Adjustable gastric banding for obesity: tightening the beltline

Abstract

The purpose of this study was to determine the role of radiographic assessment in patients who had an adjustable laparoscopic gastric banding (ALGB) procedure for treatment of morbid obesity, and to evaluate the frequency and type of postoperative complications. The ALGB system used (LAP-BAND, Bio-Enterics, Carpinteria, CA) consists of an implantable silicon band that is placed around the proximal stomach to form a small pouch between the esophagus and remainder of the stomach. The band is connected by a catheter to a subcutaneously implanted port accessible for percutaneous puncture and injection and aspiration of fluid, so that the stomal width can easily be adjusted at any time. A total of 98 patients (18 men and 80 women, mean age = 39 yr, mean body weight = 132 kg, mean body mass index = 47.1 kg/m 2) underwent ALGB. Fluoroscopy was performed postoperatively in all patients to confirm band position and to exclude perforation, and at 6–8 wk later to measure and adjust the stomal size for optimal weight loss. Twelve months after the procedure all patients had further radiographic examinations; patients with unsatisfactory weight loss or those suspected of having complications were studied earlier and on several occasions. At each examination, band position, size and shape of the proximal gastric pouch, stomal width, and presence or absence of complications were evaluated. Results showed that port puncture was feasible in all patients, and stomal adjustments could be repeated at ease. Total weight loss after 1 yr ranged from 8.8% to 39.2% (mean = 18.3%). Twenty patients showed unsatisfactory weight loss. No early complications occurred, but late complications affected 34 patients; these included pouch dilation (concentric or eccentric with posterior slippage, n = 18), eccentric band herniation (n = 6), band penetration (n = 2), disconnection (n = 1), axial pouch herniation (n = 1), and port site infection (n = 6). The authors conclude that ALGB is an effective method in the treatment of morbid obesity. Radiographic assessments are crucial in the management of weight loss and detection of postoperative complications.