发展,已经成为治疗病态肥胖的“金标准”。在2000 年开展国内第一例腹腔镜下垂直绑带式胃减容术之后,笔者单位还开展了腹腔镜下可调节胃绑带术、“Y”型胃肠短路术、改良简易型胃肠短路术、管状胃胃切除术等,并且所有手术均在腹腔镜的条件下完成,取得了非常好的效果。随着研究的不断深入,越来越多的证据表明,胃肠外科手术不仅能减重,同时可能改善甚至治愈肥胖症相关的多种代谢性疾病,尤其是2型糖尿病。目前国内外的胃肠外科医师们正致力于将手术推广到2型糖尿病的治疗中去。外科手术治疗代谢性疾病仍有巨大的发展空间。     

Distal Esophageal Erosion After Laparoscopic Adjustable Gastric Band Placement with Nissen Fundoplication Takedown

Although primary band placement is proven to be safe, gastric band placement after previous operations in the area of the gastroesophageal junction remains controversial. Erosion into the stomach has been described after failed vertical banded gastroplasty conversion to laparoscopic gastric banding (LAGB), but no reports in the English literature are available on erosion of an adjustable gastric band into the esophagus after conversion operations. To our knowledge, this is the first case report of distal esophageal erosion after LAGB placement with Nissen fundoplication takedown.     

Laparoscopic Gastric Banding: preliminary series

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

Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review

BACKGROUND: We attempted to compare the safety and efficacy of laparoscopic adjustable gastric banding with vertical-banded gastroplasty and gastric bypass. Morbid obesity presents a serious health issue for Western countries, with a rising incidence and a strong association with increased mortality and serious comorbidities, such as diabetes, hyperlipidemia, and cardiovascular disease. Unfortunately, conservative treatment options have proven ineffective. Surgical interventions, such as vertical-banded gastroplasty (stomach stapling), Roux-en-Y gastric bypass, and, more recently, laparoscopic gastric banding have been developed with the aim of providing a laparoscopically placed device that is safe and effective in generating substantial weight loss. METHODS: Electronic databases were systematically searched for references relating to obesity surgery by (1) laparoscopic adjustable gastric banding (LAGB), (2) vertical banded gastroplasty (VBG), and (3) Roux-en-Y gastric bypass (RYGB). RESULTS: Only 6 studies reported comparative results for laparoscopic gastric banding and other surgical procedures. One study reported comparative results for all 3 surgical procedures, and this study was only of moderate quality. In total, 64 studies were found that reported results for LAGB and 57 studies reported results on the comparative procedures. LAGB was associated with a mean short-term mortality rate of approximately 0.05% and an overall median morbidity rate of approximately 11.3%, compared with 0.50% and 23.6% for RYGB, and 0.31% and 25.7% for VBG. Overall, all 3 procedures produced considerable weight loss in patients up to 4 years in the case of LAGB (the maximum follow-up available at the time of the review), and more than 10 years in the case of the comparator procedures. CONCLUSIONS: The Australian Safety and Efficacy Register of New Interventional Procedures-Surgical Review Group concluded that the evidence base was of average quality up to 4 years for LAGB. Laparoscopic gastric banding is safer than VBG and RYGB, in terms of short-term mortality rates. LAGB is effective, at least up to 4 years, as are the comparator procedures. Up to 2 years, LAGB results in less weight loss than RYGB; from 2 to 4 years there is no significant difference between LAGB and RYGB, but the quality of data is only moderate. The long-term efficacy of LAGB remains unproven, and evaluation by randomized controlled trials is recommended to define its merits relative to the comparator procedures.     

Roux-en-Y gastric bypass after previous unsuccessful gastric restrictive surgery

In the treatment of morbid obesity, simple gastric restrictive methods such as silicone adjustable gastric banding, vertical banded gastroplasty, and nonadjustable gastric banding often fail to control weight in the long run or give rise to intolerable side effects. Here we review our results from conversion of such failures to Roux-en-Y gastric bypass. The study comprised 44 patients (median age 42 years, range 24 to 60 years) who underwent revision surgery in 1996 and 1997. Body mass index at revision was 35 kg/m² (range 21 to 49 kg/m²). Previous bariatric procedures included silicone adjustable gastric banding (n = 26), vertical banded gastroplasty (n = 13), and gastric banding (n = 5). The most common reasons for conversion after silicone adjustable gastric banding and nonadjustable gastric banding were band erosion (n = 12) and esophagitis (n = 11). Staple line disruption (n = 12) with subsequent weight loss failure was the primary cause after vertical banded gastroplasty. There were no postoperative deaths or anastomotic leaks. One patient underwent reexploration because of an infected hematoma. Reflux symptoms and vomiting resolved promptly. At global assessment 2 years later, 70% of the patients were very satisfied. Median body mass index had decreased to 28 kg/m² (range 18 to 42 kg/m²). No patient was lost to followup. As reported previously, failure after vertical gastric banding can be treated by conversion to Roux-en-Y gastric bypass with good results. In this study we found that failure after silicone adjustable gastric banding can be treated successfully with Roux-en-Y gastric bypass as well. Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, Louisiana, May 17–20, 1998 (poster presentation).     

Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty

BackgroundLaparoscopic sleeve gastrectomy (LSG) is considered an effective multipurpose operation for morbid obesity, although long-term results are still lacking. Also, the best procedure to be offered in the case of failed restrictive procedures is still debated. We here reported our results of LSG as a revisional procedure for inadequate weight loss and/or complications after adjustable gastric banding or gastroplasty.MethodsSince April 2005, 57 patients (20 men and 37 women), with a mean age of 49.9 ± 11.9 years, underwent revisional LSG, 52 after laparoscopic adjustable gastric banding/adjustable gastric banding and 5 after vertical banded gastroplasty at our institution. The mean interval from the primary procedure to LSG was 7.54 ± 4.8 years. The LSG was created using a 34F bougie with an endostapler, after removing the laparoscopic adjustable gastric band or the anterior portion of the band in those who had undergone vertical banded gastroplasty. An upper gastrointestinal contrast study was performed within 3 days after surgery and, if the findings were negative, a soft diet was promptly started.ResultsA total of 41 patients had undergone concurrent band removal and LSG and 16 had undergone band removal followed by an interval LSG. Three cases required conversion to open surgery because of a large incisional hernia. The mean operative time was 120 minutes (range 90–180). One patient died of multiple organ failure from septic shock. Three patients (5.7%) developed a perigastric hematoma, 3 (5.7%) had leaks, and 1 had mid-gastric short stenosis. The median hospital stay was 5 days. The mean body mass index at revisional LSG was 45.7 ± 10.8 kg/m² and had decreased to 39 ± 8.5 kg/m² after 2 years, with a mean percentage of the estimated excess body mass index lost of 41.6% ± 24.4%. Two patients required a duodenal switch for insufficient weight loss.ConclusionLSG seems to be effective as revisional procedure for failed LAGB/vertical banded gastroplasty, although with greater complication rates than the primary procedures. Larger series and longer follow-up are needed to confirm these promising results.     

Management of surgical complications of previous bariatric surgery in pregnant women. A systematic review from the BARIA-MAT Study Group

Considering the large and increasing population of women of childbearing age with history of bariatric surgery, surgical complications of bariatric surgery during pregnancy may become more frequent in the future. The aim of this study was to analyze the clinical presentation, diagnostic procedures, and treatment of surgical complications of bariatric surgery during pregnancies. A systematic literature search was performed in accordance with the PRISMA (preferred reporting items for systematic review and meta-analysis) guidelines to identify all studies published up to and including December 2018 that included women with previous bariatric surgery undergoing emergency surgery during pregnancy. Sixty-eight studies were selected, including 120 women with previous bariatric surgery undergoing emergency surgery during pregnancy. Fifty cases were reported as case reports and 70 in case series. Included patients had previous history of Roux-en-Y gastric bypass (n = 99), laparoscopic adjustable gastric banding (n = 17), Scopinaro procedure (n = 2), vertical banded gastroplasty (n = 1), or one-anastomosis gastric bypass (n = 1). Final diagnosis in 50 case reports was internal hernia in 26 cases, bowel intussusception in 10, intestinal obstruction in 2, laparoscopic adjustable gastric banding slippage in 3, bowel volvulus in 3, gastric or jejunal perforation in 2, and other complications in 4 cases. Maternal and fetal death occurred in 3 (2.5%) and 9 cases (7.5%), respectively. In the case series, the majority of women were operated for internal hernia and laparoscopic adjustable gastric banding slippage. Surgical complications of previous bariatric surgery during pregnancy have potentially severe outcomes. Availability of multidisciplinary expertise, including bariatric/digestive surgeons, and education of healthcare providers and women on clinical signs that require urgent surgical examination are recommended in this setting. Prompt diagnosis is fundamental and based on clinical and laboratory findings and on radiologic examinations if needed, including computed tomography scan or magnetic resonance if available. Rapid surgical exploration is mandatory in case of high clinical and/or radiologic suspicion.     

Laparoscopic Swedish Adjustable Gastric Banding: 6-year Follow-up and Comparison to other Laparoscopic Bariatric Procedures

Background: The advantages of laparoscopy over open surgery are well known. The aim of this study was to compare our results with Swedish adjustable gastric banding (SAGB) with other laparoscopically performed bariatric procedures (gastric bypass, LapBand^?, vertical banded gastroplasty). Methods: Between January 1996 and December 2001, 454 patients (381 women, 73 men) underwent laparoscopic SAGB. All data (demographic and morphologic, co-morbidities, operative, and follow-up) were prospectively collected in a computerized databank. Results: Mean follow-up was 30 months (range 1-66). Average total weight loss was 35.5 kg after 1 year, reaching an average total of 54 kg after 3 years. Mean excess weight loss was 72% after 3 years, and the BMI decreased from 46.7 to 28.1 kg/m². Patients with co-morbidities reported marked improvement of their accompanying diseases. Complications requiring reoperation occurred in 7.9%. There was no mortality. The clinical outcome compared with the other laparoscopic bariatric procedures showed no significant difference. Conclusion: All laparoscopically performed bariatric procedures are very promising. The great advantage of laparoscopic adjustable gastric banding is that this operation is minimally invasive to the stomach, totally reversible and adjustable to the patients' needs.