Laparoscopic Adjustable Gastric Banded Plication Research Articles

Laparoscopic adjustable gastric banded plication for weight loss: The pros and cons

Laparoscopic adjustable gastric banded plication for weight loss: The pros and cons

Increase in erosive esophagitis after laparoscopic adjustable gastric banded plication

Studies have demonstrated an increase in the prevalence of erosive esophagitis (EE) after laparoscopic sleeve gastrectomy. Laparoscopic adjustable gastric banded plication (LAGBP) is also a restrictive bariatric surgery, but its influence on EE remains unclear. The aim of the study is to evaluate the change in the prevalence of EE 1 year after LAGBP. We retrospectively reviewed medical records of patients who underwent LAGBP. Patients who underwent esophagogastroduodenoscopy both preoperatively and at least 12 months postoperatively were enrolled. Clinical characteristics including body mass index (BMI), waist circumference (WC), and metabolic syndrome (MS) were recorded. Sixty‐five severely obese patients who underwent LAGBP between February 2009 and October 2013 were included in this study. Twelve months after surgery, patients had a significant improvement in BMI, WC, and MS, but the prevalence of EE was significantly increased from 20.0% to 44.6% after LAGBP (P = 0.005). In addition, we also found that 23 (44.2%) of the 52 patients without EE at baseline developed de novo EE. Although LAGBP resulted in a significant reduction in BMI and amelioration of comorbidities, the prevalence of EE increased significantly after operation.

Management of gastric fold herniation after laparoscopic adjustable gastric banded plication: a single-center experience

BackgroundLaparoscopic adjustable gastric banded plication (LAGBP) is a novel bariatric procedure, and little is known about its potential complications. ObjectivesHerein, we report on complications of LAGBP and discuss the clinical features and diagnostic and therapeutic strategies in such situations, with emphasis on gastric fold herniation (GFH). SettingUniversity Hospital. MethodsProspectively collected data of 223 patients who underwent LAGBP for morbid obesity between August 2009 and December 2014 were retrospectively analyzed. Follow-up at 1 year was 75%. ResultsEight patients (3.5%) required readmission due to major complications, including 1 trocar site hernia, 1 band leak, 1 gastric stenosis, and 5 GFHs. GFHs occurred mostly in the first postoperative month (4/5, 80%) and at the fundus (5/5, 100%); 4 GFHs occurred in the initial 70 patients. Seven laparoscopic reoperations were required for managing GFH. The gastric band was removed in 3 patients (of 5; 60%). Two patients developed residual intra-abdominal abscess and were treated successfully by image-guided drainage. In March 2012, we reversed the order of our surgical techniques for the subsequent 153 patients and performed greater curvature plication first, followed by band placement. Only one GFH occurred after this change in surgical order (1/153 versus 4/70; P< .05). ConclusionsHigh clinical suspicion assisted by radiological investigations and early surgical intervention is the key for managing GFH after LAGBP. Though GFH complications were rare, we significantly reduced its occurrence by altering the surgical order in LAGBP to plication followed by banding.

Standardized Technique of Laparoscopic Adjustable Gastric Banded Plication with 4-Year Results.

No bariatric procedure is perfect, and a plethora of such procedures itself is a proof for the same. Laparoscopic adjustable gastric banding has a high safety profile, but also a high rate of re-operation has been reported (Schouten, Wiryasaputra, van Dielen et al. Obes Surg 20(12):1617-26, 2010). Laparoscopic sleeve gastrectomy (LSG) is becoming popular, but has its own set of complications and is irreversible. We introduced laparoscopic adjustable gastric banded plication (LAGBP) in 2009 (Huang, Lo, Shabbir et al. Surg Obes Relat Dis 8(1):41-5, 2012) In a case matched comparative study with LSG, LAGBP showed similar results at 2 years in terms of weight loss, comorbidity resolution, and complications. (Huang, Chhabra, Goel et al. Obes Surg 23(8):1319-23, 2013). Several authors have reported variations in their technique, bougie size, and suture material used to perform plication. (Ramos, Galvao Neto, Galvao et al. Obes Surg 20(7):913-8, 2010, (Mui, Lee, Lam et al. Obes Surg 23(2): 179-83, 2013, Brethauer, Harris, Kroh et al. Surg Obes Relat Dis 7(1):15-22, 2011) Our initial technique of placing the band first and then plicating the stomach resulted in higher incidence of gastric fundus herniation compared to that reported in a systematic review (Abdelbaki, Huang, Ramos et al. Obes Surg 22(10):1633-9, 2012). After the first 65 cases, we reversed the order by performing the gastric plication first which ensures proper plication of the fundus and a more uniformly placed plication line. This technique has become our standard, and the same is described in this video in a stepwise fashion. We performed LAGBP in 202 cases over the last 4 years and recorded the findings. Our standardized technique is shown in this video. The T-suspension technique was used for liver retraction. (Zachariah, Tai, Chang et al. J Laparoendosc Adv Surg Tech A 23(4):311-5, 2013) Gastric plication formula is shown in Fig. 1. Fig. 1 Gastric plication formula Two hundred two (69 male, 133 female) patients in over the last 4 years underwent LAGBP. Follow-up at 1 year was 168 patients, and 56 patients reached 4-year follow-up. Age was 16-60 years (mean = 31.1). Mean BMI was 39.5 ± 3.18 and body weight 110 kg ± 19.4. Mean operative time was 104 min ± 39 and length of hospital stay after surgery 2.1 ± 2.3 days. No mortality was recorded. Excess weight loss at 1 year was 57.84 % and at four years 68 %. LAGBP has been proven to be an effective bariatric procedure in the midterm results. Standardization with plication first and then placement of the band could be important to achieve best outcomes.

A case-matched study of the differences in bone mineral density 1 year after 3 different bariatric procedures

BackgroundStudies have reported decreased bone mineral density (BMD) after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Laparoscopic adjustable gastric banded plication (LAGBP) is a novel procedure resulting in a dual restrictive mechanism of weight loss without altering gastrointestinal anatomy. The objectives of this study were to compare the BMD changes at 1 year after LAGBP, LSG, and LRYGB. MethodsThe sample included 120 patients (40 patients [13 men/27 premenopausal women] each in LAGBP, LSG, and LRYGB groups). The mean preoperative age and body mass index were 30.0±6.5 years and 39.5±3.8 kg/m2, respectively. BMD was measured using dual energy X-ray absorptiometry at the lumbar anteroposterior spine and total hip preoperatively and 1 year postoperatively. ResultsThe mean percentage of excess weight loss was 61.9%±16.8%, 77.1%±12.3%, and 72.7%±17.4% at 1 year after LAGBP, LSG, and LRYGB, respectively. The mean BMD at the lumbar anteroposterior spine remained unchanged in the LSG and LRYGB groups, but significantly increased in the LAGBP group. The mean BMD at the total hip significantly decreased in all groups compared to the preoperative values. However, the mean BMD was significantly higher in the LRYGB than in the LAGBP group. ConclusionBone loss at the hips was observed in all patients, including those with adequate micronutrient supplementation. LRYGB caused significantly greater bone loss than the other procedures.

Laparoscopic adjustable gastric banded plication: case-matched study from a single U.S. center

BackgroundLaparoscopic adjustable gastric banded plication (LAGBP) is a novel technique for weight loss surgery. This study evaluates the safety and short-term efficacy of LAGBP in a U.S. population. The setting was an academic medical center in the United States. MethodsPatients who underwent LAGBP between 2012 and 2013 were reviewed retrospectively. Demographic characteristics, pre and perioperative details, body mass index (BMI), and percent excess weight loss (%EWL) were analyzed and compared to case-matched cohorts that had laparoscopic adjustable gastric banding (LAGB) or laparoscopic sleeve gastrectomy (LSG) during the same time period. ResultsSeventeen patients (14 females) underwent LAGBP during the study period and were case-matched based on age, sex, race, and preoperative BMI with patients having LAGB and LSG. Mean age and preoperative BMI for LAGBP cohort were 42.5±11.6 years and 47.7±6.5 kg/m2, respectively. Mean operative time and estimated blood loss were 72±16 minutes and 23±23 mL, respectively, compared to 49±16 minutes (P = .002) and 15±23 mL for LAGB, and 66±18 minutes and 36±22 mL for LSG. There were no perioperative deaths. Hospital length of stay was 1.1±.3 days for LAGBP, versus .7±.3 days (P = .004) for LAGB, and 2.7±1.4 days (P<.001) for LSG. At 12-month follow-up, patients in the LAGBP and LAGB groups had undergone similar number of band adjustments (4.7 versus 5.1; P = .68). The %EWL was 46.1±14.8% for the LAGBP cohort, compared to 38.9±20.6% for LAGB, and 57.7±16% for LSG. ConclusionLAGBP is technically feasible and safe, and offers weight loss results positioned between LAGB and LSG at 1 year. To date, this is the largest U.S. series to compare this novel technique to more traditional weight loss procedures.

Laparoscopic Adjustable Gastric Banded Plication: Evolution of Procedure and 2-Year Results

Laparoscopic adjustable gastric banded plication (LAGBP) is a new restrictive bariatric procedure combining adjustable banding and greater curvature plication of the stomach. This study aimed to report the evolution of this surgical technique and analyze the surgical results. Eighty patients who underwent LAGBP were enrolled in this study. The band-first technique was used in 50 patients from May 2009 to June 2011 and was then changed to the plication-first technique from July 2011 to October 2011. Patients' demographics and pre- and postoperative data, including complications and weight loss, were collected and analyzed. Eighty patients (26 men and 54 women) with a mean age of 30.75 ± 8.68 years and a mean body mass index of 38.05 ± 4.73 kg/m2 were evaluated with a mean follow-up of 10.52 (1-24) months. The average operation duration and hospital stay were 92.85 ± 35.86 min and 1.73 ± 1.04 days, respectively. No intraoperative complications or surgical mortality was observed in this series. Four (8%) postoperative complications occurred with the band-first technique and one (3%) with the plication-first technique. Mean excess weight loss (percentage) at 6, 12, 18, and 24 months were 42.59 ± 13.67, 56.38 ± 19.89, 57.59 ± 19.88, and 65.84 ± 17.36%, respectively. The frequency of band adjustment was 2.44 ± 2.21 times in 2 years. In this present 2-year result, LAGBP using plication-first technique revealed fewer complications and good weight loss. Longer follow-up is still necessary to be accepted as a stand-alone bariatric procedure.

Laparoscopic Adjustable Gastric Banded Plication (LAGBP): The Next Big Thing?

Bariatric surgery comprising various restrictive, malabsorptive and combined procedures is an effective modality in treating morbid obesity. Laparoscopic adjustable gastric banded plication (LAGBP) is a novel restrictive bariatric procedure which was introduced in 2009. LAGBP may provide comparable results to laparoscopic sleeve gastrectomy at 2 years in terms of complications, % excess weight loss (EWL) and co morbidity resolution. Modification in technique to a standardized LAGBP procedure which includes preserving right gastroepiploic vessels and standard plication volume facilitates in safety and feasibility of this procedure. The EWL at 6 months is 46.3 % (range 29.38–73.35). LAGBP has been proven to be an effective bariatric surgery in the mid-term and may become a popular and cost effective technique.

Laparoscopic Adjustable Gastric Banded Plication: a Case-Matched Comparative Study with Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy (LSG) has been accepted as stand-alone restrictive bariatric procedure; laparoscopic adjustable gastric banded plication (LAGBP) is an innovative technique combining gastric banding and plication of the stomach. This study aims to compare LAGBP with LSG in terms of percent excess weight loss (%EWL), resolution of comorbidities, and complications. This study was conducted in a university hospital. We retrospectively analyzed data of 60 patients: 30 each receiving LSG and LAGBP between May 2009 to October 2010. Demographics, operative data, complications, % EWL, and resolution of comorbidities were analyzed and compared. All the patients were followed for at least 1year. LSG and LAGBP were matched for age, sex, body mass index and comorbidity ratio. Mean operative time was significantly longer in LAGBP: 62.45 ± 30.1 vs. 86.01 ± 21.88 (p = 0.001). Both groups had similar complication rates (6.67%) and most of the patients achieved significant resolution of comorbidities. The mean %EWL was statistically significant for LSG till 18months follow-up as compared to LAGBP, but there was no difference at 2years (p = 0.971). Mean frequency of band adjustment after LAGBP in 2years was 1.50 ± 1.51. There was no significant difference in comorbidity resolution in both groups. LAGBP is a dual restrictive bariatric procedure offering similar results with LSG at 2years in terms of complications, % EWL, and comorbidity resolution with potential of continual weight loss due to band.

An Unusual Cause of Vomiting After Bariatric Surgery

Question: A 28-year-old woman with a body mass index of 48.7 kg/m2 underwent laparoscopic adjustable gastric banded plication (LAGBP) for the management of morbid obesity. Nausea and vomiting were noted postoperatively and she was treated with gastrokinetic or antiemetic agents. However, her symptoms deteriorated and she experienced intractable vomiting, which made her unable to swallow any liquids on the third postoperative day. In addition, epigastric pain also occurred. Physical examination was unremarkable except for mild tenderness to palpation in the epigastric area.

Reversal of gastric plication after laparoscopic adjustable gastric banded plication

4 Laparoscopic adjustable gastric banded plication (LAGBP) is a novel, restrictive, reversible bariatric procedure [1] that theoretically combines the advantages of gastric banding and plication. The initial results in terms of feasibility, safety, and patient compliance have been encouraging [1]. here have been doubts regarding the reversibility of this rocedure. We report on 2 patients in whom we were able o reverse the procedure.

P-100 Laparoscopic adjustable gastric banded plication (LAGBP): Technique and result

Background: Laparoscopic adjustable gastric band has been widely accepted as one of the safest bariatric surgeries for treating morbid obesity. However, because it produces variations in results and complications from port adjustment, alternative procedures are necessary.We developed a novel technique, laparoscopic adjustable gastric banded plication (LAGBP), to improve the weight loss effect and decrease adjustment frequency of gastric band. Methods: After getting IRB approval, we enrolled 33 patients in this study between May 2009 and October 2010. LAGBP was performed with 5-port surgery. We placed the Swedish band using the par flaccida method, divided the greater omentum, and carried out gastric plication below the band until 3 cm from the pylorus with one-row continuous suture. We collected and analyzed preand post-operative data. Results: The mean operation time was 88.7 min, without intraoperative complications. Post-operative hospitalization was 1.33 days in average. Mean excess weight loss (%) at 1, 6, 9, 12, and 18 months after surgery was 20.4%, 42.3 %, 52.8 %, 57.9%, and 70.3% respectively. The gastric band adjustment rate was 1.8 times per patient during first year. Four complications (12.1%) developed in this series, a gastro-gastric intussusceptions, a tube kinking at the subcutaneous layer, gastric band leakage and a delayed gastric perforation. All these cases could be corrected by reoperation. There was no mortality. Conclusion: LAGBP provides excellent weight loss because of the adjustable and added plication effect. But long-term follow-up for this procedure is necessary.

Novel bariatric technology: laparoscopic adjustable gastric banded plication: technique and preliminary results

Background The laparoscopic adjustable gastric band has been widely accepted as 1 of the safest bariatric procedures to treat morbid obesity. However, because of variations in the results and the complications that tend to arise from port adjustment, alternative procedures are needed. We have demonstrated, in a university hospital setting, the safety and feasibility of a novel technique, laparoscopic adjustable gastric banded plication, designed to improve the weight loss effect and decrease gastric band adjustment frequency. Methods We enrolled 26 patients from May 2009 to August 2010. Laparoscopic adjustable gastric banded plication was performed using 5-port surgery. We placed Swedish bands using the pars flaccida method, divided the greater omentum, and performed gastric plication below the band to 3 cm from the pylorus using a single-row continuous suture. The data were collected and analyzed pre- and postoperatively. Results The mean operative time was 87.3 minutes without any intraoperative complications. The average postoperative hospitalization was 1.33 days. The mean excess weight loss at 1, 3, 6, 9, and 12 months after surgery was 21.9%, 31.9%, 41.3%, 55.2%, and 59.5%, respectively. The mean follow-up time was 8.1 months (range 2–15), and the gastric band adjustment rate was 1.1 times per patient during this period. Two complications developed: gastrogastric intussusception and tube kinking at the subcutaneous layer. Both cases were corrected by reoperation. No mortality was observed. Conclusion Laparoscopic adjustable gastric banded plication provides both restrictive and reductive effects and is reversible. The technique is safe, feasible, and reproducible and can be used as an alternative bariatric procedure. Comparative studies and long-term follow-up are necessary to confirm our findings.