Laparoscopic Adjustable Gastric Banding Surgery Research Articles

IBC-Oxford University2023_BJSOral_20Video Presentation: Fundectomy and Indocyanine green fluorescence angiography in revisional laparoscopic Roux-en-Y gastric bypass

Abstract Introduction Revisional bariatric procedures are increasingly prevalent. These procedures are more complex with higher risk of complications as compared to primary procedures. The potential indications for revisional laparoscopic gastric bypass (R-LRYGB) may include weight regain and gastroesophageal reflux disease (GORD). This video abstract presents role of fundectomy and Indocyanine green fluorescence angiography (ICG-FA) for perfusion assessment of gastric pouch in R-LRYGB. Methods and Operative technique A 40-year-old female with previous laparoscopic adjustable gastric band (LAGB) surgery underwent R-LRYGB procedure following approval at bariatric multidisciplinary team meeting. LAGB was removed due to band slippage and chronic pouch dilatation, 2 years prior to the revisional procedure. Preoperative BMI was 53 kg/m2. Pre-operative upper gastrointestinal endoscopy was normal. The operative technique included dissection of angle of His, access into lesser sac along lesser curve below 2nd vessel off left gastric artery (LGA) and division of short gastric vessels to gain access to leaser sac from lateral aspect. The stomach was divided horizontally with linear stapler (EndoGIA 60 Gold cartridge), level with second vessel off LGA followed by creation of vertical gastric pouch over a size 34 Oro-gastric tube, that included excision of gastric fundus. ICG was administered intravenously according to an agreed protocol for the study. Karl Storz Image1 STM Rubina system with overlay and monochromatic modes was used for perfusion assessment. ICG-FA was utilised for qualitative assessment of gastric pouch perfusion before and after linear stapled gastro-jejunal anastomosis. Results Operative time was 240 minutes. Adhesions were encountered in the lesser sac at the site of previous LAGB. Fundectomy allowed better visualisation of lesser sac, adhesiolysis and facilitated creation of gastric pouch. ICG perfusion of gastric pouch was satisfactory. The postoperative length of stay was 2 days. There were nopostoperative complications at 6 months follow-up. The patient achieved 42% excess weight loss (BMI 43) over 6 months period. Conclusions Fundectomy is a safe and feasible operative step in R-LRYGB in patients with previous primary LAGB. ICG-FA is a promising qualitative assessment tool in revisional bariatric procedures.

1036 Colonic Erosion of a Laparoscopically Inserted Adjustable Gastric Band

Abstract The popularity of laparoscopic adjustable gastric band surgery has declined over the past decade. This is partly due to concerns about a high rate of long-term complications, including band erosions occurring in over 1% of cases. Erosion into the colon is exceedingly rare, with only three reports in the literature. Our images/video illustrate the case of a 51-year-old female patient presenting in February 2022 with abdominal pain and two chronically discharging sinuses around her port site. She had a gastric band initially fitted in 2010, which was revised in 2018. The port was re-sited in 2021 following port-migration and flipping. On this presentation, a CT scan revealed 16cm of tubing within the lumen of the descending colon. Our procedure began with diagnostic laparoscopy, showing the gastric band tubing entering an inflammatory phlegmon in the left flank involving omentum and descending colon attached to the abdominal wall beneath the port site. The tubing was cut near to the gastric band. The gastric band was freed, divided, and removed. The previous port site incision was extended around the external opening of the fistula, which was excised. The port and tubing were easily removed, though partly covered in faeces. A decision was made, based upon prior discussion with the patient, to leave the colocutaneous fistula in-tact. This avoided the risk of colonic resection and anastomosis in freeing the bowel. Stapling across the phlegmon and tract risked diverting colonic contents into another potential tract headed towards the stomach. Postoperative recovery was uneventful.

Effect of Rapid Body Weight Loss on Balance and Functional Mobility in Obese Individuals after Laparoscopic Adjustable Gastric Banding Operation

The purpose of this study was to evaluate the effect of rapid weight loss on static balance and functional mobility among excessively obese patients undergoing Laparoscopic Adjustable Gastric Banding (LAGB) surgery. Subjects (8 females; BMI >35 kg/m2) underwent baseline measurements before LAGB surgery, followed by subsequent evaluations at 6 weeks, 12 weeks, and 24 weeks during the follow-up appointments. During each evaluation, various assessments were conducted, including measurements of anthropometry such as body weight, height, hip and waist circumference, as well as functional tests for static balance, 10-meter walk, and timed get-up-and-go. There were statistically significant changes in weight, BMI, waist circumference, hip circumference, abdominal circumference, waist-hip ratio, static sway eyes open, timed up-and-go, 10-meter walk, and steps in 10-meter walk test values (p<0.001) between the baseline and the postoperative measurements. However static sway values under eyes closed condition were not statistically significant. In the 24-week follow-up, the weight loss, reduction in abdominal circumference, increase in walking speed against time and step count, and recovery in functional movements were shown to persist. Also, reduction in static balance surface oscillation confirmed the improvement of balance control.

Cecal volvulus, a rare and late complication of a laparoscopic adjustable gastric band

Introduction: Laparoscopic adjustable gastric band (LAGB) surgery is one of the three most popular bariatric procedures worldwide due to its favorable risk benefit profile, reversibility, and low rates of morbidity and mortality. Recent studies have demonstrated a myriad of long-term complications including band slip, band erosion, intra-abdominal infection, port-site infection, port breakage, and pouch enlargement. All of which contribute to alarming rates of revision, adjustment, and removal of LAGB. Case Report: We describe a novel case of a 68-year-old female presenting to the Emergency Department with a one-day history of abdominal pain, obstipation, loss of appetite, nausea and vomiting. A computed tomography (CT) scan demonstrated a cecal volvulus. Subsequently an emergency right hemicolectomy was performed which identified a LAGB encircling the hepatic flexure. Conclusion: Clinicians should hold a high index of suspicion and a low threshold for operating when treating patients with a bowel obstruction with a known history of a LAGB.

Surgery for the treatment of obesity in children and adolescents.

Child and adolescent overweight and obesity have increased globally and are associated with significant short- and long-term health consequences. To assess the effects of surgery for treating obesity in childhood and adolescence. For this update, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Latin American and Caribbean Health Science Information database (LILACS), World Health Organization International Clinical Trials Registry Platform (ICTRP)and ClinicalTrials.gov on 20 August 2021 (date of the last search for all databases). We did not apply language restrictions. We checked references of identified studies and systematic reviews. We selected randomised controlled trials (RCTs) of surgical interventions for treating obesity in children and adolescents (age < 18 years) with a minimum of six months of follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or which included participants with a secondary or syndromic cause of obesity, or who were pregnant. We used standard methodological procedures expected by Cochrane. Two review authors independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 tool. Where necessary, we contacted authors for additional information. With this update, we did not find any new RCTs. Therefore, this updated review still includes a single RCT (a total of 50 participants, 25 in both the intervention and comparator groups). The intervention focused on laparoscopic adjustable gastric banding surgery, which was compared to a control group receiving a multi-component lifestyle programme. The participating population consisted of Australian adolescents (a higher proportion of girls than boys) aged 14 to 18 years, with a mean age of 16.5 and 16.6 years in the gastric banding and lifestyle groups, respectively. The trial was conducted in a private hospital, receiving funding from the gastric banding manufacturer. For most of the outcomes, we identified a high risk of bias, mainly due to bias due to missing outcome data. Laparoscopic gastric banding surgery may reduce BMI by a mean difference (MD) of -11.40 kg/m2 (95% CI -13.22 to -9.58) and weight by -31.60 kg (95% CI -36.66 to -26.54) compared to a multi-component lifestyle programme at two years follow-up. The evidence is very uncertain due to serious imprecision and a high risk of bias. Adverse events were reported in 12/25 (48%) participants in the intervention group compared to 11/25 (44%) in the control group. A total of 28% of the adolescents undergoing gastric banding required revisional surgery. The evidence is very uncertain due to serious imprecision and a high risk of bias. At two years of follow-up, laparoscopic gastric banding surgery may increase health-related quality of life in the physical functioning scores by an MD of 16.30 (95% CI 4.90 to 27.70) and change in health scores by an MD of 0.82 (95% CI 0.18 to 1.46) compared to the lifestyle group. The evidence is very uncertain due to serious imprecision and a high risk of bias. No data were reported for all-cause mortality, behaviour change, participants' views of the intervention and socioeconomic effects. Finally, we have identified three ongoing RCTs that are evaluating the efficacy and safety of metabolic and bariatric surgery in children and adolescents. Laparoscopic gastric banding led to greater body weight loss compared to a multi-component lifestyle program in one small study with 50 participants. These results have very limited application, primarily due to more recent recommendations derived from observation studies to avoid the use of banding in youth due to long-term reoperation rates. This systematic review update still highlights the lack of RCTs in this field. The authors are concerned that there may be ethical barriers to RTCs in this field, despite the lack of other effective therapies for severe obesity in children and adolescents and the significant morbidity and premature mortality caused by childhood obesity. Nevertheless, future studies, whether pre-registered and planned non-randomised or pragmatic randomised trials, should assess the impact of the surgical procedure and post-operative care to minimise adverse events, including the need for post-operative adjustments and revisional surgery. Long-term follow-up is also critical to comprehensively assess the impact of surgery as participants enter adulthood.

Food cue reactivity in successful laparoscopic gastric banding: A sham-deflation-controlled pilot study.

Laparoscopic adjustable gastric banding (LAGB) offers a unique opportunity to examine the underlying neuronal mechanisms of surgically assisted weight loss due to its instant, non-invasive, adjustable nature. Six participants with stable excess weight loss (%EWL ≥ 45) completed 2 days of fMRI scanning 1.5–5 years after LAGB surgery. In a within-subject randomized sham-controlled design, participants underwent (sham) removal of ∼ 50% of the band’s fluid. Compared to sham-deflation (i.e., normal band constriction) of the band, in the deflation condition (i.e., decreasing restriction) participants showed significantly lower activation in the anterior (para)cingulate, angular gyrus, lateral occipital cortex, and frontal cortex in response to food images (p < 0.05, whole brain TFCE-based FWE corrected). Higher activation in the deflation condition was seen in the fusiform gyrus, inferior temporal gyrus, lingual gyrus, lateral occipital cortex. The findings of this within-subject randomized controlled pilot study suggest that constriction of the stomach through LAGB may indirectly alter brain activation in response to food cues. These neuronal changes may underlie changes in food craving and food preference that support sustained post-surgical weight-loss. Despite the small sample size, this is in agreement with and adds to the growing literature of post-bariatric surgery changes in behavior and control regions.

First‐year weight loss following gastric band surgery predicts long‐term outcomes

Laparoscopic adjustable gastric banding (LAGB) continues to be a valid surgical treatment option to address severe obesity. However, outcomes are varied and can be difficult to predict. Early prediction of suboptimal weight loss following LAGB may enable adjustments to postoperative care and consequently improve surgical outcomes. Therefore, our aim is to investigate the prognostic utility of using early weight loss following LAGB to predict long-term weight outcomes. Clinical data from patients undergoing LAGB between 2001 and 2007 at a single institution were retrospectively collected and analysed. The data was used to inform a model for predicting long-term weight loss after LAGB surgery. Percent total weight loss (%TWL) greater than 20% 1 year after surgery was considered a measurement of success since it has been associated with the improvement of comorbidities and increased patient satisfaction. The average %TWL 1 year after LAGB surgery was 23.73% (n=1524, SD=8.68%). Weight loss of less than 10% in 1 year was a negative predictor of weight loss >20% in 8-12 years (OR=0.449; p=0.002; 95% CI=0.272-0.742). Moreover, weight loss >20% in 1 year was a strong predictor of weight loss >20% in 8-12 years (OR=5.33; p < 0.001; 95% CI=3.17-8.97). Total body weight reduction of less than 10% 1 year after LAGB surgery suggests a lesser weight loss at 8-12 years. For these patients, targeted interventions would be appropriate to increase the chances of long-term success.

Morbid Obesity Treated With Laparoscopic Band Surgery Over a Sleeve Gastrectomy

Bariatric surgery is the most successful weight management modality. Laparoscopic adjustable gastric band surgery is one bariatric surgical procedure developed for weight reduction in patients with morbid obesity.

Risk of venous thromboembolism, use of enoxaparin and clinical outcomes in obese patients undergoing laparoscopic adjustable gastric band surgery: A retrospective study.

There is a lack of clear guidance for the prophylactic use of anticoagulants for patients undergoing laparoscopic adjustable gastric banding (LAGB) surgery.This study aimed to evaluate the risk of venous thromboembolism (VTE), prophylactic use of enoxaparin and clinical outcomes in patients undergoing primary and revisional LAGB procedures.A retrospective study evaluated the prophylactic use of enoxaparin in adult patients who underwent primary and revisional (band and port) LAGB procedures. The incidence of VTE and major bleeding was investigated during a 90-day follow-up period. Descriptive and inferential statistics were used for data analysis.We included 112 and 100 patients who had undergone primary and revisional (24 band procedures and 76 port procedures) LAGB surgery, respectively. The majority of patients (97%) had a mild risk of VTE development using a post-discharge VTE risk calculator tool published from the Cleveland Clinic. All primary procedure patients received prophylactic enoxaparin, compared to 79% and 20% of revisional patients who underwent band and port procedures, respectively (P < .001). The overall VTE incidence was 0.9%, with no significant difference between patients who did or did not receive chemoprophylaxis (0.7% and 1.5%, respectively; P = .58). No major bleeding events were observed.Chemoprophylaxis may not be required in all patients undergoing low-risk LAGB surgery unless there are additional risk factors, such as the presence of super-super-morbid obesity or concomitant hormone replacement therapy. More studies are needed on the prophylactic use and dosing of enoxaparin in patients undergoing LAGB procedures to provide high-level evidence.

Alcohol sensitivity in women after undergoing bariatric surgery: a cross-sectional study.

Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the most common bariatric surgeries performed worldwide, increase the risk to develop an alcohol use disorder. This might be due, in part, to surgery-related changes in alcohol pharmacokinetics. Another risk factor, unexplored within this population, is having a reduced subjective response to alcohol's sedative effects. To assess whether the alcohol sensitivity questionnaire (ASQ), a simple self-report measure, could pinpoint reduced alcohol sensitivity in the bariatric population. University medical centers in Missouri and Illinois. Women who had RYGB (n = 16), SG (n = 28), or laparoscopic adjustable gastric banding surgery (n = 11) within the last 5 years completed the ASQ for both pre- and postsurgical timeframes, and 45 of them participated in oral alcohol challenge testing postsurgery. Blood alcohol concentration (BAC) and subjective stimulation and sedation were measured before and for 3.5 hours after drinking. In line with faster and higher peak BACs after RYGB and SG than laparoscopic adjustable gastric banding surgery (P < .001), postsurgery ASQ scores were more reduced from presurgery scores after RYGB/SG than after laparoscopic adjustable gastric banding surgery (-2.3 ± .3 versus -1.2 ± .2; P < .05). However, despite the dramatic changes in BAC observed when ingesting alcohol after RYGB/SG surgeries, which resulted in peak BAC that were approximately 50% above the legal driving limit, a third of these women felt almost no alcohol-related sedative effects. Although RYGB/SG dramatically increased sensitivity to alcohol in all participants, meaningful interindividual differences remained. The ASQ might help identify patients at increased risk to develop an alcohol use disorder after surgery.

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.

Explantation of Adjustable Gastric Bands: An Observation Study of 10 Years of Experience at a Tertiary Center.

PurposeAlthough laparoscopic adjustable gastric bands are considered a standard treatment for severe obesity, their use remains controversial. We evaluated rates of band explantation and the incidences of complications leading to and following band explantation.Materials and MethodsThis retrospective review was performed on patients that underwent adjustable gastric band explantation. For each of the three groups of patients that underwent explantation, we compared demographic and anthropometric data, band duration in situ, operative approach, and morbidities.ResultsBetween January 2009 and October 2018, a total of 267 patients underwent primary laparoscopic adjustable gastric band surgery. Of these 267 patients, 99 (37.1%) underwent band explantation. Numbers (%) of patients in the slippage (SL), band erosion (BE), and intolerance (IT) groups were 13 (13.1%), 39 (39.4), and 47 (47.5%), respectively. Mean %EBMIL values at explantation in these groups were 74.6±45.5, 79.7±40.3, and 36.1±46.0, respectively (p<0.001), and mean times for maintaining bands in situ were 45.1±28.0, 39.4±24.3, and 51.2±22.7 months, respectively. Isolated band removal was performed for slippage (SLi, n=12), band erosion (BEi, n=39), and intolerance (ITi, n=31). The numbers (%) of patients in the SLi, BEi, and ITi groups that experienced a surgical complication (Clavien-Dindo class ≥1) were 0 (0.0%), 24 (61.5%), and 3 (9.7%), respectively (p<0.001). In the BEi group, four patients (4/39, 10.3%) underwent reoperation after AGB removal.ConclusionDuring our 10 years of experience, 37.1% of adjustable gastric band had to be removed. Intra-abdominal abscess and intragastric bleeding were rare but serious complications after explantation. Potential candidates for adjustable gastric band should be informed of the high long-term risk of band explantation and its associated morbidities.

The Long-Term Psychological Impact of Disclosing (Or Not) Laparoscopic Adjustable Gastric Banding Surgery

Objective: Individuals opting for bariatric surgery to assist with weight loss face stigma from a variety of sources. This stigma influences individuals' decisions for disclosing (or not) their surgical intentions. To date, the psychological impact on disclosure or nondisclosure has not been explored. Method: As part of a longitudinal study exploring the impact of laparoscopic adjustable gastric banding (LAGB), 31 participants (aged between 32 and 60 years) completed three validated psychometric scales (Hospital Anxiety and Depression Scale, Derriford Appearance Scale, and World Health Organization Quality of Life scale) seven times over a 5-year period. Results: Significant positive differences were found on all the psychometric measures across time compared with the preoperative scores; however, no differences between disclosure groups were present. Relationships between psychometric measures and weight were only found in the disclosure group. Conclusion: LAGB surgery is likely to have a positive impact...

The reasons for disclosing (or not) laparoscopic adjustable gastric banding surgery and the impact on long-term weight loss.

The reasons for disclosing (or not) laparoscopic adjustable gastric banding surgery and the impact on long-term weight loss.

Predicting Outcomes Following Laparoscopic Adjustable Gastric Banding Surgery: Weight Loss versus Improved Perceptions of Appearance

Predicting Outcomes Following Laparoscopic Adjustable Gastric Banding Surgery: Weight Loss versus Improved Perceptions of Appearance

Diabetes Outcomes More than a Decade Following Sustained Weight Loss After Laparoscopic Adjustable Gastric Band Surgery.

Long-term outcome data are needed to define the role of bariatric surgery in type 2 diabetes (T2D). To address this, we collated diabetes outcomes more than a decade after laparoscopic adjustable gastric band (LAGB) surgery. Clinical and biochemical measures from 113 obese T2D patients who underwent LAGB surgery in 2003 and 2004 were analyzed. Diabetes remission was defined as HbA1c <6.2% (44mmol/mol) and fasting glucose <7.0mmol/L. Seventy-nine patients had weight data at 10years and attained a median [Q1, Q3] weight loss of 16 [10, 21] percent. Sixty patients attended a follow-up assessment. Their baseline HbA1c of 7.8 [7.1, 9.3] percentage units (62 [54, 78] mmol/mol) had decreased to 6.6 [6.1, 8.4] (49 [43, 68] mmol/mol) despite no significant change in glucose-lowering therapy. Eleven patients (18%) were in diabetes remission and another 18 had HbA1c≤6.5%. Significant improvements in physical measures of quality of life, blood pressure, and lipid profile were also observed but there was no change in the proportion of patients with albuminuria and a significant decline in estimated glomerular filtration rate. Twelve patients in the follow-up cohort (20%) required anti-reflux medication after surgery and 26 (43%) underwent gastric band revision surgery. Weight loss for over 10years after LAGB surgery delivers clinically meaningful improvements in HbA1c, blood pressure, lipids, and quality of life at the cost of a high rate of revision surgery and increased use of anti-reflux medication. These findings support the use of bariatric surgery as a long-term treatment for weight loss and wellbeing in patients with T2D. Registered with the Australian Clinical trials registry as ACTRN12615000089538.

Clinical Vignettes/Case Reports-Obesity.

Bariatric surgeries of all types, including laparoscopic adjustable gastric band (LAGB), have gained large popularity in the past few decades as an effective method of weight loss in morbidly obese patients. Such procedures carry multiple short and long term complications. Rare and difficult to recognize surgical complications may have a significant impact on patient's quality of life and health-care cost. We report a case of a 62 year-old woman who presented to the hospital seven years after successful LAGB surgery with several months of cough, shortness of breath, and episodes of nausea associated with vomiting. She is a non-smoker and has a history of obstructive sleep apnea. Recent history is pertinent for multiple episodes of pneumonia treated with antibiotics in the outpatient. CT chest revealed extensive innumerable tiny nodular bilateral infiltrates with no significant adenopathy. It also showed distended esophagus with fluid content. Patient subsequently got admitted for further evaluation and management of her worsening symptoms. Initial workup for possible respiratory bacterial, fungal and mycobacterium infections were negative. Patient underwent extensive work up with bronchoscopy which showed erosive inflammation in various stages in the posterior oropharynx. Trans-bronchial biopsy from the right lower lobe showed inflammatory cells with no malignant cells. It also showed the presence of Enterobacter Cloacae (gut flora) on the bronchoalveolar lavage, suggestive of aspiration pneumonia. Esophagogastroduodenoscopy (EGD) showed distal migration of the gastric band, resulting in gastric retention (See image 1 & 2). Patient was then transferred to a tertiary care center where she underwent uncomplicated surgical removal of the gastric band with complete resolution of her symptoms. There have been only few reported cases of chronic cough as a long term complication of gastric band surgery. Chronic cough associated recurrent aspiration pneumonia in a patient with history of gastric band surgery should raise the suspicion of band slippage. Pathophysiology suspected is micro aspiration of acid leading to pneumonitis eventually predisposing to recurrent pneumonia and chronic cough. Early suspicion can help recognize the condition as removal of the band can result in complete resolution of symptoms.Figure: Distal esophageal dilatation with fluid stasis.Figure: Slipped band with errosions into the mid body part of the stomach.

Performance of the DiaRem Score for Predicting Diabetes Remission in Two Health Systems Following Bariatric Surgery Procedures in Hispanic and non-Hispanic White Patients.

The objective of this study was to determine whether the DiaRem, a score that predicts type 2 diabetes (T2D) remission following roux-en-y gastric bariatric surgery (RYGB), also predicts remission following laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) in white and Hispanic patients. While bariatric surgery is highly effective in reversing insulin resistance, there are patients for whom surgery will not lead to remission. To date, there is no score for predicting remission following LAGB or LSG surgery. Additionally, there is little known about how to predict whether Hispanic patients will experience remission. We conducted a retrospective cohort study of white and Hispanic patients with T2D who received bariatric surgery. There were 361 white and 130 Hispanic patients among whom 328 had RYGB surgery, 107 had LSG surgery, and 56 had LAGB surgery. We used age, diabetes treatment, and hemoglobin A1c to calculate DiaRem scores. Mann-Whitney U test was used to determine the association between DiaRem scores and remission. Area under the receiver operant curve (AUC) was used to assess the ability of the DiaRem to discriminate between patients who did and did not remit. The DiaRem was associated with partial remission in all surgery types for white and Hispanic patients (Mann-Whitney, p<0.001). The DiaRem had moderate to high discriminant ability (AUC>0.70) for all surgical and racial/ethnic groups. The DiaRem distinguishes between patients likely and unlikely to experience remission, informing expectations of patients making T2D treatment decisions.

The Effects on Obesity Related Peptides of Laparoscopic Gastric Band Applications in Morbidly Obese Patients

ABSTRACTBackground: The aim of this study was to examine the relationship between weight loss and resistin, apelin, chemerin, and visfatin after laparoscopic adjustable gastric banding (LAGB). Methods: The study group consisted of 19 patients who were operated on for morbid obesity (BMI: 48.7 ± 6.6 kg/m2), and 22 healthy, normal-weight (BMI: 22.9 ± 2.5 kg/m2) subjects formed the control group. We obtained blood samples from the study subjects at three different times: before undergoing surgery and at one month and 6 months after surgery. Blood was obtained once from the control group. Results: Significant weight loss was achieved at one and 6 months after surgery. Plasma levels of apelin, resistin, chemerin, and visfatin were higher in morbidly obese patients compared with the control group. Obesity-related peptides decreased one month and 6 months after surgery. Conclusions: Elevated plasma resistin, apelin, chemerin, and visfatin levels in morbidly obese patients are gradually reduced after weight loss. According to these findings, LAGB surgery is found to be an important and efficient means for morbidly obese patients both to lose weight and to develop a better metabolic risk profile in a short time period.

A Qualitative Longitudinal Exploration of the Lived Experience of Laparoscopic Adjustable Gastric Banding Surgery

A Qualitative Longitudinal Exploration of the Lived Experience of Laparoscopic Adjustable Gastric Banding Surgery