Laparoscopic Adjustable Gastric Band Placement Research Articles

Non-surgical treatment of staple-line suture leakage after redo sleeve gastrectomy

Redo bariatric procedures are common. However, redo sleeve gastrectomy is not a frequent case of repeated bariatric surgery and can be performed rather as a necessary measure in difficult intraoperative conditions. We report a patient who underwent laparoscopic adjustable gastric band placement, its blockage and surgical removal, sleeve gastrectomy and redo sleeve gastrectomy. After that, staple-line suture failure developed that required endoscopic clipping.

Laparoscopic adjustable gastric band remains a safe, effective, and durable option for surgical weight loss.

Despite many patients doing well after laparoscopic adjustable gastric band (LAGB) several studies caution offering this procedure for weight loss. The aim of our study was to review our long-term results over a decade. Following IRB approval, the Metabolic and Bariatric Surgery Quality Improvement Program (MBSAQIP) Data Registry was used to identify LAGB placement between 2007 and 2013 by a single surgeon. We sought to determine complications of initial operation, weight loss and resolution of comorbidities over time, the indications for reoperation including removal, revision or conversion to another weight loss surgery. Chi-square test was used to analysis. From 403 LAGB performed between January 2007 and December 2013, 75 patients required reoperation with total 79 procedures, including band revision and/or conversion. Mean follow-up time was 5.78years (73.67months). The rate of reoperation was at least 18.61%. There were 60 band removals, 10 band revisions, 9 conversions to either sleeve or gastric bypass. Only 16 patients (20.25%) required reoperation due to inadequate weight loss. Band slippage/prolapse remained the most common non weight-related indication for reoperation (23, 29.11%). Reoperation associated with longer length of stay compared to index procedures (2.12days vs 1.63days, p < 0.0001) but no statistical difference in 30_days_complication. Of those who did not require reoperation, BMI at 10th year follow-up was 37.50 from initial BMI of 42.23 with EWL of 39.22%. Lap band is effective for most patients with long-term durability. Over time approximately one fifth will need additional surgery. Only one fifth of reoperation relates to inadequate weight loss.

Esophageal Erosion of Adjustable Gastric Band, Endoscopic Solution of an Unreported Complication.

Although laparoscopic adjustable gastric band (LAGB) placement appears as a safe and reproducible procedure, serious complications can occur. We present a patient with fever, dysphagia, epigastric pain, and port site inflammation. Esophagogastroduodenoscopy and computed tomography (CT) scan diagnosed esophageal erosion of the gastric band. An endoscopic retrieval was proposed to avoid accessing the abdominal cavity and mediastinum, reduce recovery time, and minimize complications. The patient successfully underwent the procedure with immediate improvement of symptoms and discharge on the seventh postoperative day. This article aims to report the first clinical case of an esophageal erosion of LAGB completely treated with an endoscopic approach.

Obstrucción intestinal, complicación inusual por banda gástrica ajustable laparoscópica: reporte de caso

Background: The main goal of bariatric surgery is the reduction of Body mass index (BMI). Laparoscopic adjustable gastric band (LAGB) was the most popular method due to its relative advantages over others. Clinical case: A 44-year-old woman with abdominal pain and distension, with a history of LAGB placement had a diagnosis of intestinal occlusion secondary to a twist in the device tube, surgical management was given, the patient presented adequate evolution. Conclusion: The occlusion of the small intestine by the tube of the device is a serious and uncommon complication to be considered as a differential diagnosis in bariatric patients. Keywords: Bariatric surgery; complications; gastric band; bowel obstruction; obesity.

342 An Interesting Report of Endoscopic Management of a Migrated Gastric Lap Band

INTRODUCTION: Laparoscopic adjustable gastric band (LAGB) placement is a commonly performed surgical weight loss procedure. Erosion of the band through the gastric wall is an uncommon albeit life-threatening complication that can present with abdominal pain and weight gain, potentially leading to peritonitis. Diagnosis is made with imaging such as computed tomography (CT) and may be managed by endoscopic or surgical intervention. We report a case of a LAGB that eroded through the gastric wall and migrated into the jejunum, managed with successful endoscopic retrieval. CASE DESCRIPTION/METHODS: 58-year-old male with a history of class III obesity status post LAGB placement in 2008 presented with two months of abdominal pain, nausea, vomiting and weight loss. CT abdomen revealed mural thickening of gastric cardia with distal end of the gastric band tubing attached to a band in the jejunum and proximal end of tubing attached to a subcutaneous port (Figure 1). Fluoroscopy-guided enteroscopy revealed multiple mucosal ulcerations due to tracking of the displaced gastric band tubing. The tubing was noted to enter the gastric cavity at the cardia, extending into the proximal jejunum where the deflated gastric band was identified. A snare was used to pull the band into the gastric cavity. An upper endoscope was then inserted alongside the enteroscope (Figure 2). A 0.025 inch guidewire was placed around the tubing and captured with a snare. The distal end of the guidewire was then removed along with the gastroscope through the oral cavity. Both ends of the guidewire were loaded into a Sohendra rescue lithotripter which was then used to severe the lap band tubing approximately 10 cm from the point of entry into the gastric cavity. The resected band remained secure in the snare and was removed along with the enteroscope from the oral cavity (Figure 3). The subcutaneous port with residual gastric tubing was surgically removed two weeks later. DISCUSSION: LAGB erosion is an uncommon late complication of band placement. Endoscopic removal of an eroded band represents an important modality for the management of this complication and an important minimally-invasive alternative to surgery. While patients typically present with weight gain, our patient presented with weight loss likely due to intermittent obstruction. There are several reported cases of endoscopic retrieval. Our case highlights that endoscopic management should be considered as the initial treatment for eroded LAGB. Watch the video: http://bit.ly/2XPqnPS

A246 High-Grade Small Bowel Obstruction Caused by Adjustable Gastric Band Tubing

There has been a sharp decline in laparoscopic adjustable gastric band (LAGB) placement, making up less than 3% of the US bariatric procedures in 2017. This decline is due to high rate of long-term failure, and myriad of complications including device malfunction, band slippage, esophageal and pouch dilation, and gastric erosion. We present a rare case of high-grade small bowel obstruction caused by gastric band tubing.

Utilization of Public System for Gastric Bands Placed by Private Providers: a 4-Year Population-Based Analysis in Ontario, Canada.

Laparoscopic adjustable gastric band (LAGB) placement remains a common bariatric procedure. While LAGB procedure is performed within private clinics in most Canadian provinces, public health care is often utilized for LAGB-related reoperations. We identified 642 gastric band removal procedures performed in Ontario from 2011 to 2014 using population-level administrative data. The number of procedures performed increased annually from 101 in 2011 to 220 in 2014. Notably, 54.7% of the patients required laparotomy, and 17.6% of patients underwent a subsequent bariatric surgery. Our findings demonstrated that LAGB placement in private clinics resulted in a large number of band removal procedures performed within the public system. This represents a significant public health concern that may result in significant health care utilization and patient morbidity.

Upper Gastrointestinal Function in Morbidly Obese Adolescents Before and 6Months After Gastric Banding.

The effects of laparoscopic adjustable gastric band (LAGB) placement on upper gastrointestinal tract function in obese adolescents are unknown. Therefore, our aim was to determine the short-term effects of LAGB on esophageal motility, gastroesophageal reflux, gastric emptying, appetite-regulatory hormones, and perceptions of post-prandial hunger and fullness. This study was part of a prospective cohort study (March 2009-December 2015) in one tertiary referral hospital. The study included obese adolescents (14-18years) with a body mass index (BMI)>40 (or ≥35 with comorbidities). Gastric emptying was assessed by 13C-octanoic acid breath test, pharyngeal, and esophageal motor function by high-resolution manometry with impedance (HRIM), and appetite and other perceptions using 100-mm visual analogue scales. Dysphagia symptoms were scored using a Dakkak questionnaire. Data were compared pre- and post-LAGB placement and at a 6-month follow-up. Based upon analysis of 15 adolescents, at the 6-month follow-up, LAGB placement: (i) led to a significant reduction in weight and BMI; (ii) increased fullness and decreased hunger post-meal; (iii) increased symptoms of dysphagia after solid food; and, despite these effects, (iv) caused little or no changes to appetite hormones, while (v) effects on gastric emptying, esophageal motility, esophageal bolus transport, and esophageal emptying were not significant. In adolescents, LAGB improved BMI and altered the sensitivity to nutrients without significant effects on upper gastrointestinal tract physiology at the 6-month follow-up.

Long-Term (over 10Years) Retrospective Follow-up of Laparoscopic Adjustable Gastric Banding.

Laparoscopic adjustable gastric banding (LAGB) placements have progressively decreased in recent years. This is related to poor long-term weight loss outcomes and necessity for revision or removal of these bands. Long-term outcome results following LAGB are limited. The aim of our study was to determine the long-term outcome after LAGB at our institution. The aim of our study was to determine the long-term outcome after LAGB at our institution. The setting of this is Academic Center, Israel. Patients who underwent LAGB between 1999 and 2004 were reviewed. Patient comorbidities and weight loss parameters were collected preoperatively and at defined postoperative periods. Improvement in weight loss was defined as percent excess weight lost, and improvement in comorbidities was defined based on standardized reporting definitions. In total, 74 (80%) patients who underwent LAGB met inclusion criteria. The mean age at LAGB placement was 50.5±9.6years, and the mean body mass index (BMI) was 45.5±4.8kg/m2. Preoperative comorbidities were diabetes mellitus (13.5%), hypertension (32%), hyperlipidemia (12.1%), obstructive sleep apnea (5.4%), joints disease (10.8%), mood disorders (5.4%), and gastro-esophageal reflux disease (GERD) symptoms (8.1%). The mean follow-up was 162.96±13.9months; 44 patients (59.4%) had their band removed, and 22 (30%) had another bariatric surgery. The follow-up BMI was 35.7±6.9 (p<0.001), and the % total weight loss was 21.0±0.13. There was no improvement in any of the comorbidities. GERD symptoms worsened at long-term follow-up (p<0.001). Undergoing another bariatric procedure was associated with a higher weight loss (OR 12.8; CI 95% 1.62-23.9; p=0.02). LAGB required removal in the majority of our patients and showed poor resolution of comorbidities with worsening of GERD-related symptoms. Patients who go on to have another bariatric procedure have more durable weight loss outcomes.

Recurrent Pneumonia: The Answer Is in the Esophagus

Laparoscopic adjustable gastric banding (LAGB) can impair esophageal peristalsis and relaxation of the lower esophageal sphincter, possibly leading to esophageal dilation. Stomach and esophagus dilation are rare; both are occasional complications of LAGB. Bronchoaspiration can occur as a late complication of gastric band placement, a serious complication that can be prevented by immediate deflation of the gastric band. We describe a case of a 44 year-old male patient who was treated for recurrent respiratory infections for several months and was subsequently found to have megaesophagus on further evaluation. A 44 year-old male with history of laparoscopic adjustable gastric band placement 4 years prior, presented to pulmonary clinic as a consultation for frequent respiratory infections requiring at least 7 courses of antibiotics over few months. He complained of persistent productive cough, exertional dyspnea and chest pain. Rest of review of systems was negative. His physical examination was normal. CT chest showed multiple tiny lung nodules representing a manifestation of recurrent and chronic aspiration and substantially dilated esophagus with fluid in the lumen (image 1). The patient was referred to GI clinic and after thorough evaluation, EGD was done that showed fluid in the lower third of the esophagus, dilated lumen of the lower third of the esophagus with no stenosis or stricture in the entire esophagus. It also showed a 4 cm gastric pouch in the stomach with fluid content proximal to the constriction from the lap band (EGD views are shown in images 2 and 3). Removal of the gastric band was performed with subsequent resolution of his symptoms. LAGB is approved for treatment of morbid obesity with successful outcomes by many bariatric surgeons worldwide. It is preferred due to ease of implementation and low rate of perioperative mortality. Megaesophagus with dysphagia can occur as a long term sequelae of LAGB. The preoperative manometry results cannot predict for its occurrence. The management of megaesophagus caused by LAGB requires band removal in most cases. Clinicians should be made aware of this rare entity when they encounter patients with frequent aspiration who had bariatric procedures. Inquiry about detailed relevant surgical history is also recommended.Figure 1Figure 2Figure 3

Woman With Abdominal Pain

A 42-year-old woman with a history of laparoscopic adjustable gastric band (lap band) placement 8 years previously presented to the emergency department with a several-week history of progressively worsening abdominal pain, nausea, and vomiting. She exhibited diffuse abdominal tenderness to deep palpation. The patient underwent abdominopelvic computed tomography (CT) imaging (Figure 1). She was admitted to the hospital for esophagogastroduodenoscopy and laparoscopy (Figure 2).Figure 2Upper endoscopy findings. Black arrow indicates the gastric lap band, which eroded through the stomach wall.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Adjustable gastric band erosion. The abdominopelvic CT indicated that a portion of the gastric band was intraluminal, raising the suspicion for gastric wall erosion (Figure 1). Esophagogastroduodenoscopy affirmed erosion of the gastric lap band into the gastric lumen (Figure 2). Surgeons performed laparoscopic removal of the gastric band and repair of the gastric wall. Used to assist with obesity treatment, gastric band complications include band malposition or slippage, bowel obstruction, port-related infection, and gastric wall erosion or perforation.1Altieri M.S. Yang J. Telem D.A. et al.Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York.Surg Endosc. 2015 Jul 23; ([Epub ahead of print])Google Scholar Gastric band removal or revision may be required in 20% of cases. Symptoms of gastric band erosion include abdominal pain followed by loss of satiety and weight regain as the band loses its ability to constrict the stomach.2Brown W.A. Egberts K.J. Franke-Richard D. et al.Erosions after laparoscopic adjustable gastric banding: diagnosis and management.Ann Surg. 2013; 257: 1047-1052Crossref PubMed Scopus (42) Google Scholar, 3Cherian P.T. Goussous G. Ashori F. et al.Band erosion after laparoscopic gastric banding: a retrospective analysis of 865 patients over 5 years.Surg Endosc. 2010; 24: 2031-2038Crossref PubMed Scopus (62) Google Scholar The rate of lap band erosion has been reduced by replacement of the traditional perigastric approach (erosion rate of 6.77%) with the pars flaccida approach (erosion rate of 1.07%), which incorporates the gastrohepatic ligament into the band.2Brown W.A. Egberts K.J. Franke-Richard D. et al.Erosions after laparoscopic adjustable gastric banding: diagnosis and management.Ann Surg. 2013; 257: 1047-1052Crossref PubMed Scopus (42) Google Scholar Management of suspected gastric band erosion involves endoscopic and laparoscopic examination, with subsequent band removal and gastric wall repair, if indicated.

Concurrent Large Para-oesophageal Hiatal Hernia Repair and Laparoscopic Adjustable Gastric Banding: Results from 5-year Follow Up.

The objective of the study is to identify the efficacy and safety of combining laparoscopic adjustable gastric banding with repair of large para-oesophageal hernias. Para-oesophageal hernias are more common in the obese with higher recurrence rates following repair. The effect and safety of combining para-oesophageal hernia repair with laparoscopic adjustable gastric banding is unknown. One-hundred fourteen consecutive patients undergoing primary laparoscopic adjustable gastric banding with concurrent repair of a large para-oesophageal hernia were prospectively identified and matched to a control group undergoing primary laparoscopic adjustable gastric banding only. Weight loss and complication data were retrieved from a prospectively maintained database, and a standardised bariatric outcome questionnaire was used to assess post-operative symptoms, satisfaction with surgery and satiety scores. At a mean follow up of 4.9 ± 2.1 years, total weight loss was 16.4 ± 9.9% in the hernia repair group and 17.6 ± 12.6% in the control group (p = 0.949), with 17 vs. 11% loss to follow up rates (p = 0.246). No statistically significant difference in revisional surgery rate and symptomatic recurrence of hiatal hernia was documented in four patients in the hernia repair group (3.5%). No statistically significant difference in mean reflux (9.9 vs. 10.3, p = 0.821), dysphagia (20.7 vs. 20.1, p = 0.630) or satiety scores was identified. Concurrent repair of large para-oesophageal hiatal hernia and laparoscopic adjustable gastric banding placement is safe and effective both in terms of symptom control and weight loss over the intermediate term. In obese patients with large hiatal hernias, consideration should be given to combining repair of the hernia with a bariatric procedure.

Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York.

We sought to determine the rate of revision and explant of the laparoscopic adjustable gastric banding (LAGB) over a ten-year period in the state of New York. Following IRB approval, the SPARCS administrative database was used to identify LAGB placement from 2004 to 2010. We tracked patients who underwent band placement with subsequent removal/revision, followed by conversion to either Roux-en-Y gastric bypass (RYBG) or sleeve gastrectomy (SG) between 2004 and 2013. McNemar test and Chi-square test were used to compare complications between primary procedure and subsequent revision and to compare complication rates and mortality rates, respectively. Log-rank test was used to assess patient characteristics and comorbidities. p<0.05 was considered significant. During a 7-year period, there were 19,221 records of LAGB placements and 6567 records of revisions or removal. We were able to follow up 3158 (16.43%) who subsequently underwent a band removal or revision over the course of this period. An additional 3606 patients had no records in the state of New York following the procedure, thus making the rate of revision 20.22%. Initial revision procedures were coded as band removal in 32.77% (n=1035), band revision in 30.53% (n=964), band removal and replacement in 19.09% (n=603), removal and conversion to SG in 5.64% (n=178), or removal and conversion to RYGB in 11.97% (n=378). From the 3158 patients, 2515 (79.64%) required only one revision. Six hundred and forty-three patients underwent two or more revisions. Thirty-one out of 3158 (0.0098%) patients had complications at their initial operation, but 919 (29.1%) had complications during revision (p<0.0001). Over a 7-year period, at least 20.22% of LAGB required removal or revision. Based on all case numbers, total revision rate may be as high as 34.2%. Although the band is believed to be a reversible procedure, revisional procedures are significantly more morbid than the initial procedure.

Laparoscopic vertical sleeve gastrectomy significantly improves short term weight loss as compared to laparoscopic adjustable gastric band placement in morbidly obese adolescent patients

BackgroundBariatric surgery has shown to be an effective weight loss treatment in morbidly obese adolescents. We compared outcomes of laparoscopic adjustable gastric band (LAGB) to laparoscopic vertical sleeve gastrectomy (VSG). MethodsA single institution, retrospective evaluation of a prospectively collected database of LAGB and VSG patients. Results174 morbidly obese patients underwent bariatric surgery at our institution between 2006 and 2013. 137 patients underwent LAGB and 37 underwent VSG. There were no significant differences between LAGB vs. VSG groups on day of surgery for age, gender, ethnicity, weight, and BMI. At 24-month follow up, patients who underwent VSG vs. LAGB displayed significantly greater percent excess weight loss (70.9±20.7 vs. 35.5±28.6, P=0.004) and percent preoperative BMI loss (32.3±11.0 vs. 16.4±12.7, P=0.004). Both VSG and LAGB significantly improved levels of HDL, HgA1c, and fasting glucose. LAGB patients had more complications than VSG patients. ConclusionBariatric surgery is an effective treatment strategy in morbidly obese adolescents who have failed medical management. VSG results in greater short term weight and BMI loss when compared to LAGB. Longer follow up with more patients will be required to confirm the long term safety and efficacy of VSG in adolescent patients.

A comparison of postoperative effects of bariatric surgery on medical markers of morbidity

BackgroundBariatric surgery reduces the prevalence of diabetes and improves lipid profiles. Low-density lipoprotein particle (LDL-P) is a more accurate predictor of cardiovascular events than high-density lipoprotein (HDL) and LDL cholesterol. The effects of bariatric procedures on LDL-P have not been previously reported. MethodsTwo hundred thirty patients undergoing bariatric surgery, including gastric bypass, sleeve gastrectomy, and laparoscopic adjustable gastric band placement at a single institution were included. HDL, LDL, hemoglobin A1c, and LDL-P were measured preoperatively and at 3, 6, and 12 months postoperatively. Weight was recorded at baseline and after 1 year. ResultsThere was a decrease in serum LDL-P levels, averaging 472.58 (P < .0001) over 1 year. HDL levels increased. Hemoglobin A1c and LDL levels declined. On average, patients lost 58% of excess weight. ConclusionLDL-P significantly decreased after bariatric surgery in relation to weight loss. It may be inferred that bariatric surgery decreases the risk of cardiovascular events.

The effect of bariatric surgery on serum TRAIL and osteoprotegerin levels in obesity complicated by glucose disorders

Summary Background and aims Bariatric surgery improves health outcomes in the obese and reduces some aspects of obesity-associated systemic inflammation. Little is known however about its effects on circulating TNF-related apoptosis-inducing ligand (TRAIL) and osteoprotegerin level, which regulate apoptosis and are implicated in atherogenesis. Our objective was to identify whether circulating TRAIL and osteoprotegerin levels are influenced by the energy restriction and weight loss that follows bariatric surgery in obese patients with glucose disorders. Methods 15 morbidly obese individuals with type 2 diabetes mellitus (T2D) or glucose intolerance were recruited for bariatric surgery. Participants were assessed for weight, waist circumference and BMI at baseline, then 2 and 12 weeks following energy restriction with bariatric surgery. Laparoscopic adjustable gastric band placement was performed. Fasted blood samples were collected and an oral glucose tolerance test was performed at each visit. Metabolic parameters and plasma chemistries were assessed. Circulating TRAIL, osteoprotegerin and leptin levels were measured. Results A significant increase in circulating TRAIL levels was observed at 12 weeks relative to baseline in participants who suppressed leptin levels. The percentage change in TRAIL was inversely related to the percentage change in fasting insulin and HOMA-β. In contrast, osteoprotegerin levels and the osteoprotegerin:TRAIL ratio were significantly reduced following bariatric surgery. The change in osteoprotegerin:TRAIL ratio positively related to the percentage change in fasting glucose. Conclusions Energy restriction after bariatric surgery is associated with increased circulating TRAIL levels and reduced osteoprotegerin levels and osteoprotegerin:TRAIL ratio in obese humans with dysglycaemia. Changes in the TRAIL and osteoprotegerin:TRAIL ratio related to changes in fasting insulin, suggesting a possible role in glucose improvements after bariatric surgery. Mechanistic studies will clarify the role of TRAIL and osteoprotegerin in health and disease.

Exacerbation of left ventricular outlet obstruction in hypertrophic obstructive cardiomyopathy: an unexpected complication of gastric banding

Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by a dynamic left ventricular outlet tract (LVOT) obstruction, which may be exacerbated by reduced preload and Valsalva. Laparoscopic adjustable gastric band (LAGB) placement is a restrictive bariatric procedure which may be complicated by recurrent vomiting and Valsalva. Pre-operative cardiac evaluation of patients scheduled for LAGB usually focuses on ischemic heart disease. Reported here is the case of a 64-year-old female admitted for evaluation of recurrent pre-syncopal episodes. The patient was diagnosed with HOCM with a significant increase in an LVOT pressure gradient during Valsalva. Thus, recurrent vomiting secondary to LAGB exacerbated a pre-existing cardiomyopathy. Symptoms resolved after gastric band deflation. This is the first report of such a complication after LAGB, demonstrating the hemodynamics of HOCM in a unique setting and underscoring the need for a structural cardiac assessment prior to bariatric surgery.

Long-term results after laparoscopic adjustable gastric banding: a mean fourteen year follow-up study

BackgroundFor over a decade, the laparoscopic adjustable gastric band (LAGB) was 1 of the most performed bariatric procedures in Europe. This study is a retrospective analysis with prospectively collected data of the experience in 1 specialized Dutch center with the adjustable gastric band over 14 years. MethodsBetween 1995 and 2003, 201 patients underwent an LAGB for morbid obesity in our hospital. Data on preoperative clinical characteristic, postoperative outcome and weight loss patterns, and co-morbidities for up to 18 years are presented and evaluated using the Bariatric Analysis and Reporting Outcome System (BAROS). ResultsAverage follow-up was 13.6 (±2.0) years (163 mo) and 99% of patients with complete follow-up. Two thirds of patients reached an excess weight loss (EWL)>50% at some point after LAGB placement. However, due to insufficient weight loss or complications in 53% of patients, the LAGB had to be removed or converted to a Roux-en-Y gastric bypass. Additionally, half of the remaining patients had disappointing results according to the BAROS score. In total, less than one quarter (22%) of patients had a functioning band with a good result after the follow-up period. Although initially the number of patients experiencing co-morbidities was reduced, most of them returned and a large number of patients developed new co-morbidities. Complications, other than weight regain, were numerous as 47% of patients experienced at least 1. In total, 204 reoperations were performed in 137 (68%) patients. Furthermore, patients who were lost to follow-up did almost twice as bad in terms of EWL compared to patients who had regular follow-up. ConclusionMorbid obesity is a chronic disease that can be resolved with bariatric surgery. One of the treatment options is the LAGB, which in the short term shows good results in terms of EWL and co-morbidity reduction. In the long term, however, EWL and co-morbidity reduction are disappointing, and the LAGB does not seem to live up to expectations. Besides the decrease in EWL over time, the number of reoperations required is alarming. In total, less than a quarter of patients still had a functioning band after a mean 14 years of follow-up.

Radiographic predictability of hiatal hernia prior to gastric band surgery.

Background:Hiatal hernia (HH) is closely associated with morbid obesity. There is controversy over the need for preoperative imaging before laparoscopic adjustable gastric band placement. The aim of this study is to determine the predictive value of preoperatively diagnosing HH with upper gastrointestinal (UGI) series imaging.Methods:A retrospective review of a single surgeon's experience with laparoscopic adjustable gastric band placements was performed. All patients received a preoperative UGI series. The decision to perform an HH repair at the time of gastric banding was based on intraoperative findings. Each patient's UGI study was compared with the operative report. Patients' outpatient records were also reviewed for subjective reflux symptoms or use of antireflux medications.Results:Of 146 patients, 63 (43%) had intraoperative findings consistent with an HH and underwent repair. Of these, only 32 (50%) had a preoperative UGI study that showed an HH (positive predictive value, 50%). Of the 83 patients who did not have an intraoperative HH, only 51 (61%) had a congruent UGI (negative predictive value, 62%). No correlation was found between patient-reported symptoms and either radiologic or intraoperative findings.Conclusions:UGI series have poor positive and negative predictive values in preoperatively diagnosing HH. In addition, subjective patient symptoms and the need for antireflux medication did not correlate with either radiologic or intraoperative findings of HH. Our results suggest that direct operative diagnosis is a more accurate method of detecting HH.

Hiatal hernia repair and gastroesophageal reflux disease in gastric banding patients: Analysis of a national database

BackgroundHiatal hernia (HH) is a risk factor for complications after laparoscopic adjustable gastric banding (LAGB), with recommendation to repair these at the time of LAGB placement. We reviewed the characteristics and outcomes of bariatric patients undergoing HH repair during LAGB. The aim of this study was to determine the prevalence of HH repair in LAGB patients and its potential effect on outcomes. MethodsUsing the Bariatric Outcomes Longitudinal Database, we identified patients who had hiatal hernia repair at the time of their LAGB (HHR group) and compared them to other LAGB patients without a HH repair (NonHHR group). ResultsOf 41,611 patients who underwent LAGB during 2007–2010, 8120 (19.5%) had HH repair (HHR), adding only 4 minutes to the operating time, without an increase in blood transfusion, length of stay, or band-related complications. Preoperatively, the HHR cohort had a higher incidence of gastroesophageal reflux disease (GERD) compared with nonHHR (49% versus 40%, respectively; P<.001) with a higher GERD score (1.13 versus .88, respectively; P<.001). Of those with GERD, similar percentage of patients in the HHR and nonHHR groups experienced improvement 1-year after surgery (53% versus 52%, respectively, P = .4), with similar GERD scores at this time point. ConclusionHH are repaired in one fifth of LAGB patients, with a surprisingly minimal increase in operative times and no change in length of stay, morbidity, or mortality. In patients with GERD, HH repair had minimal effect on postoperative improvements in reflux symptoms. These findings suggest that many of the repairs may involve small hernias with unclear clinical effect.