Laparoscopic Adjustable Gastric Banding Patients Research Articles

Comparison of One Anastomosis Gastric Bypass and Sleeve Gastrectomy for Revision of Laparoscopic Adjustable Gastric Banding: 5-Year Outcomes.

Laparoscopic adjustable gastric banding (LAGB) is in continuous decline due to low effectiveness and high reoperation rates. This study aims to evaluate outcomes of converting LAGB to one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG) for insufficient weight loss or weight regain. Retrospective comparative study, based on prospective registry database of a tertiary center (2012-2019). In all, 276 LAGB patients were converted to OAGB (n = 125) and SG (n = 151). Body mass index (BMI) at revision was 41.3 ± 6.6 and 42.3 ± 9.6kg/m2 (P = 0.34) in OAGB and SG patients, respectively. Time interval was longer in OAGB patients (p < 0.001). Major early complication rates were comparable (2.4% and 4%; p = 0.46). At 5-years, OAGB patients had lower BMI (31.9 vs. 34.5kg/m2; p = 0.002), and a higher total weight loss (25.1% vs. 18.8%; p = 0.003), compared with SG patients. Resolution of type 2 diabetes was higher in OAGB patients (93.3% vs. 66.6%; p = 0.047), while resolution of hypertension was not significantly different (84.6% and 80.5%; p = 0.68). Revision due to delayed complications was required in five (4%) OAGB patients and nine (8.6%) SG patients (p = 0.14). OAGB for revision after LAGB due to insufficient weight loss or weight regain is safe, and has better effectiveness in weight reduction and resolution of type 2 diabetes than SG.

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

Comparing Diabetes Outcomes: Weight-independent Effects of Sleeve Gastrectomy Versus Matched Patients With Similar Weight Loss.

To determine if sleeve gastrectomy has weight-independent benefits on diabetes outcomes. Weight loss is recommended when treating conditions such as diabetes, hypertension, and hyperlipidemia. Bariatric surgery has been shown to improve or resolve metabolic conditions, but weight loss outcomes vary by procedure type. Using data from a statewide bariatric surgery registry, a total of 988 patients with a preoperative diagnosis of diabetes who underwent either laparoscopic sleeve gastrectomy (LSG) or laparoscopic adjustable gastric banding (LAGB) were included in the study. The patients were matched based on age, race, sex, preoperative body mass index (BMi) and weight loss at 1 year after surgery. Chi-square comparisons were conducted for medication discontinuation for diabetes. Secondary outcome measures included discontinuation of medications for hypertension and hyperlipidemia. The mean age of patients was 53.9 years, 75.5% were female, 89.3% were White. Mean preoperative BMi was 44.8 kg/m2 and 75.7% had noninsulin dependent diabetes, whereas 24.3% had insulin dependent diabetes. Mean % BMi loss at 1 year is similar between the 2 groups (8.3% vs 8.1%, P = 0.3811). LSG patients had significantly higher rates of discontinuation of oral diabetes medication (70.4% vs 46.0%, P < 0.0001), insulin (51.7% vs 38.3%, P = 0.0341), anti-hypertensive (41.1% vs 26.0%, P < 0.0001), and cholesterol-lowering medications (40.1% vs 27.8%, P = 0.0016) when compared to LAGB patients. Despite similar preoperative characteristics and postoperative weight loss, LSG patients experienced significantly higher rates of medication discontinuation for diabetes, hypertension, and hyperlipidemia than LAGB. These results suggest that LSG may have weight-independent effects on metabolic disease and should be considered in the treatment of diabetes, regardless of perceived weight loss outcomes.

Health disparity in access to bariatric surgery.

Sociodemographic disparities in terms of access to bariatric surgery are ongoing. This study aimed to examine the trends for bariatric interventions based on patient characteristics from 2011 to 2018 in the state of New York. Administrative statewide database. This study used the New York Statewide Planning and Research Cooperative System database to identify all patients with obesity who underwent Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) between 2011 and 2018. The trends were studied for the types of bariatric procedures performed across different patient characteristics, including median household income as determined based on ZIP code. A multivariable logistic regression analysis was performed to compare the yearly trends. We identified 111,793 patients who underwent bariatric surgery. The number of bariatric procedures increased from 9304 in 2011 to 16,946 in 2018. RYGB was the most performed bariatric operation in 2011, but was replaced by SG from 2013 to 2018. Patients living in the highest decile median household income ZIP code areas had the highest increase in SG (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.46-1.55; P < .0001) and the largest decrease in LAGB (OR, .53; 95% CI, .51-.56; P = .0007). The use of bariatric surgery increased significantly from 2011 to 2018. However, the disproportionately and substantially increased use of SG and the decreased use of LAGB in patients living in wealthier areas suggest that disparity in the use of bariatric interventions still exists. Public health efforts should be made to equalize access to bariatric surgery.

Clinical characteristics vary between women and men in 67,524 patients with moderate obesity preoperative for laparoscopic adjustable gastric band (LAGB)

Background: As of 2018, LAGB represents &lt;2% of weight loss operations, but with excellent long-term outcomes in selected patients. Thus, every clinical insight can help in selecting LAGB patients and planning surgery. While more women than men undergo bariatric surgery, differences between the sexes in obesity-related clinical conditions pre-operatively among patients seeking LAGB have not been investigated. The objective of this study was to identify variations in obesity-related co-morbidities among women and men who chose laparoscopic adjustable gastric band (LAGB). Methods: Pre-operative data on 53,292 women and 14,222 men undergoing LAGB were examined retrospectively from the Surgical Review Corporation’s Bariatric Outcomes Longitudinal Database (BOLD). Results: Women were more frequently African American and on Medicaid while men were more frequently Caucasian insured with Medicare. Men were older, heavier, and used alcohol, tobacco, and illicit substances more frequently. Men had higher rates of cardiovascular and pulmonary disease, diabetes, gout, impaired functional status, abdominal hernia, and liver disease. Women had higher rates of asthma, cholelithiasis, urinary incontinence, panniculitis, and mental health. Conclusion: Pre-operative characteristics of LAGB patients vary by sex. This clinical knowledge may aid physicians and surgeons in facilitating anticipatory management of patients with moderate obesity

Hospital Length of Stay after Metabolic and Bariatric Surgery by Race/Ethnicity and Procedure Type among Florida Patients

ObjectivesMetabolic and Bariatric Surgery (MBS) has become increasingly common as a treatment option for severely obese. We examined the association of hospital length of stay (LOS) by race-ethnicity (Hispanic, non-Hispanic white [NHW], NH black [NHB]) and MBS-procedure among Florida inpatients. DesignSecondary analysis of inpatient records was performed using the 2016 Florida Agency for Health Care Administrative (AHCA) data. Records of Laparoscopic Roux-en-Y Gastric Bypass (RYGB), Laparoscopic Adjustable Gastric Banding (LAGB), and Sleeve Gastrectomy (SG) procedures based on ICD 10th edition code were analyzed. Via logistic regression analysis, the adjusted odds ratio (aOR) of longer LOS (≥2 versus < 2days) and the corresponding 95% confidence interval (CI) were calculated for racial-ethnic groups (NHW versus other groups) and MBS type (SG versus LAGB or RYGB) adjusted for age, sex, BMI, and insurance status. ResultsThe majority of the sample (N = 10,630, approximately 56% NHW, 21% NHB, 20% Hispanic, 3% Other) underwent SG (71%), followed by RYGB (24%) and LAGB (5%). Hispanic were more likely (aOR 1.27; 95% CI 1.14–1.42) and NHB were less likely (0.68; 0.61–0.75) than NHW to have longer LOS regardless of MBS type. Compared to SG, LAGB patients were more likely (2.09; 1.70–2.55) but RYGB patients were less likely (0.32; 0.29–0.36) to have longer LOS. ConclusionsAlthough LAGB is considered the least invasive MBS, recipients tend to stay longer in hospital after adjustment for health insurance and sociodemographic factors. Medical and socioecological reasons for racial-ethnic variations in LOS relating MBS should be explored further.

Medium-term outcomes of converting laparoscopic adjustable gastric band to Roux-en-Y gastric bypass in patients with body mass index

The rates of primary laparoscopic adjustable gastric banding (LAGB) have declined in the last 5 years due to band removal secondary to complications and the subsequent weight regain that requires revisional procedures. This study aimed to present medium-term weight loss results and the safety profile of converting LAGB to Roux-en-Y gastric bypass in patients with body mass index (BMI) <35.0 kg/m2 who presented with LAGB intolerance or complications. Many health services do not permit such procedures on low BMI patients. Single-surgeon series, including public and private practice, Brisbane, Australia. A prospectively maintained database was reviewed and retrospectively analyzed for LAGB patients with a BMI <35.0 kg/m2 who underwent conversion to Roux-en-Y gastric bypass by a single surgeon. Indications for conversion, weight loss data, and early (30 d postoperative) and late complications were recorded with follow-up out to 5 years. One hundred thirty-two adult patients with a BMI <35.0 kg/m2 underwent conversion from 2009 to 2016. The main indications for conversion were reflux and band complications. Median BMI at bypass was 32.8 kg/m2 (23.1-35.0). Median percentage excess weight loss was 77%, 90%, 73%, 47%, 49%, and 44% at 1, 2, 3, 4, and 5 years, respectively among patients who were eligible and present at follow-up. Median BMI was <30.0 kg/m2 (29.1-40.9) at 5 years with only 1 subject exceeding >35.0 kg/m2. Mortality was 0%. Early morbidity occurred in 31.8% of patients. The most common late complication was gastrojejunostomy stricture requiring endoscopic dilation. In combination with our 2014 study showing morbidity data in the short-term period being comparable to patients with BMI >35.0 kg/m2, our study demonstrates that converting LABG to Roux-en-Y gastric bypass in low BMI patients is a feasible and safe option that avoids weight regain and maintains adequate weight loss at 5 years, with acceptable morbidity and no mortality.

1839 From the Lap to the Lung: The Esophagus Is the Answer

INTRODUCTION: Esophageal pathologies are significant yet under-reported complications of laparoscopic adjustable gastric banding (LAGB). We report a case of LAGB-associated esophageal dilatation and dysmotility that resulted in multifocal aspiration pneumonia (PNA) and a lung abscess 8 years after LAGB. CASE DESCRIPTION/METHODS: A 48-year-old morbidly obese man who underwent LAGB in 2011 presented with productive cough, dyspnea, and pleuritic chest pain for 3 weeks. He also reported intermittent postprandial gastric reflux and regurgitation of food since his LAGB, which he had been managing with lifestyle modifications. In the Emergency Room, he was febrile to 102F with leukocytosis to 16.8k/uL. CT chest revealed a fluid-filled esophagus (Figure 1) and a thick-walled cavity in the right lower lobe with an air-fluid level, consistent with a lung abscess (Figure 2). Additional consolidations were seen in the bilateral upper lobes. An esophagram was done due to a suspicion for aspiration PNA, and this confirmed a dilated distal esophagus (Figure 3) with impaired peristalsis and nonpropulsive contractions indicative of dysmotility. The patient’s esophageal pathologies and multifocal PNA were determined to be complications from his LAGB. He completed 3 weeks of antibiotics and was discharged with bariatric follow up for revision or removal of his LAGB. DISCUSSION: LAGB has several advantages over other bariatric procedures including band adjustability, reversibility, and small surgical risk. Despite this, the prevalence of LAGB has declined significantly due to several long-term complications including esophageal pathologies. In fact, one study reported esophageal dysmotility in 68% and esophageal dilatation in 25% of patients 5-7 years after LAGB. Esophageal dilatation is thought to occur from an overly tight band and in patients who overeat and use their distal esophagus as a food reservoir. This results in unsynchronized esophageal contractions and, thus, dysmotility. These patients may report reflux, vomiting, and regurgitation, which put them at high risk for aspiration PNA and, more rarely, complications such as lung abscesses. Patients who present with aspiration PNA or lung abscesses require antibiotics, but esophageal pathology alone should lead to consideration of band deflation or removal in order to prevent future recurrences. This case of LAGB-associated esophageal dysfunction highlights the importance of long-term monitoring of LAGB patients, especially in the setting of continued reflux or regurgitation.

Long-Term Inpatient Hospital Utilisation and Costs (2007-2008 to 2015-2016) for Publicly Waitlisted Bariatric Surgery Patients in an Australian Public Hospital System Based on Australia's Activity-Based Funding Model.

BackgroundWithin the Australian public hospital setting, no studies have previously reported total hospital utilisation and costs (pre/postoperatively) and costed patient-level pathways for primary bariatric surgery and surgical sequelae (including secondary surgery) informed by Australia’s Independent Hospital Pricing Authority’s activity-based funding (ABF) model.ObjectiveWe aimed to provide our Tasmanian state government partner with information regarding key evidence gaps about the resource use and costs of bariatric surgery (including pre- and postoperatively, types of surgery and comorbidities), the costs of surgical sequelae and policy direction regarding the types of bariatric surgery offered within the Tasmanian public hospital system.MethodsHospital inpatient length of stay (days), episodes of care (number) and aggregated cost data were extracted for people who were waiting for and subsequently received bariatric surgery (for the fiscal years 2007–2008 to 2015–2016) from administrative sources routinely collected, clinically coded/costed according to ABF. Aggregated ABF costs were expressed in 2016–2017 Australian dollars ($A). Sensitivity (cost outliers) and subgroup analyses were conducted.ResultsA total of 105 patients entered the study. Total costs (pre/postoperative over 8 years) for all inpatient episodes of care (n = 779 episodes of care) were $A6,018,349. When the ten cost outliers were omitted from the total cost, this cost reduced to $A4,749,265. Mean costs for primary laparoscopic adjustable gastric band (LAGB) and sleeve gastrectomy (SG) bariatric surgery were $A14,622 and $A15,014, respectively. The average cost/episode of care for people with diabetes decreased in the first year postoperatively, from $A7258 to $A5830/episode of care. In total, 27 LAGB patients (30%) required surgery due to surgical sequelae (including revisional/secondary surgery; n = 58 episodes of care) and 56% of these episodes of care were secondary LAGB device related (mostly port/reservoir related), with a mean cost of $A6267.ConclusionsTaking into account our small SG sample size and the short time horizon for investigating surgical sequalae for SG, costs may be mitigated in the Tasmanian public hospital system by substituting LAGB with SG when clinically appropriate due to costs associated with the LAGB device for some patients. At 3 years postoperatively versus preoperatively, episodes of care and costs reduced substantially, particularly for people with diabetes/cardiovascular disease. We recommend that a larger confirmatory study of bariatric surgery including LAGB and SG be undertaken of disaggregated ABF costs in the Tasmanian public hospital system.

A 5-Year History of Laparoscopic Gastric Band Removals: an Analysis of Complications and Associated Comorbidities.

This study was undertaken to examine the factors contributing to laparoscopic adjustable gastric band (LAGB) removals among adults > 18years of age. We hypothesized that female patients with multiple comorbidities would have increased removals. This retrospective exploratory study uses internal records and standard statistical methods of analysis. Eighty-five bands were removed (11.8% males, 88.2% females). The average BMI was 40.7 (n = 83). 2.4% of patients had removals between 0 and 12months, 18.8% between 39 and 51months, and 35.3% between 39 and 64months. 8.2% of treatment times were unknown. The average treatment time was 67.9months. 48.2% of patients had ≥ 2 comorbidities, GERD (44.2%) being the most frequent. 49.4% of patients reported dysphagia as the reason for band removal. 22.4% of removals were associated with band failures, none with port complications. The reason for band removal was unknown in 21.2% of patients. 67.1%, 32.9%, and 23.5% attended 30-, 60-, and 90-day follow-up appointments, respectively. Weight post-band removal surgery at 30, 60, and 90days was noted to be - 0.4%., 0.9%, and 0.4%, respectively. This study supports current literature suggesting LAGB may not be an effective long-term surgical intervention for obesity. Patients with > 2 comorbidities had increased rates of removal. Dysphagia was noted to be the primary reason cited for LAGB removal. Postoperative follow-up was found to be a significant challenge for LAGB removal patients. Further study is warranted to explore if these poor follow-up rates should be considered when risk stratifying LAGB patients for revisional surgery.

Laparoscopic Adjustable Gastric Banding: an Underestimated Risk Factor for the Development of Esophageal Cancer?\u2014a Nationwide Survey

BackgroundApproximately 14% of Austria’s 8.5 million inhabitants have a body mass index (BMI) > 30 kg/m2. The laparoscopic adjustable gastric banding (LAGB) was introduced in Austria in 1994, where about 10.300 patients have received it so far. One of our LAGB patients developed an adenocarcinoma of the distal esophagus 13 years after implantation.ObjectivesIn order to calculate whether after LAGB patients are at higher risk for carcinoma of the esophagus, we performed a nationwide survey.MethodsA questionnaire was sent to all surgical departments in Austria, primarily in order to detect cases with esophageal carcinoma after LAGB, but also to evaluate the policy in Austria concerning preoperative work-up, operation, and follow-up in LAGB patients.ResultsSince 1994, 37 of the 119 surgical departments in Austria have performed a total of about 10.300 LAGB implantations. Six patients have been identified with esophageal cancer following LAGB. The WHO statistical report on esophageal cancer shows an incidence of 2.8/100.000 per year in Austria, about 1/3 of which cases are adenocarcinoma of the distal esophagus.ConclusionFollowing LAGB, the incidence of esophageal cancer might be up to fivefold higher than the aged standardized overall population of Austria.

A455 - Outreach to laparoscopic adjustable gastric band patients: A quality improvement project

A455 - Outreach to laparoscopic adjustable gastric band patients: A quality improvement project

Long-Term Outcomes After Bariatric Surgery: a Systematic Review and Meta-analysis of Weight Loss at 10 or More Years for All Bariatric Procedures and a Single-Centre Review of 20-Year Outcomes After Adjustable Gastric Banding

IntroductionDurability is a key requirement for the broad acceptance of bariatric surgery. We report on durability at and beyond 10 years with a systematic review and meta-analysis of all reports providing data at 10 or more years and a single-centre study of laparoscopic adjustable gastric banding (LAGB) with 20 years of follow-up.MethodsSystematic review with meta-analysis was performed on all eligble reports containing 10 or more years of follow-up data on weight loss after bariatric surgery. In addition, a prospective cohort study of LAGB patients measuring weight loss and reoperation at up to 20 years is presented.ResultsSystematic review identified 57 datasets of which 33 were eligible for meta-analysis. Weighted means of the percentage of excess weight loss (%EWL) were calculated for all papers included in the systematic review. Eighteen reports of gastric bypass showed a weighted mean of 56.7%EWL, 17 reports of LAGB showed 45.9%EWL, 9 reports of biliopancreatic bypass +/− duodenal switch showed 74.1%EWL and 2 reports of sleeve gastrectomy showed 58.3%EWL. Meta-analyses of eligible studies demonstrated comparable results. Reoperations were common in all groups. At a single centre, 8378 LAGB patients were followed for up to 20 years with an overall follow-up rate of 54%. No surgical deaths occurred. Weight loss at 20 years (N = 35) was 30.1 kg, 48.9%EWL and 22.2% total weight loss (%TWL). Reoperation rate was initially high but reduced markedly with improved band and surgical and aftercare techniques.ConclusionAll current procedures are associated with substantial and durable weight loss. More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy. Reoperation is likely to remain common across all procedures.

PS02.252: LAPOROSCOPIC ADJUSTABLE GASTRIC BANDING: AN UNDERESTIMATED RISK FACTOR FOR THE DEVELOPMENT OF ESOPHAGEAL CANCER?–A NATIONWIDE SURVEY

Abstract Background Among the population of Austria (8,4 Mill.) about 870.000 (12%) have a body mass index (BMI) &gt; 30 kg/m2. For those with morbid obesity, Bariatric surgery is currently the only effective treatment in the long term. In 1994 the laparoscopic adjustable gastric banding (LAGB) was introduced in Austria and about 10.300 patients received it so far. One of our LAGB-patients developed adenocarcinoma of the distal esophagus after 13 years. In order to calculate if patients after LAGB are at higher risk for carcinoma of the esophagus, we performed a nationwide survey. Methods A questionnaire was sent to all surgical departments in Austria, primarily in order to detect cases with esophageal carcinoma after LAGB, but also to evaluate the policy in Austria concerning the preoperative work-up, the operation and the follow-up in LAGB patients. Results Since 1994, 37 out of 119 surgical departments in Austria have been performing about 10300 LAGB implantations in total. Moreover, eight surgical departments are performing resective esophageal cancer surgery. Seven patients could be identified with development of upper gastrointestinal malignoma/dysplasia after LAGB implantation. Conclusion To our knowledge less than 20 cases of esophageal cancer after laparoscopic adjustable gastric banding have been described so far, but there is sound evidence that the development of Barrett's metaplasia after LAGB is much higher The most recent nationwide Austrian statistical report on esophageal cancer (2015) shows an incidence of 8,8: 100.000/per year, les than 1% of the annually emerging malignant tumors. About 48% of the emerging malignant tumors are squamous cell carcinoma (male: 47,6%, female: 48,3%) whereas about 30% are adenocarcinoma (male: 32,6%; female: 25,3%). Our data suggests that the incidence for developing an adenocarcinoma of the esophagus in Austria is currently about 3/100.000/a. Compared to the five patients we detected, the incidence of developing a carcinoma of the esophagus after LAGB is about up to fthree fold higher. In patients with a laparoscopic adjustable gastric banding, a diligent preoperative evaluation and aggressive postsurgical follow-up including gastroscopy and in selected cases esophageal manometry seems mandatory. Disclosure All authors have declared no conflicts of interest.

Conversion Surgery for Failed Adjustable Gastric Banding: Outcomes with Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass.

Laparoscopic adjustable gastric banding (LAGB) was once a preferred method of obesity treatment featuring a straightforward technique, removability, and good early results. In a significant proportion of patients, however, it was not a durable weight-loss procedure and has been associated with a high longer-term complication rate. The purpose of this study was to directly compare the results of conversion to laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) after failed LAGB. Post-LAGB complications and weight outcomes of conversion (absolute weight, excess weight loss [%EWL], total weight loss [%TWL]) to LSG vs LRYGB were retrospectively reviewed and statistically compared using Fisher's exact test and the independent samples t test. Over a 6-year period, 74/272 (27.2%) morbidly obese LAGB patients experienced marked complications requiring band removal. Forty-nine of these patients underwent conversion by LRYGB (n = 29) or LSG (n = 20). There was no statistically significant difference in complication rates between converted procedures and no significant difference in respective EWL and TWL (6-month EWL: LRYGB, 53.6% vs LSG, 51.3% and respective TWL, 22.8 vs 21.3%; 12-month EWL, 70.1 vs 56.1%; and TWL, 30.7 vs 23.2%; p > 0.05). All conversion patients were present at each time point. Outcomes for LSG vs LRYGB following failed LAGB were equally safe and effective.

Rate of revisions or conversion after bariatric surgery over 10 years in the state of New York

BackgroundA primary measure of the success of a procedure is the whether or not additional surgery may be necessary. Multi-institutional studies regarding the need for reoperation after bariatric surgery are scarce. ObjectivesThe purpose of this study is to evaluate the rate of revisions/conversions (RC) after 3 common bariatric procedures over 10 years in the state of New York. SettingUniversity Hospital, involving a large database in New York State. MethodsThe Statewide Planning and Research Cooperative System database was used to identify all patients undergoing laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) between 2004 and 2010. Patients were followed for RC to other bariatric procedures for at least 4 years (up to 2014). Multivariable cox proportional hazard regression analysis was performed to identify risk factors for additional surgery after each common bariatric procedure. Multivariable logistic regression was used to check the factors associated with having ≥2 follow-up procedures. ResultsThere were 40,994 bariatric procedures with 16,444 LAGB, 22,769 RYGB, and 1781 SG. Rate of RC was 26.0% for LAGB, 9.8% for SG, and 4.9% for RYGB. Multiple RC ( = />2) were more common for LAGB (5.7% for LAGB, .5% for RYGB, and .2% for LSG). Band revision/replacements required further procedures compared with patients who underwent conversion to RYGB/SG (939 compared with 48 procedures). Majority of RC were not performed at initial institution (68.2% of LAGB patients, 75.9% for RYGB, 63.7% of SG). Risk factors for multiple procedures included surgery type, as LAGB was more likely to have multiple RC. ConclusionsReoperation was common for LAGB, but less common for RYGB (4.9%) and SG (9.8%). RC rate are almost twice after SG than after RYGB. LAGB had the highest rate (5.7%) of multiple reoperations. Conversion was the procedure of choice after a failed LAGB.

Perioperative Factors Affecting Ambulatory Outcomes Following Laparoscopic-Adjustable Gastric Banding.

Morbidly obese patients are traditionally hospitalised following bariatric surgery. However, laparoscopic-adjustable gastric banding (LAGB) is amenable for ambulatory care. We hypothesised that the majority of patients can receive an ambulatory LAGB and that both surgical and anaesthetic perioperative factors will significantly affect non-ambulatory LAGB outcomes. Medical records of 201 consecutive LAGB patients performed at the University of Kansas Medical Centre during a 3-y period were reviewed. Demographic, medical, laboratory, anaesthetic, intraoperative and postoperative data were collected. Factors associated with non-ambulatory outcomes were identified and analysed using logistic regression, and a classification tree analysis was used to rank the descriptive model factor to the non-ambulatory outcome. Average patient age was 43.4±11.4 years, and average body mass index was 48.2±10.3 kg m2-1. A total of 155 patients (77.1%; 95% confidence interval, 71%-83%; p<0.0001) were discharged home within 2-3 hours of surgery, whereas 36 stayed for 23 hours and 10 required hospital admission for 1-2 days. Increased surgical port numbers (p=0.007), ≥50% of total intraoperative fentanyl administered in the recovery room (post-anaesthesia care unit) for the treatment of postoperative pain (p=0.007) and a lack of prophylactic beta-blockade (p=0.001) were three factors associated with non-ambulatory outcomes. Obstructive sleep apnoea was not associated with a non-ambulatory outcome (p=0.83). The majority of patients received an ambulatory LAGB. Meticulous laparoscopic surgical technique with the least feasible number of access ports and multimodal analgesic technique aimed at reduction of postoperative opioid consumption are the most important factors for a successful ambulatory LAGB outcome.

Weight Loss Failure and Reoperation After Laparoscopic Adjustable Gastric Banding and Gastric Bypass: a Case-Matched Cohort Study.

Not long ago, laparoscopic adjustable gastric banding (LAGB) was considered a safe and effective treatment of morbid obesity; however, long-term outcomes revealed significant complication and failure rates. We hypothesized that LAGB has higher rates of weight loss failure, reoperation, and overall failure compared to laparoscopic gastric bypass (LRYGB) at long-term follow-up. A matched case-control study was performed. Patients who underwent primary LAGB or LRYGB at a university hospital between 2004 and 2011 were propensity matched for age, gender, race, body mass index (BMI), and weight-related co-morbidities. Outcomes included demographics, percent excess weight loss (% EWL) and reoperation, weight loss failure (<50% EWL), and overall failure (procedure-related reoperation and/or <50% EWL) at 3- and 5-year follow-up. In all, 228 LAGB and 228 LRYGB patients matched. LAGB patients had less mean EWL at 3years (35 vs. 71%, P<0.05) and 5years (29.3 vs. 66.7%, P<0.05). LAGB (11%) and LRYGB (11.5%) patients required procedure-related reoperation. More LAGB patients suffered weight loss failure at 3years (75 vs. 10.5%, P<0.05) and 5years (81.5 vs. 15.4%, P<0.05). Overall failure rates were higher after LAGB. The most common complication after LAGB was pouch/esophageal enlargement (9.7%) and after LRYGB was internal hernia (4.8%). LAGB patients had higher morbidity (19 vs. 12.7%, P=0.04) but similar procedure-related mortality (0 vs. 0.4%). LAGB has significantly higher rates of weight loss failure compared to LRYGB with similar rates of procedure-related reoperation. Overall failure rates are higher after LAGB. These data suggest the long-term effectiveness of LAGB might be limited.

The Physiology and Pathophysiology of Gastroesophageal Reflux in Patients with Laparoscopic Adjustable Gastric Band.

The effect of the laparoscopic adjustable gastric band (LAGB) on esophageal acid exposure and reflux is poorly understood. Optimal technique and normative values for acid exposure have not been established in this group. High-resolution manometry (HRM) and 24-h ambulatory esophageal pH monitoring were performed in three groups: asymptomatic LAGB, symptomatic LAGB, and pre-operative reflux patients. This technique utilized intraluminal pressure signatures during HRM to guide accurate pH sensor placement. The LAGB groups were well matched: age 48 vs 51years (p=0.249), weight loss 27.3 vs 26.7kg (p=0.911). The symptomatic group had a larger gastric pouch (5.2 vs 3.3cm, p=0.012), with higher esophageal acid exposure (10.8 vs 0.9%, p<0.001). Two acidification patterns were observed: irritant and volume acidification, associated with substantial supine acidification. Symptomatic LAGB had altered esophageal motility, with poorer lower esophageal sphincter basal tone (8.0 vs 17.7mmHg, p=0.022) and impaired contractility of the lower esophageal segment (90 vs 40%, p=0.009). Compared to pre-operative reflux patients, symptomatic LAGB patients demonstrated higher total and supine esophageal acid exposure (10.8 vs 7.0%, p=0.010; 14.9 vs 5.1%, p<0.001), less symptoms (2 vs 6, p=0.001) and lower symptom index (0.7 vs 0.9, p=0.010). Ambulatory pH monitoring is an effective technique if the pH sensor is positioned appropriately using HRM. The correctly positioned LAGB appears associated with low esophageal acidification. In contrast, patients with symptoms or pouch dilatation can have markedly elevated esophageal acidification, particularly when supine. This is a different pattern compared to pre-operative patients and importantly can be disproportionate to symptoms.