Kinking Of Tube Research Articles

Retromolar Intubation - A Non-Invasive Approach of Airway Management during Maxillofacial Surgery

Background: Patients of maxillofacial injury require precise attention for securing and protecting the shared airway. Moreover, intraoperative assessment of dental occlusion and maxillomandibular fixation is often required for meticulous reduction of facial fractures, which makes the presence of oral endotracheal tube unfeasible. The aim of the study was to evaluate the retromolar placement of tracheal tube to secure the airway in patients of maxillofacial injury.  Subjects and Methods: Thirty seven adult consenting patients of ASA physical status I and II of either gender aged 20 to 58 years who met the inclusion criteria, were enrolled for this prospective cohort study. After induction, orotracheal intubation was done with flexometallic tube, then the tube was grasped with gloved fingers and mobilize to retromolar apace, fixed with elastic tap at the angle of mouth and oropharyngeal packing was done. After completion of surgery, patients were extubated after proper suction of oral cavity and removal of oropharyngeal pack. There was no intraoperative or postoperative complication due to anesthetic technique. Results: Retromolar intubation was performed successfully without any difficulty in all patients. Intraoperative assessment of dental occlusion and maxillomandibular fixation could be performed without any noticeable changes in airway pressure or visible tube kinking. No anesthetic or surgical complications were encountered in any patient. Conclusion: Retromolar intubation efficiently secured the airway and provided uninterrupted operating field to the surgeon during maxillofacial surgery. Lack of any adverse events encouraged us to present the advantages of retromolar intubation on the basis of our own experience.

Intraoperative kinking of armored endotracheal tube leading to airway obstruction in obese patients positioned prone for spine surgeries: A report of two cases

Obesity is an important problem with increasing incidence in affluent society. Managing obese patients in prone positions under general anesthesia requires optimization and adequate preparation for a successful outcome. Despite all optimizing measures are taken preoperatively, complications such as kinking of armored endotracheal tubes may take place in these patients in prone position leading to problems during mechanical ventilation. Armored tubes are being widely used in anesthesia practice in surgeries involving procedures during which kinking are anticipated. There have been reports of armored tube kinking both intraorally and extraorally in the prone position. Hence, prompt anticipation of tube kinking is desirable, especially in obese patients (increased neck circumference and submental fat) positioned prone. Herewith, we report two cases of unusual complication of armored tube kinking in prone position in obese patients.

A kinked epidural catheter.

Sir, The rate of failed epidural anesthesia ranges from 13% to 47%. Anatomical catheter location, patient position, puncture site, approach type, localization of the epidural space, catheter insertion and fixation, test dose application, equipment used, local anesthetic dose or volume, choice of local anesthetic, and addition of opioids and epinephrine are all the factors that influence the success of epidural anesthesia.[1] Here, we report a failed epidural catheterization due to kinking of the catheter tube. A 22-year-old man who underwent laparoscopic acute appendectomy under general anesthesia without any complications needed to undergo surgical exploration because of hemorrhagic drainage during the postoperative period. As the patient was pale and cold, with a significantly reduced hemoglobin level, an emergency surgery was planned. Combined spinal epidural anesthesia was decided as the patient's fasting duration was not appropriate for general anesthesia. After appropriate preoperative preparation, combined spinal epidural anesthesia was performed at the L4–5 level via loss of resistance technique with saline, and 15 mg of 0.5% bupivacaine was injected intrathecally. The epidural space was entered at the 8th cm under the skin. While inserting the epidural catheter through the Tuohy needle, resistance was felt. Telling the patient to take a deep breath, the catheter was pushed against the resistance, which was lost for 1 cm, and the catheter was pushed until the 14th cm. No check with a saline injection was made after fixing the catheter; however, aspiration was negative. The catheter was fixed and surgery was initiated after ensuring successful spinal anesthesia. After 3 h of surgery, the patient started to feel pain. The surgeon was warned to wait, and the level of spinal anesthesia was checked and found to be insufficient. On attempting local anesthetic injection through the epidural catheter, negative aspiration was noted but an abnormal resistance was felt. After another failed attempt, the epidural catheter connection point was checked and recapped, but no difference was noted. As a result of the failed catheterization, general anesthesia was administered with fast track intubation. No complications, such as vomiting and aspiration, were noted. After surgery, during extubation, an attempt was made to pull out the epidural catheter. The first few centimeters of the catheter came out easily, but then a resistance was felt. Applying a small force, the catheter was pulled out totally and a kink was observed at the 9th cm [Figure 1].Figure 1: Kinking in the epidural catheter (expressed in red circle)There are many examples of epidural catheter kinking under the skin in the literature.[234] Hence, it is very important to check the epidural catheter after insertion using saline injection in addition to negative aspiration, to ensure proper functioning. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

An engineering approach towards a more discrete and efficient urinary drainage system.

Modern urinary catheter-to-leg-bag systems suffer from a number of shortcomings. Drainage tubing of current urinary leg bags is perceived as unnecessarily bulky compared to the indwelling catheters to which it is connected, and catheter designs are prone to the formation of biofilms, leading ultimately to encrustation and blocking. We used analytical and experimental engineering methodologies, aligned with current international (International Standards Organisation) and European standards, to optimise drainage tube size and flow efficiency and characterise tube kinking behaviour. Using computational fluid dynamics, we studied the influence of modern Foley catheter design on urodynamics and explored its potential influence on biofilm formation and encrustation. Results indicate that tubing diameters could be reduced by 40%-50% and still satisfy current International Standards Organisation flow rate standards for leg bags; this might also reduce the likelihood of tube kinking. The computational study showed how current catheter design may promote the development of lower velocity recirculating flows and high shear in proximity of regions known to be affected by bacterial adhesion and biofilm formation. If confirmed, these findings will give manufacturers greater flexibility to develop less obtrusive and more encrustation-resistant products for end users.

Flexometallic versus RAE Endotracheal Tube in Cleft Lip and Palate Surgery

Aim and Objectives: The present study was carried out with an objective to evaluate ease of insertion of catheter and suctioning through Flexo-metallic tube versus Ring Adair Elwin (RAE) tube, to know the incidence of kinking of RAE tube and to note down the endo-bronchial placement of Flexo-metallic versus RAE tube and surgeon’s comfort zone. Methods: A prospective observational randomized study was conducted on 60 ASA grade I and II pediatric patients of age group 4 month to 16 years undergoing cleft lip and palate surgeries. Patients were randomly allocated in two groups of 30 each. Group R: intubated with RAE South pole tube and group F: intubated with flexo-metallic tube. The ease of insertion of suction catheter, ease of suctioning of secretions, refixation required, kinking of tracheal tube, incidence of displacement, airway complications and surgeons’ feedback- Comfort zone were noted. Results: The ease of suctioning through lumen of Tracheal tube was easier in group ‘F’ as compared to RAE tube. No kinking of tracheal tube was found in any group. The displacement of tracheal tube was observed in 2 patients in group ‘R’. Refixation of tracheal tube was required in 2 patients in group ‘R’. Bronchospasm and cough was noted in 1 patient in group ‘R’. No variations in vitals (e.g. blood pressure and heart rate) were observed in any group. Surgical team was comfortable in both groups but more so with Flexo-metallic tracheal tube group. On extubation we found retained secretions at distal portion of RAE tube in 2 patients. Conclusion : Flexometallic tracheal tube provides advantage of easy suctioning of tracheal secretions. Do not kink in mouth gag of surgical field, provides better airway security and stability, less intra-operative manipulation by anaesthetist, less airway complications, provides better surgical field.

CT-Guided Translumbar Placement of Permanent Catheters in the Inferior Vena Cava: Description of the Technique with Technical Success and Complications Data.

To evaluate indications, technical success rate and complications of CT-guided translumbar catheter placement in the inferior vena cava for long-term central venous access (Port and Hickman catheters) as a bail-out approach in patients with no alternative options for permanent central venous access. This retrospective study included 12 patients with a total of 17 interventions. All patients suffered from bilaterally chronically occluded venous vessels of their upper extremities, without patent internal jugular and/or subclavian veins. Catheter implantation was performed as a hybrid procedure with CT-guided translumbar access into the inferior vena cava with subsequent angiography-guided catheter placement of a Hickman-type catheter (7×) or a Port catheter (10×). All interventions were technically successful. The total 30-day complication rate was 11.8% (n = 2). The two detected complications were bleeding at the subcutaneous port hub and subcutaneous kinking of the venous tube. Mean follow-up time was 68.4 ± 41.4months (range 3.4-160months). Six patients (50%) died during follow-up from non-procedure-related complications associated with the underlying disease. Late complications occurred in 8/17 (47.1%) cases and were infections of the catheter system in 35.3% (n = 6), mechanical defect of the catheter system in 5.8% (n = 1) and dislocation of the catheter system in 5.8% (n = 1). The overall infection rate was 0.77 per 1000 catheter days. CT-guided translumbar placement of permanent catheters is a technically feasible and safe method for permanent central venous access as last resort in chronically occluded veins of the upper extremities.

Intraoral kinking of an endotracheal tube during position change in a patient with tracheal deviation

Introduction: The maintenance of ventilation through the endotracheal tube during surgery is essential, and failure to do so can cause serious consequences. Case Report: We experienced a case of intraoral kinking of the polyvinyl chloride, single-lumen endotracheal tube (ETT) in a patient with severe tracheal deviation caused by pulmonary tuberculosis. During surgery, the operation table was tilted upward and to the left, which caused change in patient’s head position and led to intraoral kinking. Conclusion: If there is a severe tracheal deviation expected to cause deformity of the ETT, it is recommended to use a reinforced tube.

Understanding the Transferrin Receptor and Cellular Iron Deficiency Outside the Erythron

Our laboratory showed that mouse embryos lacking the classical transferrin receptor, Tfrc, experienced anemia, pericardial effusion and a kinking of the neural tube, but otherwise appeared to be developing normally, suggesting that Tfrc was not needed by most tissues (Levy et al. 1999). Subsequently, we reported that Tfrc was essential for hematopoiesis but seemed to be dispensable in other tissues (Ned et al., 2003). A recent paper showing that a missense mutation in the TFRC internalization motif resulted in immunodeficiency without other clinical manifestations was consistent with this idea (Jabara et al., 2016). Nonetheless, we were not entirely convinced. More than thirty years ago, Larrick and Hyman described a patient with an anti-TFRC autoantibody who suffered from a broader range of clinical problems, suggesting that TFRC might have other roles (Larrick and Hyman, 1984). To help resolve the issue, we developed mice carrying an allele of Tfrc that can be conditionally inactivated, and used Cre/lox-mediated recombination to disrupt that allele in vivo, in several key cell types. We asked two questions: (1) is Tfrc important in those cell types and, if so, (2) what are the cellular consequences of Tfrc loss? We found that some cell types do not need Tfrc but others are highly dependent upon it. Those cell types that depend upon Tfrc generally need it for iron uptake, as expected, with one exception. Tfrc is critically important for normal development of the intestinal epithelium, but our data indicate that its essential role does not involve iron uptake. While surprising in view of our earlier results, the roles of Tfrc that we have unmasked through conditional knockout experiments would not have been apparent prior to the death of global Tfrc knockout embryos in mid-gestation. Nonetheless those roles are important, and our results give insight into why iron deficiency exacerbates heart failure, how muscle iron deficiency leads to disruption of systemic carbon metabolism, and how iron deficiency, rather than iron excess, may play a role in the pathogenesis of neurodegenerative disorders. Levy JE, Jin O, Fujiwara Y, Kuo F, Andrews NC. Transferrin receptor is necessary for development of erythrocytes and the nervous system. Nat Genet. 1999;21:396-9. Ned RM, Swat W, Andrews NC. Transferrin receptor 1 is differentially required in lymphocyte development. Blood. 2003;102:3711-8. Jabara HH, Boyden SE, Chou J et al. A missense mutation in TFRC, encoding transferrin receptor 1, causes combined immunodeficiency. Nat Genet. 2016;48:74-8. Larrick JW, Hyman ES. Acquired iron-deficiency anemia caused by an antibody against the transferrin receptor. N Engl J Med. 1984;311:214-8. Disclosures Andrews: Novartis: Membership on an entity's Board of Directors or advisory committees.

A New and Easy Procedure to Place an Esophagostomy Tube into Dogs and Cats

Enteral nutrition improves survival rates and hospitalization times. Some diseases affecting the oral cavity can hinder spontaneous nutrition; in these cases the use of an esophagostomic tube can resolve nutritional problems. The innovative method described in this study is easier and more rapid than those currently known because the end of the tube does not need to be extracted from the oral cavity and then be reinserted with a number of maneuvers into the esophagus. The procedure does not require specific instruments, endotracheal intubation, and nor does it require the head to be moved or lifted. In addition, it can be carried out without the support of an assistant even with big or giant dogs. The new method involves the introduction of hemostatic forceps into the oral cavity, which pass through the esophagus wall and skin, then the distal extremity of the tube is firmly held between the extremity of the forceps and oriented caudally. The forceps, holding the tube, need to be retracted in the esophagus and then pushed ventrally and aborally in order to pass the esophagus stoma, without needing to extract the tube from the oral cavity and thus the risk of tube kinking.

Concealed kinking of pediatric flexometallic tube at fixation point

Concealed kinking of pediatric flexometallic tube at fixation point

On the Ratio of Periods of the Fundamental Harmonic and First Overtone of Magnetic Tube Kink Oscillations

We study kink oscillations of thin magnetic tubes. We assume that the density inside and outside the tube (and possibly also the cross-section radius) can vary along the tube. This variation is assumed to be of such a form that the kink speed is symmetric with respect to the tube centre and varies monotonically from the tube ends to the tube centre. Then we prove a theorem stating that the ratio of periods of the fundamental mode and first overtone is a monotonically increasing function of the ratio of the kink speed at the tube centre and the tube ends. In particular, it follows from this theorem that the period ratio is lower than two when the kink speed increases from the tube ends to its centre, while it is higher than two when the kink speed decreases from the tube ends to its centre. The first case is typical for non-expanding coronal magnetic loops, and the second for prominence threads. We apply the general results to particular problems. First we consider kink oscillations of coronal magnetic loops. We prove that, under reasonable assumptions, the ratio of the fundamental period to the first overtone is lower than two and decreases when the loop size increases. The second problem concerns kink oscillations of prominence threads. We consider three internal density profiles: generalised parabolic, Gaussian, and Lorentzian. Each of these profiles contain the parameter $\alpha$ that is responsible for its sharpness. We calculate the dependence of the period ratio on the ratio of the mean to the maximum density. For all considered values of $\alpha$ we find that a formula relating the period ratio and the ratio of the mean and maximum density suggested by Soler, Goossens, and Ballester (Astron. Astrophys. 575, A123, 2015) gives a sufficiently good approximation to the exact dependence.

Standing kink oscillations of thin twisted magnetic tubes with continuous equilibrium magnetic field

In this article we study standing kink waves in twisted magnetic tubes. We use the cold plasma and thin tube approximation. We assume that the plasma density is constant inside and outside the tube. We also assume that the magnetic twist is weak and take the ratio of the azimuthal and axial component of the magnetic field to be of the order of ratio of the tube radius and tube length. The azimuthal component of the magnetic field is proportional to the distance from the tube axis inside the tube, and inversely proportional to this distance outside the tube. Using the method of asymptotic expansions we derived the governing integral equation that determines the eigenfrequencies and eigenmodes of the tube kink oscillations. In the approximation of a very weak twist, we calculated analytically the corrections to the frequencies of the fundamental mode and first overtone of a straight magnetic tube related to the presence of twist. The analytical results are compared with the numerical results obtained using the full set of linear ideal magnetohydrodynamic equations. We also calculated the ratio of frequencies of the fist overtone and fundamental mode. We found that the magnetic twist enhances this ratio for moderate values of the density ratio, and reduces this ratio for large values of the density ratio. In general, the deviation of the frequency ratio from 2 caused by the magnetic twist is comparable to that found in simultaneous observations of the fundamental mode and first overtone of the coronal loop kink oscillations. Finally, we studied the eigenmode polarization. We found that, in a particular case of linear polarization, the polarization direction rotates along the tube.

Transcutaneous port for levodopa/carbidopa intestinal gel administration in Parkinson's disease.

To evaluate the safety and tolerability of the T-Port(®) for intestinal infusion of levodopa/carbidopa gel in patients with advanced Parkinson's disease (PD). This prospective study was carried out in 24 patients with PD (15 males, mean age 61.8 years, mean duration PD 18.7 years). All adverse device effects were evaluated at 2 weeks, 3 months and 6 months and until explantation or death. Post-operative complications were similar to endoscopic gastrojejunostomy placement (four peritoneal irritation, one pocket pain). Eight patients with prior experience with the endoscopic gastrojejunostomy preferred the T-Port. The total device experience was 83.6 years, and the average survival time was 3.6 (range 1.1-5.2) years. Six T-Ports were still in use, and two patients had died due to non-device-related reasons. Sixteen T-Ports had been explanted due to 15 stoma reactions (14 inflammations and one infection) and one tilting of the T-Port. The T-Ports were replaced with endoscopic gastrojejunostomy system as replacements with T-Ports were not part of the study. Only two device malfunctions occurred (one catheter breakage at 3 year post-implant and one T-Port leakage of levodopa/carbidopa gel). No tube kinking, dislocation or blockage occurred. The number of adverse device effects proved to be significantly lower as compared to the endoscopic gastrojejunostomy literature data. The T-Port is safe and well tolerated, and the low number of tube problems is a potential advantage compared with the endoscopic gastrojejunostomy system. Proper cleaning and local treatment of the stoma site around the T-Port are essential to prolong its longevity.

ENERGY PROPAGATION BY TRANSVERSE WAVES IN MULTIPLE FLUX TUBE SYSTEMS USING FILLING FACTORS

In the last few years, it has been found that transverse waves are present at all times in coronal loops or spicules. Their energy has been estimated with an expression derived for bulk Alfvwaves in homogeneous media, with correspondingly uniform wave energy density and flux. The kink mode, however, is localized in space with the energy density and flux dependent on the position in the cross-sectional plane. The more relevant quantities for the kink mode are the integrals of the energy density and flux over the cross-sectional plane. The present paper provides an approximation to the energy propagated by kink modes in an ensemble of flux tubes by means of combining the analysis of single flux tube kink oscillations with a filling factor for the tube cross-sectional area. This finally allows one to compare the expressions for energy flux of Alfv´ en waves with an ensemble of kink waves. We find that the correction factor for the energy in kink waves, compared to the bulk Alfv´ en waves, is between f and 2f, where f is the density filling factor of the ensemble of flux tubes.

Ventilation despite an endotracheal tube kink!

The Sri Lankan Journal of Anaesthesiology is the official journal of the College of Anaesthesiologists of Sri Lanka. It publishes clinical investigations, research articles, audits, case reports, review articles and CME articles relating to anaesthesiology, critical care and pain. It is published bi annually in January and June. Sri Lankan Journal of Anaesthesiology is included on DOAJ and Scopus.

Sa1468 Acceptability of Naso-Gastric Feeding Tubes in Nursing Homes: NYC vs. USA

procedural attempts at DPEJ, procedure duration, technical success rate, causes for failed DBE-DPEJ placement, and adverse events. Results: A total of 90 patients (55 women; mean age 55 18 years; mean BMI 22.9 6.3) underwent DBE-DPEJ placement (Table 1). Indications for DPEJ included: gastroparesis (nZ29), previous failed PEG (e.g., intrathoracic stomach, nZ16), nutritional support in altered gut anatomy unsuitable for PEG (nZ16), recurrent or high risk for aspiration (nZ13), gastric outlet obstruction (nZ11), and miscellaneous (e.g., nutritional support in setting of necrotizing pancreatitis, nZ5). Altered gut anatomy was noted in 35 (39%) patients. DBE-DPEJ was successful in all patients (nZ12) who had prior failed DPEJ attempts by extended push endoscopy or single balloon endoscopy. Mean duration of the DBE-DPEJ procedure was 31 minutes (range 10-49). DBE-DPEJ placement was successful in 83 (92%) patients. Reasons for failed DBE-DPEJ placement in 7 (8%) patients included: small bowel fixation from adhesions precluding endoscope advancement (nZ5), duodenal stenosis (nZ1), and lack of transillumination (nZ1). Post-procedural adverse events occurred in 8 (9%) patients and included: gastrointestinal bleed secondary to DPEJ site ulceration (nZ3), abdominal hematoma (nZ2), cellulitis (nZ1), kinking of the PEJ tube requiring replacement (nZ1) and gastric interposition (nZ1). Conclusion: Compared to published outcomes of DPEJ placement by conventional endoscopy, DBE-assisted DPEJ was technically successful in a high proportion of patients and with a relatively low rate of significant adverse events.

External reinforcement for extraoral kinking of tracheal tube during pediatric anesthesia

External reinforcement for extraoral kinking of tracheal tube during pediatric anesthesia

A prolonged observational study of tracheal tube displacements: Benchmarking an incidence

Background and Aims:Tracheal tubes are commonly used in intensive care unit (ICU) and lead to complications like displacements. The primary aim of the study was to evaluate if the rate of tracheal tube displacement benchmarked at <1% per patient and <0.5% per tracheal tube day, could be sustained over a prolonged period. The secondary aim was to document the patterns of all forms airway accident and to evaluate their consequences.Subjects and Methods:This was a prospective observational study of Intubated and ventilated patients in a General Medical-Surgical Adult ICU. The incidence of accidental extubation, self extubation, partial displacement and blockages of tracheal tubes were recorded.Results:The overall tracheal tube displacement rate was 61/10,112 (0.6%) per patient and 61/28,464 (0.22%) per tracheal tube day. There were 30 additional incidents of blockage, kinking or biting of the tracheal tube. Physiological consequences-69 were mild, 10 moderate, 12 major and one death. Of the 91 accidents, 30 were partly and 30 were completely preventable. 76 incidents involved an endotracheal tube (54 displaced, 12 blocked and 10 bitten-kinked) and 15 a tracheostomy tube (seven displaced and eight blocked). Accidents were more common in medical than surgical patients (medical = 48, cardiac surgical = 17 and other surgical/trauma = 26).Conclusion:Tracheal tube displacement rate in a mixed medical-surgical adult ICU was maintained below the pre-set benchmark of <1% per patient and <0.5% per intubated day over nearly a decade.

Levodopa/carbidopa intestinal gel infusion in advanced Parkinson's disease: a 7‐year experience

Levodopa/carbidopa intestinal gel (LCIG) infusion is nowadays becoming an established therapeutic option for advanced Parkinson's disease (PD) patients with fluctuating symptoms unresponsive to conventional oral treatment. As the implementation of LCIG therapy is increasing, there is a need for safety and efficacy data from current clinical practice. All PD patients treated with LCIG at our centre over a 7-year period were analysed to determine the duration of treatment, retention rate, reasons for discontinuation, LCIG efficacy in motor complications, modifications of concomitant therapy and adverse events. Of the 59 patients, seven subjects (12%) died of causes unrelated to LCIG infusion and 11 patients (19%) discontinued therapy prior to the cut-off date. Duodopa improved motor complications and over 90% of patients reported an improvement in their quality of life, autonomy and clinical global status. The most common adverse events were dislocation and kinking of the intestinal tube. LCIG infusion is effective for the long-term treatment of advanced PD patients and exerts a positive and clinically significant effect on motor complications with a relatively low dropout rate.

Clinical outcomes of the Realize Adjustable Gastric Band-C at 2 years in a United States population

BackgroundIn 2008, the Realize Band (RB) adopted a precurved design (RB-C). We present 2-year outcomes data from the first multiinstitutional study of RB-C. The objective of this study was to analyze weight loss and safety data from bariatric practices in the United States, including academic, nonacademic, public, and private. MethodsThe study included adult RB-C patients with a preoperative body mass index (BMI)≥40 kg/m2 or>35 kg/m2 with co-morbidity. Exclusions included RB-C’s label contraindications for use. Outcomes parameters were percent excess weight loss (%EWL), BMI change, number and volume of band adjustments, and adverse events. ResultsA total of 231 patients met inclusion/exclusion criteria. Of these, 161 had 24-month data available. Mean %EWL was 44.4%±26.9% (P<.0001). BMI decreased from 44.1±5.7 kg/m2 to 35.3±6.9 kg/m2 (P<.0001). Percent EWL varied by preoperative BMI (P = .0002), bariatric practice (P<.0001), aftercare frequency (P = .0004), and band fill frequency (P = .0271), but %EWL was not influenced by gender, race, or age (P>.20 each). Adverse events were dysphagia (21.2%), gastroesophageal reflux (21.6%), and vomiting (30.7%). Incidence of pouch dilation, esophageal dilation, and slippage was≤1%. Revisions (2.2%) were for unbuckled band, tube kinking, slippage, and suspected band leak (1 each). No erosions, explants, or mortality were reported. ConclusionRB-C appears to be as well tolerated and effective as the first generation RB for weight loss. The near 45% EWL at 2 years is consistent with other high-quality publications on the RB. Preoperative BMI and frequency of postoperative care, including frequency of band fills, influence %EWL. Significant weight loss is achievable with RB-C despite variable postoperative management practices. The low morbidity and the absence of mortality at 24 months reflect positively on the RB-C characteristics.