Value of Routine Postoperative Gastrographin Contrast Swallow Studies After Laparoscopic Gastric Banding (original) (raw)
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Reduction in Co-morbidities 4 Years after Laparoscopic Adjustable Gastric Banding
Obesity Surgery, 2004
Methods: Between December 1996 and October 2002, 295 patients with mean BMI 45 kg/m 2 were operated (79% women, average age 41 years). Mean follow-up was 44 months. Reduction in co-morbidity was scaled relative to the preoperative co-morbidity level as having been cured, improved, unchanged, or worsened. Patients needing reoperations were analyzed separately.
Outcome after Laparoscopic Adjustable Gastric Banding – 8 Years Experience
Obesity Surgery, 2003
Background: Laparoscopic adjustable gastric banding (LAGB) has been our choice operation for morbid obesity since 1994. Despite a long list of publications about the LAGB during recent years, the evidence with regard to long-term weight loss after LAGB has been rather sparse. The outcome of the first 100 patients and the total number of 984 LAGB procedures were evaluated. Methods: 984 consecutive patients (82.5% female) underwent LAGB. Initial body weight was 132.2 ± 23.9 SD kg and body mass index (BMI) was 46.8 ± 7.2 kg/m 2. Mean age was 37.9 (18-65). Retrogastric placement was performed in 577 patients up to June 1998. Thereafter, the pars flaccida to perigastric (two-step technique) was used in the following 407 patients. Results: Mortality and conversion rates were 0. Follow-up of the first 100 patients has been 97% and ranges in the following years between 95% and 100% (mean 97.2%). Median follow-up of the first 100 patients who were available for follow-up was 98.9 months (8.24 years). Median follow-up of all patients was 55.5 months (range 99-1). Early complications were 1 gastric perforation after previous hiatal surgery and 1 gastric slippage (band was removed). All complications were seen during the first 100 procedures. Late complications of the first 100 cases included 17 slippages requiring reinterventions during the following years; total rate of slippage decreased later to 3.7%. Mean excess weight loss was 59.3% after 8 years, if patients with band loss are excluded. BMI dropped from 46.8 to 32.3 kg/m 2. 5 patients of the first 100 LAGB had the band removed, followed by weight gain; 3 of the 5 patients underwent laparoscopic Roux-en-Y gastric bypass (LRYGBP) with successful weight loss after the redo-surgery. 14 patients were switched to a "banded" LRYGBP and 2 patients to a LRYGBP during 2001-2002. The quality of life indices were still improved in 82% of the first 100 patients. The percentages of good and excellent results were at the highest level at 2 years after LAGB (92%). Conclusions: LAGB is safe, with a lower complication rate than other bariatric operations. Reoperations can be performed laparoscopically with low morbidity and short hospitalizations. The LAGB seems to be the basic bariatric procedure, which can be switched laparoscopically to combined bariatric procedures if treatment fails. After the learning curve of the surgeon, results are markedly improved. On the basis of 8 years long-term follow-up, it is an effective procedure.
Journal of Gastrointestinal Surgery, 2005
Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB) are common surgical procedures for morbid obesity, but few studies have compared LRYGB and LAGB. All patients who underwent LRYGB and LAGB by a single surgeon at Legacy Health System were identified from a prospectively maintained database. Preoperatively, most patients were allowed to choose between LRYGB and LAGB. Age, sex, body mass index (BMI), complications, mortality, and weight loss were examined. From October 2000 to November 2003, 219 patients underwent LRYGB and 154 patients underwent LAGB. Mean preoperative BMI was 49.5 Ϯ 6.6 and 50.9 Ϯ 9.4 kg/m 2 , respectively (P ϭ 0.10). Mean age was 42 Ϯ 9 and 47 Ϯ 11 years (P Ͻ 0.001). The LAGB group had a higher proportion of male patients (21% versus 7%, P Ͻ 0.001). Patients undergoing LRYGB had longer operative times (134 versus 76 minutes, P Ͻ 0.001), more blood loss (43 versus 28 ml, P Ͻ 0.01), and longer hospital stays (2.6 versus 1.3 days, P Ͻ 0.001). Excess weight loss was 35% for LRYGB versus 19% for LAGB at 3-month follow-up (P Ͻ 0.001), 49% versus 25% at 6 months (P Ͻ 0.001), 64% versus 36% at 12 months (P Ͻ 0.001), 70% versus 45% at 24 months (P Ͻ 0.001), and 60% versus 57% at 36 months (P ϭ 0.85). Major complications occurred in 7% and 6% (P ϭ 0.58) and minor complications occurred in 18% and 20% (P ϭ 0.65) of patients, respectively. Reoperation occurred in 21 patients (10%) after LRYGB and 31 (20%) patients after LAGB (P Ͻ 0.01). Of patients undergoing reoperation, eight (38%) LRYGB patients and one (3%) LAGB patient required open laparotomy. One death occurred in each group. Patients undergoing laparoscopic adjustable gastric banding have shorter operative times, less blood loss, and shorter hospital stays compared with laparoscopic gastric bypass patients. The incidence of major and minor complications is similar; however, morbidity after LRYGB is potentially greater and the reoperation rate is higher in the LAGB group. Early weight loss is greater with gastric bypass, but the difference appears to diminish over time. ( J GASTROINTEST SURG 2005;9:30-41)
Long-Term (over 10 Years) Retrospective Follow-up of Laparoscopic Adjustable Gastric Banding
Obesity Surgery, 2017
Background Laparoscopic adjustable gastric banding (LAGB) placements have progressively decreased in recent years. This is related to poor long-term weight loss outcomes and necessity for revision or removal of these bands. Longterm outcome results following LAGB are limited. The aim of our study was to determine the long-term outcome after LAGB at our institution. Objectives The aim of our study was to determine the longterm outcome after LAGB at our institution. Setting The setting of this is Academic Center, Israel. Methods Patients who underwent LAGB between 1999 and 2004 were reviewed. Patient comorbidities and weight loss parameters were collected preoperatively and at defined postoperative periods. Improvement in weight loss was defined as percent excess weight lost, and improvement in comorbidities was defined based on standardized reporting definitions. Results In total, 74 (80%) patients who underwent LAGB met inclusion criteria. The mean age at LAGB placement was 50.5 ± 9.6 years, and the mean body mass index (BMI) was 45.5 ± 4.8 kg/m 2. Preoperative comorbidities were diabetes mellitus (13.5%), hypertension (32%), hyperlipidemia (12.1%), obstructive sleep apnea (5.4%), joints disease (10.8%), mood disorders (5.4%), and gastro-esophageal reflux disease (GERD) symptoms (8.1%). The mean followup was 162.96 ± 13.9 months; 44 patients (59.4%) had their band removed, and 22 (30%) had another bariatric surgery. The follow-up BMI was 35.7 ± 6.9 (p < 0.001), and the % total weight loss was 21.0 ± 0.13. There was no improvement in any of the comorbidities. GERD symptoms worsened at longterm follow-up (p < 0.001). Undergoing another bariatric procedure was associated with a higher weight loss (OR 12.8; CI 95% 1.62-23.9; p = 0.02). Conclusion LAGB required removal in the majority of our patients and showed poor resolution of comorbidities with worsening of GERD-related symptoms. Patients who go on to have another bariatric procedure have more durable weight loss outcomes.
Laparoscopic adjustable gastric banding (LAGB): surgical results and 5-year follow-up
Surgical Endoscopy, 2011
Background LAGB is a technique increasingly used in the USA. The aim of this study is to analyze the 5-year outcome in terms of weight loss and complications. Method We reviewed our prospective electronic database for all patients undergoing LAGB between 2002 and 2007. We assessed weight progression, complications, and reoperations. Results We performed 199 cases during this period (70.4% females). Mean age was 37.8 ± 12.4 years. Preoperative body mass index (BMI) was 36.0 ± 3.8 kg/m 2 . Preoperative comorbidities were dyslipidemia in 52.3%, insulin resistance in 30.7%, arterial hypertension in 24.6%, and type 2 diabetes in 5.5%. There were no conversions to open technique. Early complications were observed in two patients (1%): one hemoperitoneum and one ileitis. Mortality was 0%. Late complication rate was 33.6% (18.0% related to the band). Reoperation was required in 40 patients (20.1%). Laparoscopic repositioning was done in seven patients, and port/reservoir revision was done in five patients. Band removal was required in 28 patients, due to inadequate weight loss in 9, slippage in 9, gastric erosion in 1, bowel obstruction in 1, acute stomach dilatation in 1, and food intolerance in 7. Twenty of these patients underwent revisional surgery: sleeve gastrectomy in 12 and laparoscopic Roux-en-Y gastric bypass in 8 cases. Unrelated band complication was seen in 15.6%, mainly due to anemia (7.5%), alopecia (4.5%), and cholelithiasis (3.5%). With a median follow-up of 48 months (1-72 months), 75, 60, and 95% of patients were available for follow-up at 1, 3, and 5 years, respectively. Mean percent excess weight loss (%EWL) at 1, 3, and 5 years was 58.8 ± 30.0%, 56.8 ± 35.0%, and 58.4 ± 46.6%, respectively. However, failure rate (%EWL \50%) at 1, 3, and 5 years was 40.4, 43.5, and 46.3%, respectively. Conclusions LAGB has low perioperative morbidity. However, its late complications are significant, and inadequate weight loss can be as high as 46.3% after 5 years.
Obesity Surgery, 2016
Background Laparoscopic adjustable gastric banding (LAGB) is the third most popular bariatric procedure worldwide. Various authors present ambivalent long-term follow up results. Methods We revised records of the patients who underwent LAGB between 2003 and 2006 along with history of additional check-ins. Patients with outdated details were tracked with the national health insurance database and social media (Facebook). An online survey was sent. The patients who did not have their band removed were included in this study. We calculated the percent total weight loss (%TWL) and percent excess weight loss (%EWL), along with changes in body mass index (ΔBMI). Satisfactory weight loss was set at >50% EWL (for BMI = 25 kg/m 2). Since eight patients gained weight, we decided to include negative values of %TWL, %EWL, and ΔBMI. Results One hundred seven patients underwent LAGB from 2003 to 2006. The mean follow-up time was 11.2 (±1.2) years. Eleven percent of patients were lost to follow up (n = 12). There was one perioperative death. Fifty-four of the patients (n = 57) had their band removed. Thirty-seven patients still have the band (39%) and were included in the study. The mean %EWL was 27% (−56-112%) and %TWL was 11% (−19-53%). Twelve patients achieved %EWL > 50% (32%). Thiry-two patients still suffer from obesity, with BMI over 30 kg/m 2. Eight patients (22%) gained additional weight. Patients with %EWL > 50% suffered less from gastroesophageal reflux disease symptoms than those with EWL < 50% (p < 0.05). Conclusions Out of 107 cases, only 11.2% of patients with gastric band (n = 12) achieved satisfactory %EWL. Twentytwo percent of patients regained their weight or even exceeded it. Overall results suggest that LAGB is not an effective bariatric procedure in long term observation.
Short- and long-term results of laparoscopic gastric banding for morbid obesity
Langenbeck's Archives of Surgery, 2008
Background Today, gastric banding has become a common bariatric procedure. Weight loss can be excellent, but is not sufficient in a significant proportion of patients. Few longterm studies have been published. We present our results after up to 9 years of follow-up. Materials and methods One hundred twenty-seven patients (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004) were analyzed retrospectively after laparoscopic gastric banding (perigastric technique: n=60; pars flaccida technique: n=67) in terms of preoperative characteristics, weight loss, comorbidities, short-and long-term complications, and quality of life. Results Median follow-up was 63 months (range 2-104). Incidence of postoperative complications were: gastric perforation in 3.1%, band erosion in 3.1%, band or port leak in 2.3%, port infection in 5.3%, port dislocation in 6.9%, and pouch dilatation in 16.9%. Total number of patients requiring reoperation was 34 (26.7%) [perigastric technique n=23 (38.8%) versus pars flaccida technique n=11 (16%), p=0.039]. Mean excess body weight loss (%) was 50.6%. Most patients reported an increase in quality of life after surgery. Conclusions Gastric banding is effective for achieving weight loss and improving comorbidity in obese patients. Obviously, gastric banding can be performed more safely with the pars flaccida technique, although the complication rate remains relatively high. Nevertheless, based on adequate patient selection, gastric banding should still be considered a valuable therapeutic option in bariatric surgery.