The Swedish Adjustable Gastric Banding (SAGB) for morbid obesity — Weight loss, complications, pouch volume, and stoma diameter in a four-year follow-up

Summary Background: We have developed an adjustable gastric band in which the stoma diameter can be adjusted from the outside. The aim of this study was to evaluate the new standardized operating technique with our band in terms of weight loss and complication rate. Another aim of this study was to investigate the changes in pouch volume with time and the relationship between pouch volume and stoma diameter, and subsequent weight loss following the placement of the Swedish Adjustable Gastric Band (SAGB). Methods: Between August 1990 and November 1991, 50 patients (15 men and 35 women) were operated on by laparotomy. Mean preoperative weight was 134 (106–181) kg and the mean BMI was 46 (33–59) kg/m². During endoscopy, pouch volume was estimated according to a standardized classification system, and the stoma diameter was measured using balloon catheters. Results: At follow-up, mean weight was 80 kg and mean BMI was 27.5 kg/m². The patients had lost a mean of 54 kg. 2 patients (4%) had abdominal reoperation because of technical problems. There was 1 incisional hernia and 1 minor wound infection, but no other significant complications. We found that pouch volume was of crucial importance. If the pouch is small enough, regulation of the stoma diameter is an important tool for steering weight loss dynamics. If the pouch is too big, further narrowing of the stoma will not lead to additional weight loss. Conclusions: This relatively simple method appears to be at least as good as the other operations, and weight loss can be adjusted to patient comfort. Currently, the procedure is being performed laparoscopically.