Laparoscopic Adjustable Gastric Banding Group Research Articles

Revisional surgery after restrictive surgery: midterm outcomes of a tertiary center.

Revisional bariatric surgery (RBS) is a challenging type of procedure for the surgeons due to its specific morbidity and efficiency. The RBS has a higher prevalence nowadays and this study may help to improve scarce data upon this specific topic. Data from 252 patients undergoing RBS after laparoscopic adjustable gastric banding (LAGB) or laparoscopic sleeve gastrectomy (LSG) between 2005 and 2019, were analyzed at 2years of follow up. A subgroup analysis of third procedure was also performed. Overall morbidity occurred in 35 patients (37%) in the LSG group and 40 patients (25%) in the LAGB group (p = 0.045). At 2years of RBS, mean weight was 92.8 ± 26.7kg, BMI was 33.1 ± 8.56kg/m2 for patients who had RBS after LSG. When RBS was performed after LAGB, mean weight at 2years was 90.1 ± 20.7kg and BMI was 32.5 ± 6.45kg/m2. TWL for RBS performed after LSG was 12.7 ± 16.4% versus 25.5 ± 10.3% after LAGB (p < 0.001). RBS after LSG seems to lead to higher overall morbidity whereas RBS after LAGB lead to more perioperative issues.

Predictors of Nutritional Deficiencies After Bariatric Surgery in the United States: Analysis of Real-World Data

ObjectivesBariatric surgery can lead to postoperative nutritional deficiencies due to restrictive and malabsorptive mechanisms, but there is limited literature quantifying this risk.MethodsPatients who underwent Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) in the IBM® MarketScan® Commercial Database (2006–2016) were identified. Nutritional deficiencies (anemia, protein malnutrition, vitamin B12 deficiency, vitamin D deficiency, other) were assessed at 1 year prior to surgery and at 3 years post-surgery. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) across bariatric surgery types after adjusting for potential confounders (demographics, lifestyle, and comorbidities). Interactions of bariatric surgery types with age, sex, and baseline nutritional deficiencies in relation to post-surgery nutritional deficiencies risk were assessed by likelihood ratio tests.ResultsA total of 82,885 patients (mean (SD) age of 44.5 (9.5) years) were identified with 38.8% (n = 32,190) undergoing RYGB, 33% (n = 27,388) undergoing SG, and 28.1% (n = 23,307) undergoing LAGB. The most common 3-year postoperative nutritional deficiencies were anemia (28%), vitamin D (24%), protein malnutrition (9%), and vitamin B12 (9%). Relative to the LAGB group, the adjusted OR of developing any 3-year nutritional deficiency postoperatively was 3.03 (95% CI, 2.92–3.15) for the RYGB group and 2.45 (95% CI, 2.36–2.55) for the SG group. These associations were stronger among patients younger than 45 years, men, and those without baseline nutritional deficiency (P‐interaction < 0.05 for all). Baseline nutritional deficiencies were independently associated with higher odds of postoperative nutritional deficiencies. Similar results were observed for anemia, protein malnutrition, and vitamin B12 deficiency.ConclusionsRYGB and SG were associated with two- to three-fold odds of developing postoperative nutritional deficiencies compared to LAGB, independent of baseline nutritional deficiency status. Pre- and postoperative nutritional assessment are recommended for all bariatric surgery patients to optimize postoperative outcomes.Funding SourcesNone.

Effectiveness and safety of sleeve gastrectomy and adjustable gastric banding in morbidly obese patients single centre study

Introduction: This retrospective study aimed to compare short- and long-term outcomes between laparoscopic sleeve gastrectomy (SG) and laparoscopic adjustable gastric banding (LAGB). Material and methods: This retrospective one-centre study included patients who underwent bariatric surgery in the form of LAGB and SG. Results: %BMIL was significantly higher in the SG group than in the LAGB group during postoperative follow-up months (p &lt; 0.001). LAGB patients had a lower %EWL compared to SG at each postoperative follow-up month (p &lt; 0.05). After LAGB, 25.0% patients had %EW ≥ 50%; in the LSG group, 44.8% patients achieved %EWL ≥ 50% (p &lt; 0.0001). The LAGB group’s %EWL ≥ 50 was dependent on BMI before operation (p = 0.049). There are no postoperative complications after LAGB. A total of 221 patients in the SG group 6 (2.7%) had postoperative surgical complications within 30 days after surgery. Postoperative complications in the long term were significantly higher for LAGB than for LSG (p = 0.0062). Reoperation was performed in 16 (7%) patients after LAGB compared to 2 (0.9%) patients after LSG. Conclusions: LSG is a more effective procedure than LAGB, contributing to greater improvement of weight loss. LAGB is associated with lower surgery-related complications in the early postoperative period, but long-term outcomes contributing to a higher late complication rate led to a higher reoperation rate than SG procedure.

Ten-Year Results of Laparoscopic Sleeve Gastrectomy: Retrospective Matched Comparison with Laparoscopic Adjustable Gastric Banding\u2014Is There a Significant Difference in Long Term?

BackgroundThe laparoscopic sleeve gastrectomy (LSG) is the most common bariatric procedure performed worldwide while the laparoscopic adjustable gastric banding (LAGB) has been almost abandoned. Aim of this study was to retrospectively assess 10-year outcomes of LSG through a matched comparison with LAGB.Materials and MethodsRetrospective search of prospectively maintained database of our university was carried out to find all patients that underwent LSG before December 2010. Each subject with LSG was matched one-to-one with a patient that had undergone LAGB in the same period with correspondent preoperative age, BMI, and sex.ResultsA total of 76 patients underwent LSG before 2010 and were all included in this study; a matched group of 76 out of 178 LAGB patients with 10-year follow-up was retrieved from our database. Comparison between the two groups showed better outcomes after LSG at 1 and 5 years but weight loss was comparable with the LAGB group at 10 years (%TWL 22.2 ± 13 vs 21.2 ± 16.1; p = 0.89). No significant difference was found in conversion/removal rate (15.8% vs 18.4%; p = 0.67).ConclusionLSG is an effective stand-alone bariatric procedure with better outcomes than LAGB in medium term, but results are comparable at 10 years. Subjects undergoing LSG should be informed that conversion to RYGB or OAGB may be necessary to achieve further weight loss or to treat reflux.Graphical abstract

Roux-en-Y gastric bypass and gastric sleeve surgery result in long term bone loss.

Little is known about the long-term skeletal impact of bariatric procedures, particularly the increasingly commonly performed gastric sleeve surgery (GS). We examined bone density (BMD) change following three types of bariatric surgery Roux-en-Y gastric bypass (RYGB), GS and laparoscopic adjustable gastric banding (LAGB), compared with diet, over 36 months. Non-randomized, prospective study of participants with severe obesity (n = 52), undergoing weight-loss interventions: RYGB (n = 7), GS (n = 21), LAGB (n = 11) and diet (n = 13). Measurements of calciotropic indices, gut hormones (fasting and post prandial) peptide YY (PYY), glucagon-like peptide 1 (GLP1) and adiponectin together with dual-X-ray absorptiometry and quantitative computed tomography scans were performed thorough the study. All groups lost weight during the first 12 months. Despite weight stability from 12 to 36 months and supplementation of calcium and vitamin D, there was progressive bone loss at the total hip (TH) over 36 months in RYGB -14% (95% CI: -12, -17) and GS -9% (95% CI: -7, -10). In RYGB forearm BMD also declined over 36 months -9% (95% CI: -6, -12) and LS BMD declined over the first 12 months -7% (95% CI: -3, -12). RYGB and GS groups experienced significantly greater bone loss until 36 months than LAGB and diet groups, which experienced no significant BMD loss. These bone losses remained significant after adjustment for weight loss and age. RYGB and GS procedures resulted in elevated postprandial PYY, adiponectin and bone turnover markers up to 36 months without such changes among LAGB and diet participants. RYGB and GS but not LAGB resulted in ongoing TH bone loss for three postoperative years. For RYGB, bone loss was also observed at LS and non-weight-bearing forearms. These BMD changes were independent of weight and age differences. We, therefore, recommend close monitoring of bone health following RYGB and GS surgeries.

Conversion for failed adjustable gastric banding warrants hiatal scrutiny for hiatal hernia

Failure or complications following laparoscopic adjustable gastric banding (LAGB) may necessitate band removal and conversional surgery. Band position and band-induced chronic vomiting create ideal conditions for de novo hiatal hernia (HH) formation. HH presence impedes and complicates conversional surgery by obscuring crucial anatomical landmarks and hindering precise gastric sleeve or pouch formation. The aim of this study was to evaluate the incidence of a HH in patients with an LAGB undergoing conversion compared to patients undergoing primary bariatric surgery (BS). Retrospective review of consecutive BS performed between 2010 and 2015. Data collected included demographics, anthropometrics, comorbidities, previous BS, preoperative and intra-operative HH detection, operation time, perioperative complications and length of hospital stay. During the study period, 2843 patients (36% males) underwent BS. Of these, 2615 patients (92%) were "primary" (no previous BS-control group), 197 (7%) had a previous LAGB (study group), and 31 (1%) had a different previous BS and were excluded. Reasons for conversion included weight regain, band intolerance and band-related complications. Mean age and body mass index were similar between the study and the control groups. HH was preoperatively diagnosed by upper gastrointestinal (UGI) fluoroscopy in 9.1% and 9.0% of the LAGB and control groups (p = NS), respectively. However, HH was detected intra-operatively in 20.3% and 7.3%, respectively (p < 0.0001). Preoperative diagnosis of a HH by UGI fluoroscopy for patients who have undergone LAGB is unreliable. Intra-operative hiatal exploration is highly recommended in all cases of conversional BS after LAGB.

Is the Sleeve Gastrectomy Always a Better Procedure? Five-Year Results from a Retrospective Matched Case-Control Study.

Bariatric surgery is considered the most effective treatment for obesity. A recent worldwide survey demonstrated that Laparoscopic Sleeve Gastrectomy (LSG) is the most commonly performed bariatric procedure, while Laparoscopic Adjustable Gastric Banding (LAGB) has been almost abandoned. The aim of this retrospective study was to compare 5-year results of LSG and LAGB at our Institution. Prospective maintained database of our Institution was reviewed to find all patients who had undergone LSG between January 2009 and December 2011. Inclusion criteria were BMI of 40-50kg/m2 and age of 18-60years old. Patients with Class I and II obesity, superobese subjects, and patients with previous history of bariatric surgery were excluded. Data on sex, age, pre-operative BMI, obesity-related diseases (diabetes, hypertension, dyslipidemia), and early and late complications were collected. Each subject who underwent LSG was matched one-to-one with a patient that had undergone LAGB. Outcomes were analyzed at 1, 3, and 5years of follow-up. A total number of 122 patients were included in this study, 61 in each group. Better %EWL was observed in the LSG group at 1, 3, and 5years. Both procedures induced improvements of obesity-related diseases without significant difference. In the LAGB group, ten patients underwent uneventful band removal. In the LSG group, two patients had serious postoperative complications. LSG achieves better %EWL than LAGB within 5years, but comorbidities improvement is not significantly different. Severity of complication is higher after LSG. LAGB is still a good option for selected patients.

A Novel Auxiliary Device for Preventing Band Slippage After Laparoscopic Adjustable Gastric Banding: Infra-Band Fixation Using S-Loop.

Band slippage is known to be a troublesome complication of laparoscopic adjustable gastric banding (LAGB), often requiring surgical intervention. To prevent band slippage, a new auxiliary device "S-loop" was developed. From July 2010 to January 2014, a total of 814 LAGBs were performed by a single surgeon. The patients were divided into two groups based on the application of S-loop: conventional LAGB group (n = 378) and S-loop group (n = 436). The operative outcomes were compared between the two groups. The mean operative time and the length of hospital stay were significantly longer in the conventional LAGB group than in the S-loop group (64.3 minutes versus 57.1 minutes; P < .001 and 5.0 hours versus 3.6 hours; P < .001, respectively). The complications occurred in 7.1% of the conventional LAGB group and 1.6% in the S-loop group (P < .001). Slippage was the most common complication: 13 cases were observed in the conventional LAGB group, whereas no slippage was observed in the S-loop group. Infra-band fixation using S-loop is a simple and effective method for preventing band slippage compared with the conventional LAGB.

Decreased Prevalence of Nonspecific Functional Bowel Disorders and Increased Constipation in Patients after Sleeve Gastrectomy or Gastric Banding

Aim: To examine the effect of laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG) on the prevalence of functional gastrointestinal disorders (FGIDs) as defined by the Rome III criteria. Methods: All patients fulfilled the French consensus inclusion criteria for bariatric surgery (BS). Patients eligible for BS, but did not undergo surgery, constituted the control group (n = 124), whereas patients that underwent LAGB (n = 93) and SG (n = 70) formed the two BS groups. Results: The control group was younger (p = 0.041). Dysphagia (22.1% vs. 9.7%; p = 0.005) and constipation (45.4% vs. 28.2%; p < 0.003) were significantly increased in operated patients; however, these factors were not significantly different between the LAGB and SG groups. In the presence of functional defecation disorder, the odds of constipation in the LAGB and SG groups were increased threefold. In operated patients, the number of nonspecific abdominal symptoms was significantly decreased from that in the control patients (16.6% vs. 33.1%; p < 0.001); this factor was not significantly different between the LAGB and SG groups. Conclusions: No differences were found between the LAGB and SG groups regarding the postoperative prevalence of FGIDs. Improved screening for FGIDs before BS may prevent increased prevalence of dysphagia and constipation.

Effect of Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding on gastrointestinal metabolism of ingested glucose

Data from studies conducted in animal models suggest that intestinal glucose uptake and metabolism are upregulated after Roux-en-Y gastric bypass (RYGB) surgery, which contributes to a weight-loss-independent improvement in glycemic control. We conducted a cohort study to evaluate whether an increase in gastrointestinal metabolism of ingested glucose occurs in obese people who underwent RYGB compared with those who underwent laparoscopic adjustable gastric banding (LAGB). A mixed meal containing stable isotope-labeled glucose was used to determine the gastrointestinal (small intestine and liver) retention, and presumably metabolism, of ingested glucose in obese subjects before and after matched weight loss (∼21%) induced by RYGB (n = 16) or LAGB (n = 9). The total percentage of ingested glucose that appeared in the systemic circulation was slightly lower after than before RYGB (85% ± 9% and 90% ± 8%, respectively) but was slightly higher after than before LAGB (89% ± 3% and 85% ± 4%, respectively) (P-interaction < 0.05). Accordingly, gastrointestinal clearance of ingested glucose (cumulative percentage cleared over 6 h postprandially) increased after RYGB (from 10% ± 8% before to 15% ± 9% after surgery) but decreased after LAGB (from 15% ± 4% before to 11% ± 3% after surgery) (P < 0.05). Surgery-induced weight loss caused a similar decrease in the 6-h postprandial plasma glucose area under the curve in both RYGB and LAGB groups (-4% ± 9% and -6% ± 5%, respectively; P = 0.475). These data support the notion that intestinal glucose disposal increases after RYGB surgery. However, the magnitude of the effect was small and did not result in weight-loss-independent therapeutic effects on postprandial glycemic control. This trial was registered at clinicaltrials.gov as NCT00981500.

Our panel of experts highlight the most important research articles across the spectrum of topics relevant to the field of diabetes management

*Core Technology Facility, Centre for Diabetes & Endocrinology, Institute of Human Development, University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK; shazli.azmi@manchester.ac.uk Ardestani A, Rhoads D, Tavakkoli A. Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated Type 2 diabetes. Diabetes Care 38(4), 659–664 (2015). Ardestani et al. studied 3318 patients who underwent Roux-en-Y gastric bypass surgery (RYGB) and 1907 that had laparoscopic adjustable gastric banding (LAGB) with Type 2 diabetes mellitus (T2D) and were on insulin presurgery. They report that the proportion of insulin cessation in the RYGB was approximately twice that of the LAGB group in all four time points assessed after surgery, 1, 3, 6 and 12 months. Additionally, clinical remission of T2D was greater in the RYGB versus LAGB at all postoperative time points; 1 month (22.5 vs 7%), 3 months (34.4 vs 11.3%), 6 months (43.2 vs 16%) and 12 months (50.3 vs 19.3%). Weight loss was also greater in the RYGBtreated patients at all time points. Multiple regression analysis revealed that RYGB was a strong predictor of postoperative cessation of insulin therapy. Younger age and weight loss were weaker predictors of insulin cessation d uring the early stages. This study shows that even in subjects described as having ‘advanced diabetes’, based on the use of insulin therapy, may benefit from RYGB through remission of T2D. If this does not occur they may have cessation of insulin therapy. A limitation of the study is that the HbA1C, duration of diabetes, fasting blood glucose or dose of insulin was not assessed in the database used. This meant that the authors evaluated diabetes remission through a categorical clinical evaluation scale to assess diabetes severity. – Written by Shazli Azmi

Surgical Treatment of Diabetes: Making a Case for a Pragmatic Approach.

The development of type 2 diabetes mellitus (T2DM) is one of the most serious consequences of weight gain and obesity. Despite an understanding of this association by patients and their physicians, weight loss through diet and exercise, the typical lifestyle modifications recommended to break the yoke of diabetes that hangs on obese individuals, requires intensive interventions that can be difficult to maintain (1, 2). Moreover, lifestyle measures are generally inadequate in patients with severe obesity who are at particularly high risk of developing T2DM and its complications. Although developed primarily to facilitate weight loss, bariatric surgery has been noted to cause marked improvement in diabetes control (3). Emerging data have provided convincing evidence that bariatric surgery can produce rapid, effective, and sustainable remission of T2DM in addition to weight loss and is superior to nonsurgical interventions (3–7). Both the American Diabetes Association (8) and the American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery (9) have now expanded their treatment recommendations to include bariatric surgery as an option for individuals with morbid obesity, body mass index (BMI) 40 kg/m or 35 kg/m with comorbid conditions such as T2DM. Recently, the US Food and Drug Administration approved laparoscopic adjustable gastric banding (LAGB) for individuals with BMI of 30–34 kg/m and comorbidities. LAGB is a relatively simple bariatric procedure in which a saline-filled silicon band is fitted around the stomach near the esophageal junction. The level of gastric restriction imposed by the band can be adjusted by infusing saline through a sc port maintaining the desired level of gastric restriction. LAGB is the least invasive of the commonly used bariatric surgical procedures, with a perioperative mortality rate of approximately 0.05% (10). The safety, ease, and greater effectiveness for weight loss than what is usually obtained with lifestyle measures make the rationale for use of LAGB at lower levels of BMI, and raise the possibility of applying this procedure more widely in the treatment of T2DM. The outcomes of two previous randomized controlled studies have demonstrated that subjects receiving LAGB have superior weight loss and improvement in diabetes control relative to those getting medical or lifestyle management (4, 11). In this issue of the JCEM, Ding et al (12) add another study comparing the effectiveness of LAGB to medical/ lifestyle measures for the treatment of T2DM. They conducted a 12-month randomized, controlled, single-center trial comparing 23 diabetic subjects assigned LAGB with 22 subjects given intensive medical and weight management (IMWM) in a structured program based on previous successful regimens. Notably, they recruited diabetic patients without regard to ongoing treatment or duration of disease and with a broad range of diabetic control. In this sense, the study was arguably more pragmatic than some previous trials in that it involved a population reflective of the average diabetes practice. The average BMI for the study group was 36.5 3.7 kg/m; they had been diagnosed with diabetes for 9 5 years (10 6 in the surgery group and 8 4 in the control), and their glycated hemoglobin (HbA1c) was 8.2 1.2%. About 40% of the patients were on insulin (72% in the surgery group and 18% in the IMWM group). After 1 year, the primary endpoint (HbA1c 6.5% and fasting glucose 7.0 mmol/L) was achieved in 33% of the LAGB group and 23% of the IMWM group, a difference that did not differ statistically. HbA1c reduction over the course of the trial was similar between groups ( 1%), but weight loss was greater in the

The Effect of Weight Loss on Indigenous Australians with Diabetes: a study of Feasibility, Acceptability and Effectiveness of Laparoscopic Adjustable Gastric Banding.

Diabetes and obesity are common and serious health challenges for indigenous people worldwide. The feasibility of achieving substantial weight loss, leading to remission of diabetes, was evaluated in a regional indigenous Australian community. A prospective cohort study of 30 obese indigenous adults from the Rumbalara Aboriginal Co-operative in Central Victoria was performed. Inclusion criteria included aboriginality, BMI > 30 kg/m(2) and diabetes diagnosed within the last 10 years. Weight loss was achieved using laparoscopic adjustable gastric banding (LAGB). Participants were treated in their community and followed for 2 years. Outcomes were compared with those of non-indigenous Australians from an earlier randomized controlled trial (RCT) using a similar protocol. 30 participants (26 females, mean age 44.6 years; mean BMI 44.3) had LAGB at the regional hospital. Twenty-six participants completed diabetes assessment at 2 years follow-up. They showed diabetes remission (fasting blood glucose < 7.0 mmol/L and haemoglobin A1c (HbA1c) < 6.2 % while off all therapy except metformin) in 20 of the 26 and a mean weight loss (SD) of 26.0 (14) kilograms. Based on intention-to-treat, remission rate was 66 %. Quality of life improved. There was one early event and 12 late adverse events. The outcomes for weight loss and diabetes remission were not different from the LAGB group of the RCT. For obese indigenous people with diabetes, a regionalized model of care centred on the LAGB is an effective approach to a serious health problem. The model proved feasible and acceptable to the indigenous people. Australian New Zealand Clinical Trials Registry (ACTRN 12609000319279).

Laparoscopic Gastric Banding in Obese Patients with Sleep Apnea: A 3-Year Controlled Study and Follow-up After 10 Years.

The purpose of this study was to compare the effects of intensive nutritional care (INC) and laparoscopic adjustable gastric banding (LAGB) on nocturnal non-invasive ventilation (NIV) requirement in obese patients using short-, medium-, and long-term follow-up data. This prospective randomized controlled trial included obese patients with obstructive sleep apnea (OSA) treated by NIV. Patients were randomized to the INC and LAGB groups. The primary endpoint was the theoretical rate of weaning from NIV at years 1 and 3. Data were also collected from patients 10 years after randomization. Sixty-three patients were randomized. The rate of weaning from NIV did not differ significantly between the LAGB and INC groups at year 1 (35 vs. 13%) or year 3 (14 vs. 21%). Percentages of excess weight loss were greater in the LAGB group than in the INC group at years 1 (33 vs. 15%, p = 0.002) and 3 (27 vs. 8%, p = 0.014). Decreases in the apnea-hypopnea index were observed in the LAGB group from baseline to year 1 (-44%, p = 0.001) and from baseline to year 3 (-26%, p = 0.044). After 10 years, the weaning rate was low and similar between groups. LAGB was not superior to INC for weaning from NIV at 1 and 3 years in obese patients with OSA.

Insulin cessation and diabetes remission after bariatric surgery in adults with insulin-treated type 2 diabetes.

The impact of bariatric surgeries on insulin-treated type 2 diabetes (I-T2D) in the general population is largely undocumented. We assessed changes in insulin treatment after bariatric surgery in a large cohort of I-T2D patients, comparing Roux-en-Y gastric bypass surgery (RYGB) with laparoscopic adjustable gastric banding (LAGB), controlling for differences in weight loss between procedures. Of 113,638 adult surgical patients in the Bariatric Outcomes Longitudinal Database (BOLD), 10% had I-T2D. Analysis was restricted to 5,225 patients with I-T2D and at least 1 year of postoperative follow-up. Regression models were used to identify factors that predict cessation of insulin therapy. To control for differences in weight loss patterns between RYGB and LAGB, a case-matched analysis was also performed. Of I-T2D patients who underwent RYGB (n = 3,318), 62% were off insulin at 12 months compared with 34% (n = 1,907) after LAGB (P < 0.001). Regression analysis indicated that RYGB strongly predicted insulin cessation at both 1 and 12 months postoperatively. In the case-matched analysis at 3 months, the proportion of insulin cessation was significantly higher in the RYGB group than in the LAGB group (P = 0.03), and the diabetes remission rate was higher at all time points after this surgery. RYGB was a weight-independent predictor of insulin therapy cessation early after surgery, whereas insulin cessation after LAGB was linked to weight loss. I-T2D patients have a greater probability of stopping insulin after RYGB than after LAGB (62% vs. 34%, respectively, at 1 year), with weight-independent effects in the early months after surgery. These findings support RYGB as the procedure of choice for reversing I-T2D.

Safety of laparoscopic adjustable gastric banding with concurrent cholecystectomy for symptomatic cholelithiasis.

The prevalence of cholelithiasis correlates with obesity. Patients often present for bariatric surgery with symptomatic cholelithiasis. There is a concern of cross-contamination when performing laparoscopic adjustable gastric banding (LAGB) with concurrent cholecystectomy. The primary goal of this study is to address the safety and feasibility of this practice. A retrospective cohort study was designed from a prospectively collected database. All LAGB patients from July 2005 to April 2013 were included. Patients undergoing LAGB with concurrent cholecystectomy comprised the study group (LAGB/chole). The control group (LAGB) consisted of patients undergoing LAGB alone, and was selected using a 3:1 (control:study) case-match based on demographic and comorbidity data. The primary outcome was overall complication rate, with secondary outcomes including operating room (OR) time, length of stay (LOS), 30-day readmission/reoperation, erosion, infection, and band/port revisional surgery. There were 4,982 patients who met criteria. Of these, 28 patients had a LAGB with concurrent cholecystectomy, comprising the LAGB/chole (study) group. The remaining 4,954 patients were eligible controls, of which 84 were selected for the LAGB (control) group. Demographic and comorbidity data, along with mean follow-up time, were similar between the two groups. OR time was longer in the LAGB/chole group, but LOS was the same. The overall complication rate in the LAGB/chole group was 21 (n = 6) versus 20% (n = 17) in the LAGB group (p = 0.893). Thirty-day readmission and reoperation were similar. There was also no difference in port site, wound, and intra-abdominal infections. There were no band erosions in either group. Performing a concurrent cholecystectomy at the time of LAGB does not result in increased immediate or delayed morbidity. Although longer to perform, this safe operation would avoid a second surgery for a patient already diagnosed with symptomatic cholelithiasis.

Bariatric surgery in elderly patients. A comparison between gastric banding and sleeve gastrectomy with five years of follow up

Introduction: The prevalence of obesity is rising progressively, even among elderly patients. Many studies investigated about safety and efficacy of bariatric surgery among aged obese patients. The objective of this review is to assess the benefits relative to risks of weight loss that may be obtained by performing two common bariatric procedures in obese elderly patient. Materials and methods: We retrospectively evaluated 10 morbid obese patients older than 60 years reaching 5 years of follow up who respectively underwent Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Adjustable Gastric Banding (LAGB). Eventual changes in comorbidities, weight loss, EWL% were investigated. Results: Although LSG patients required a longer postoperative hospital stay than LAGB patients (p < 0.001), both procedures have shown to be safe and equally effective for weight loss achievement in elderly patients. Whereas all patients showed comorbidities resolution, no significant difference in weight loss between LAGB group and LSG group was found at 1 year (EWL% p = 0.87; BMI p = 0.32), 3 years (EWL% p = 0.62; BMI p = 0.79) and 5 years (EWL% p = 0.52; BMI p = 0.46) of follow up. Conclusions: Bariatric surgery is safe and effective to reach obesity related comorbidities resolution among elderly obese patients. Both LAGB and LSG determine a weight loss lesser than observed in a standard bariatric population. In this study LSG is significantly less cost effective than LAGB. Larger studies with longer follow up are however needed to evaluate the real impact of bariatric surgery on weight loss, resolution of comorbidities and improvement of quality of life in elderly obese patients.

Surgery for weight loss in adults.

Surgery for weight loss in adults.

Comparison of percentage excess weight loss after laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding.

IntroductionLaparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) are acceptable options for primary bariatric procedures in patients with body mass index (BMI) 35–55 kg/m2.AimThe aim of this study is to compare the effects of these two bariatric procedures 6, 12 and 24 months after surgery.Material and methodsTwo hundred and two patients were included 72 LSG and 130 LAGB patients. The average age was 38.8 ±11.9 and 39.4 ±10.4 years in LSG and LAGB groups, with initial BMI of 44.1 kg/m2 and 45.2 kg/m2, p = NS.ResultsThe mean percentage of excess weight loss (%EWL) at 6 months for LSG vs. LAGB was 36.3% vs. 30.1% (p = 0.01) and at 12 months was 43.8% vs. 34.6% (p = 0.005). The greatest difference in the mean %EWL at 12 months was observed in patients with initial BMI of 40–49.9 kg/m2 in favor of LSG (47.5% vs. 35.6%; p = 0.01). Two years after surgery there was no advantage of LSG and in the subgroup of patients with BMI 50–55 kg/m2 there was a trend in favor of LAGB (57.2% vs. 30%; p = 0.07). The multiple regression model of independent variables (age, gender, initial BMI and the presence of comorbidities) proved insignificant in prediction of the best outcome in means of %EWL for either operative modality. None of these factors in the logistic regression model could determine the type of surgery that should be used in particular patients.ConclusionsDuring the first 2 years after surgery, the best results were obtained in women with lower BMI undergoing LSG surgery. The LSG provides greater %EWL after a shorter period of time though the difference decreases in time.

Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial.

Many questions remain unanswered about the role of bariatric surgery for people with type 2 diabetes mellitus (T2DM). To determine feasibility of a randomized clinical trial (RCT) and compare initial outcomes of bariatric surgery and a structured weight loss program for treating T2DM in participants with grades I and II obesity. A 12-month, 3-arm RCT at a single center including 69 participants aged 25 to 55 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 to 40 and T2DM. Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB), and an intensive lifestyle weight loss intervention (LWLI). Primary outcomes in the intention-to-treat cohort were feasibility and effectiveness measured by weight loss and improvements in glycemic control. Of 667 potential participants who underwent screening, 69 (10.3%) were randomized. Among the randomized participants, 30 (43%) had grade I obesity, and 56 (81%) were women. Mean (SD) age was 47.3 (6.4) years and hemoglobin A1c level, 7.9% (2.0%). After randomization, 7 participants (10%) refused to undergo their allocated intervention (3 RYGB, 1 LAGB, and 3 LWLI), and 1 RYGB participant was excluded for current smoking. Twenty participants underwent RYGB; 21, LAGB; and 20, LWLI, with 12-month retention rates of 90%, 86%, and 70%, respectively. In the intention-to-treat cohort with multiple imputation for missing data, RYGB participants had the greatest mean weight loss from baseline (27.0%; 95% CI, 30.8-23.3) compared with LAGB (17.3%; 95% CI, 21.1-13.5) and LWLI (10.2%; 95% CI, 14.8-5.61) (P < .001). Partial and complete remission of T2DM were 50% and 17%, respectively, in the RYGB group and 27% and 23%, respectively, in the LAGB group (P < .001 and P = .047 between groups for partial and complete remission), with no remission in the LWLI group. Significant reductions in use of antidiabetics occurred in both surgical groups. No deaths were noted. The 3 serious adverse events included 1 ulcer treated medically in the RYGB group and 2 rehospitalizations for dehydration in the LAGB group. This study highlights several potential challenges to successful completion of a larger RCT for treatment of T2DM and obesity in patients with a body mass index of 30 to 40, including the difficulties associated with recruiting and randomizing patients to surgical vs nonsurgical interventions. Preliminary results show that RYGB was the most effective treatment, followed by LAGB for weight loss and T2DM outcomes at 1 year. clinicaltrials.gov Identifier: NCT01047735.