Laparoscopic Adjustable Silicone Gastric Banding Research Articles

Long-Term Outcomes of Laparoscopic Adjustable Silicone Gastric Banding (LAGB) in Moderately Obese Patients With and Without Co-morbidities

Overweight and obesity independently increase cardiovascular risk, while even modest weight loss can result in clinically significant improvements in cardiovascular risk and reduce long-term mortality. Lowering the body mass index (BMI) threshold for bariatric surgery to those with moderate obesity might be one way to lower the burden of this disease. The aim of this study was to evaluate the efficacy and safety of laparoscopic adjustable silicone gastric banding (LAGB) in moderately obese subjects with or without obesity-related co-morbidities. Thirty-four patients with BMI between 30 and 35 kg/m(2) (5 males/29 females, mean age 36 ± 10 years, mean preoperative weight 87.9 ± 7.1 kg, mean BMI 32.6 ± 1.6 kg/m(2) and mean percentage excess weight 48.7 ± 9 %) who underwent LAGB via pars flaccida between June 1, 2002 and August 31, 2010 were included. Good response was defined as BMI <30 kg/m(2) or percentage estimated weight loss (%EWL) >50. Poor response was defined as BMI >30 kg/m(2) or %EWL less than 50 after a minimum of 1 year. Mean weight, BMI and %EWL were recorded at 1, 3, 5 and 7 years and were 77.4 ± 7.6, 69.9 ± 10.8, 70.9 ± 9.3 and 73.3 ± 12.0 kg; 28.8 ± 2.9, 26.4 ± 3.2, 26.5 ± 3.4 and 27.4 ± 5.0 kg/m(2); and 36 ± 23, 46.1 ± 33.8, 58.6 ± 31.5 and 45 ± 57, respectively (p < 0.01). Co-morbidities were diagnosed in 17/34 (50 %) patients at baseline and underwent remission or improvement in all cases after 1 year. LAGB in a safe and effective procedure in patients with a BMI <35 kg/m(2).

Gastroesophageal reflux disease and esophageal motility in morbidly obese patients submitted to laparoscopic adjustable silicone gastric banding or laparoscopic vertical banded gastroplasty

Laparoscopic adjustable silicone gastric banding (LASGB) and laparoscopic vertical banded gastroplasty (LVBG) are the most frequently performed restrictive operations for morbid obesity. The question of whether bariatric restrictive procedures increase or reduce gastroesophageal reflux disease (GERD) remains open. This study aimed to compare the long-term results of LASGB with those of LVBG in terms of postoperative GERD and esophageal motility function. From February 1999 to December 2000, 175 patients underwent bariatric surgery. After 75 of these patients were excluded from the study, the remaining 100 patients were randomly assigned to one of two treatment groups: LASGB or LVBG. The end points of the study were evaluation of clinical and instrumental GERD and esophageal function. The follow-up protocol included clinical assessment using the Gastroesophageal Reflux Health-Related Quality-of-Life (GERD-HRQOL) scale at 3, 12, and 96 months. Esophageal manometry, 24-h pH monitoring, and endoscopy were performed at 12 and 96 months. At 12 months, GERD had developed in 13 (26%) LASGB and 11 (21.6%) LVBG patients. In the majority of cases, GERD resulted from pouch dilation or poor compliance and required either reoperation (ten after LASGB and three after LVBG) or endoscopic dilation of the neopylorus (four after LVBG). In all, 71 patients completed the 96-month follow-up protocol. The findings showed that three (11.5%) of 26 LASGB patients and four (9%) of 45 LVBG patients were receiving proton pump inhibitor (PPI) therapy for GERD. Postoperative lower esophageal sphincter (LES) pressure and esophageal motility did not differ from preoperative data except for the presence of aperistaltic waves in one LASGB and two LVBG symptomatic GERD patients. No significant association between gastric restrictive procedures and GERD or esophageal function was found during long-term follow-up assessment. The increased occurrence of GERD in the early follow-up period often is due to a technical defect or poor patient compliance.

Laparoscopic Adjustable Silicone Gastric Banding vs Laparoscopic Vertical Banded Gastroplasty in Morbidly Obese Patients: Long-Term Results of a Prospective Randomized Controlled Clinical Trial

Aim of the study is to present long-term results of a prospective randomized single-institution clinical trial comparing laparoscopic adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbid obesity. A total of 100 morbidly obese patients (body mass index 40 to 50 kg/m2) were randomized to LASGB (n=49) or LVBG (n=51) and followed up for a minimum of 7 years. Mean operative time was 65.4 min in LASGBs and 94.2 min in LVBGs (p<0.05); mean hospital stay was 3.7 and 6.6 days, respectively (p<0.05). Late complication rates were 36.7% in LASGBs vs 15.7% in LVBGs at 3 years (p<0.05), 46.9% vs 43.1% at 5 years (NS), and 55.1% vs 47.1% at 7 years (NS). Late reoperation rates were 28.6% in LASGBs and 2.0% in LVBGs at 3 years (p<0.001), 38.8% and 2.0% at 5 years (p<0.001), and 46.9% and 7.8% at 7 years (p<0.001). Excess weight loss in LASGBs was 41.8% at 3 years, 33.2% at 5 years, and 29.9% at 7 years; excess weight loss in LVBGs was 60.9%, 57%, and 53.1%, respectively (p<0.05). This study demonstrates that in a carefully selected group of patients, LVBG is significantly more effective than LASGB in terms of late complications, late reoperations, and long-term results on weight loss.

Esophageal dilation after laparoscopic adjustable gastric banding: a more systematic approach is needed

The occurrence of esophageal dilation after laparoscopic adjustable silicone gastric banding (LASGB) had not been yet investigated systematically. In this study, standardized barium swallow studies were used to assess 45 LASGB patients for the development of esophageal dilation after the operation and after a mean follow-up period of 39.3 months. The diameter of the esophagus postoperatively and during the follow-up period was calculated in millimeters using the known diameter of the gastric band. An increase in diameter exceeding 130% compared with the postoperative diameter was considered as dilation. Symptoms were assessed by a questionnaire. For 11 patients with dilation, the band was emptied and a barium swallow performed to assess whether the dilation was reversible. A significant increase in the esophageal diameter (median and interquartile range [IQR]) was found by comparing the early postoperative and follow-up data: median, 16.3 mm (IQR, 14-18.7 mm) versus median, 20.7 mm (IQR, 18.1-26.8 mm; p < 0.01). For 25 (55.6%) of the 45 patients, the dilation percentage exceeded 130%. For 7 of the 11 patients, the dilation after emptying of the band still exceeded 130%. The increase in esophageal diameter was significantly correlated with the duration of follow-up evaluation, regurgitation, heartburn at night, and slow esophageal clearance. Laparoscopic adjustable gastric banding causes esophageal dilation in about half of patients. This dilation is correlated with symptoms and is partly reversible after emptying of the band. The clinical relevance of the dilation is unclear.

GH and IGF-I deficiency are associated with reduced loss of fat mass after laparoscopic-adjustable silicone gastric banding

GH and IGF-I deficiency are associated with reduced loss of fat mass after laparoscopic-adjustable silicone gastric banding

Growth Hormone Treatment Prevents Loss of Lean Mass after Bariatric Surgery in Morbidly Obese Patients: Results of a Pilot, Open, Prospective, Randomized, Controlled Study

The loss of lean body mass (LBM) negatively influences the outcome in bariatric surgery. Impaired GH secretion is frequent in obese patients. Our objective was to investigate if GH treatment prevents LBM loss in the early postoperative period. This was an open, prospective, randomized, and controlled study. A total of 24 women (body mass index: 44.4 +/- 7.6 kg/m(2), aged 36.8 +/- 11.7 yr) undergoing laparoscopic-adjustable silicone gastric banding (LASGB) and with GH deficiency after LASGB was included in the study. Group A (n = 12) included a standardized diet regimen and exercise program plus recombinant human GH (0.5 +/- 0.13 mg every day), and group B (n = 12) included a standardized diet regimen and exercise program. The follow-up duration was 6 months. The excess of body weight loss did not differ between groups A and B after 3 and 6 months. At 3 months, LBM loss was lower (P < 0.0001) and fat mass (FM) loss was higher (P = 0.02) in group A than group B. At 3 and 6 months, appendicular skeletal muscle mass loss was lower (P = 0.000) in group A than group B. At 3 (P = 0.0003 and 0.0005, respectively) and 6 months (P < 0.0001 and 0.0002, respectively), the percent changes of FM and lean body mass were significantly higher in group A than group B. In both groups fasting and postglucose area under the plasma concentration-time curve insulin significantly reduced. The homeostasis model assessment of insulin and insulin sensitivity indexes and total to high-density lipoprotein cholesterol ratio improved only in group A. GH treatment for 6 months after LASGB reduces loss in LBM and appendicular skeletal muscle mass during a standardized program of low-calorie diet and physical exercise program, with improvement of lipid profile and without a deterioration of glucose tolerance.

GH and IGF‐I deficiency are associated with reduced loss of fat mass after laparoscopic‐adjustable silicone gastric banding

GH secretion is reduced in obese subjects and increases after body weight loss. It is still unclear if changes in the GH/IGF-I axis after laparoscopic-adjustable silicone gastric banding (LASGB) are associated with changes of body composition. To analyse the relationships between changes in the GH/IGF-I axis and those of body weight and composition before and after LASGB. Observational, prospective. University 'Federico II' of Naples (Italy). Seventy-two severely obese females (BMI: 44.9 +/- 4.68; mean age: 33.1 +/- 11.34 years) were studied. GH peak after GHRH plus arginine test, IGF-I, IGFBP-3 and ALS levels, fat mass (FM) and free fat mass (FFM) (by Bioelectrical Impedance Analysis) at baseline and 6 months after LASGB. The change in percentage of individual variables was calculated as well as that of excess of body weight loss (EBWL%). The FM%, FFM% and EBWL% were correlated with peak GH and IGF-I levels changes. At baseline, GH deficiency (GHD) (GH peak = 4.1 microg/l) was found in 22 patients (31%), 16 of them also had IGF-I deficiency (< -2SDS). IGF-I levels were inversely correlated with waist circumference (r = -0.72, P < 0.001) and FM% (r = -0.75, P < 0.001). Post-LASGB the patients were classified as follows: group (1) GH and IGF-I sufficient (n = 44; 61.1%); group (2) GH and IGF-I deficient (n = 14; 19.4%) and group (3) GH sufficient and IGF-I deficient (n = 14; 19.4%). The percentage changes of EWBL (P < 0.05, P = 0.051, respectively) and FM (P < 0.001, P < 0.01, respectively) were lower in groups (2) and (3) than in group (1). At the stepwise linear regression analysis, postoperative IGF-I levels were the strongest determinant of percent changes of FM (P < 0.0001), of FFM (P = 0.009) and of EBWL (P < 0.0001). IGF-I levels is the most sensitive to unfavourable changes in body composition 6 months after LASGB making investigation of the somatotropic axis useful in the evaluation of bariatric surgery outcomes.

Is Lean Body Mass Decreased after Obesity Treatment by Adjustable Gastric Banding?

There is concern that surgically-induced weight loss in obese subjects is associated with a disproportionate decrease in lean body mass (LBM) and in skeletal muscle mass (SMM), a major constituent of LBM. To address this issue, 1) we measured total and regional body composition following gastric banding in a group of obese subjects, and 2) we compared these data to those of a non-surgical control group of similar age and body size. Body composition was assessed by dual-energy X-ray absorptiometry (DEXA) before and after laparoscopic adjustable silicone gastric banding (LAGB) in 32 women (after 1 year: age 43.7+/-8.4 years, BMI 36.4+/-5.9 kg/m2, mean+/-SD), and in 117 control women (age 44.5+/-7.5 years; BMI 36.7+/-5.5 kg/m2) referred for non-surgical weight management, prior to weight loss. SMM was estimated using a published equation based on LBM of the extremities (appendicular LBM). 1 year after LAGB, body weight loss (-23.7+/-11.6 kg, P<10(-6)) was mainly due to decreased fat mass (-21.2+/-11.2 kg, P<10(-6)), and total LBM was modestly, although significantly, decreased (-2.1+/-4.2 kg, P=0.01). Appendicular LBM (-0.7+/-2.7 kg) and total SMM (-0.9+/-3.0 kg) were not significantly modified. None of the body composition variables was significantly decreased in weight-reduced subjects compared to the control group, especially appendicular LBM and total SMM. Results provide no evidence for a decrease in appendicular LBM and total SMM with weight loss following LAGB. Follow-up of these obese patients revealed a very favorable pattern of change in total and regional body composition, with preservation of muscle mass.

Cardiovascular risk factors after bariatric surgery: Do patients gain more than expected from their substantial weight loss?

Background While it has been established that even limited weight loss (5–10%) improves obesity-associated cardiovascular risk factors, it is not known if considerable weight loss following laparoscopic adjustable silicone gastric banding (LASGB) results in a cardiovascular risk profile that is comparable, worse, or even better than that of matched control subjects. Methods Cardiovascular risk factors were compared in three groups of 24 women each: an index group that had lost considerable weight following LASGB for morbid obesity (BMI > 40 kg/m 2), a control group with the same BMI that the index group achieved after weight loss, and a pre-weight loss group of women with a BMI above 40 kg/m 2. Anthropometric measures, fasting serum glucose, insulin, lipids, C-reactive protein, and homocysteine levels were determined and insulin sensitivity was estimated using a homeostasis model assessment index (HOMA-IR). Results After bariatric surgery, the index group had a BMI of 32.0 ± 0.8 kg/m 2. This resulted in a significantly better cardiovascular risk profile than that of the pre-weight loss group (BMI 42.8 ± 0.6 kg/m 2). Unexpectedly, after weight loss, the index group had significantly lower systolic blood pressure, fasting serum insulin, and HOMA-IR than the BMI-matched (32.8 ± 0.9 kg/m 2) control group. Although not significant, diastolic blood pressure, LDL-cholesterol, and CRP levels were also lower. Conclusion Considerable weight loss following bariatric surgery leads to a greater improvement in cardiovascular risk factors than might be expected from the weight loss.

Conservative management of esophageal perforation following obesity surgery

Laparoscopic adjustable silicone gastric banding (LASGB) is one of the several surgical techniques for treating patients with morbid obesity. Erosion and perforation in the gastric chamber caused by LASGB are rare complications that have already been described. There have not yet been any reports of perforation of the middle esophagus during this procedure. The authors describe the case of a patient who presented the complication of very extensive perforation of the middle third of the esophagus following LASGB. This was successfully managed using conservative treatment.

Micronutrient deficiencies and bariatric surgery

Purpose of reviewBariatric surgery is associated with the development of several micronutrient deficiencies that are predictable, preventable and treatable based on the surgically altered anatomy and imposed dietary changes. With an increasing number of severely obese patients undergoing bariatric s

Preoperative esophageal manometry and outcome of laparoscopic adjustable silicone gastric banding

Laparoscopic adjustable silicone gastric banding (LASGB) for morbid obesity has been reported to provide long-term weight loss with a low risk of operative complications. Nevertheless, esophageal dilation leading to achalasia-like and reflux symptoms is a feared complication of LASGB. This study evaluates the clinical benefit of routine preoperative esophageal manometry in predicting outcome after LASGB in morbidly obese patients. A review of prospectively collected data on 77 patients who underwent routine esophageal manometry prior to LASGB for morbid obesity from February 2001 to September 2003 was performed. Aberrant motility, abnormal lower esophageal sphincter (LES) pressures, and other nonspecific esophageal motility disorders noted on preoperative esophageal manometry defined patients of the abnormal manometry group. Outcome differences in weight loss, emesis, band complications, and gastroesophageal reflux disease (GERD) resolution or improvement were compared between patients of the abnormal and normal manometry groups after LASGB. Analysis of variance (ANOVA) and chi-square tests were performed to determine the significance of these outcomes. Of the patients tested, 14 had abnormal esophageal manometry results, whereas 63 had normal manometry results before LASGB. There was no significant difference in percent excess weight loss (%EWL) at 6 and 12 months between the groups after gastric banding. Severe postoperative emesis occurred more frequently in patients with abnormal manometry results than in those with normal manometry results. There were two band-related complications, both of which occurred in patients of the normal manometry group. Preoperative esophageal manometry does not predict weight loss or GERD outcomes after LASGB in morbidly obese patients. Postoperative emesis was more common in patients with abnormal manometry findings, but such symptoms were manageable and did not lead to poor weight loss or to band removal or increased band-related complications.

A Simple Technique for Laparoscopic Removal of Silicone Adjustable Gastric Banding

Laparoscopic adjustable silicone gastric banding is currently among the most common surgical procedures performed in morbidly obese patients. The safety, reversibility, and technical simplicity of this procedure account for its wide and rapid diffusion. Concern still exists about the long term efficacy of the procedure in achieving weight loss and mechanical complications continue to represent the Achilles' heel of the procedure. Little or no attention has been given in the literature to the technical aspects of band removal. The surgical technique must be as simple and minimally invasive as possible. We report the technique we currently use to remove failed bands.

Early U.S. outcomes of laparoscopic gastric bypass versus laparoscopic adjustable silicone gastric banding for morbid obesity

Laparoscopic gastric bypass (LGBP) is the gold standard operation for long-term weight control in the United States. Laparoscopic adjustable silicone gastric banding (LASGB) is the preferred operative method for morbid obesity worldwide. Limited data are available comparing the two procedure in the United States. This study compares weight loss, complications, and early outcome of comorbidity resolution in patients who underwent LGBP versus LASGB. A review of prospectively collected data was performed on 392 patients undergoing primary LGBP (n = 232) and LASGB (n = 160) procedures between February 2001 and July 2004. Differences in percentage excess weight lost (%EWL) at 3, 6, 12, 18, and 24 months postop, improvement or resolution of comorbidities, and complications across procedure types were evaluated. Mean initial body mass index between groups was not significantly different (LGBP 47.2 vs LASGB 47.1, p < 0.53). There were significant differences in age, gender, and self-reported sweet-eating behavior between operative groups. There was a significantly greater %EWL in patients who underwent LGBP compared to patients of the LASGB groups 3, 6, 12, and 18 months after surgery. There were no significant differences in resolution or improvement of comorbidities between the groups. Although LGBP patients experienced more complications compared to LASGB patients (5.6 vs 4.3%, respectively; p < 0.56), this did not reach statistical significance. Early after surgery, LGBP patients lose more weight than LASGB patients but have similar improvements in comorbidities. Further follow-up is needed to determine the relative long-term efficacy of these procedures.

Changes in Body Composition and Insulin Sensitivity in Severely Obese Subjects After Laparoscopic Adjustable Silicone Gastric Banding (LASGB).

Laparoscopic adjustable silicone gastric banding (LASGB) is a viable therapeutic approach to achieve stable body weight reduction in severe obesity. The aim of this study was to evaluate body composition and metabolic features in morbidly obese patients before and after LASGB. There were 15 severely obese patients (Ob) (M/F: 4/11; mean age: 32.5 +/- 3.8 years) and 16 age-and sex-matched healthy lean controls (C) (M/F: 4/12; mean age: 39.5 +/- 2 years). Body mass index (BMI), waist circumference, waist-to-hip ratio, blood pressure, lipid profile, serum glucose and insulin during OGTT, and HOMA-IR were evaluated in all subjects. Body composition and fat distribution were measured using dual energy X-ray absorptiometry (DEXA). Patients were assessed before and six months after LASGB. The obese subjects showed several metabolic alterations. There were also positive correlations between waist, fat mass (FM), and HOMA-IR at baseline. After LASGB, mean BMI fell from 42.2 kg/m2 to 33.2 kg/m2; waist circumference and abdominal FM% decreased significantly. FM% declined, whereas FFM% increased. The ratio of FM loss to FFM loss was 3.7:1. Serum glucose and insulin levels during OGTT diminished slightly after weight loss and triglyceride levels fell dramatically. After LASGB, fasting insulin and HOMA-IR declined. LASGB induced a significant improvement in insulin sensitivity and a redistribution of body composition with a relative increase of FFM.

Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding.

We investigated the reduction in co-morbidities following laparoscopic adjustable silicone gastric banding (LAGB). Between December 1996 and October 2002, 295 patients with mean BMI 45 kg/m(2) were operated (79% women, average age 41 years). Mean follow-up was 44 months. Reduction in co-morbidity was scaled relative to the preoperative co-morbidity level as having been cured, improved, unchanged, or worsened. Patients needing reoperations were analyzed separately. The preoperative frequencies of co-morbidities were as follows: hypertension 52%, diabetes 20%, dyspnea 85%, peripheral edema 63%, sleep apnea 36%, arthralgia 89%, reflux 57%, reduced self-esteem 95%, reduced general physical performance 96%, hyperlipidemia 39%, hyperuricemia 36%, and menstrual problems 22%. Excess weight loss after 1 year was 40%, after 2 years 46%, after 3 years 47%, and after 4 years 54%. After 4 years, the rate of cure/improvement of the co-morbiditites were: hypertension 58% / 42%, diabetes 75% / 8%, dyspnea 85% / 12%, arthralgia 52% / 24%, reflux 79% / 11%, self-esteem 45% / 39%, and general physical performance 58% / 33%. We also found an improvement in stress incontinence, sleep apnea, peripheral edema, and regulation of menstruation. Greater weight loss was associated with greater reduction in dyspnea, arthralgia, self-esteem, and physical performance. Hypertension, diabetes, reflux, and edema improved independent of the amount of weight loss. Reoperated patients undergoing either rebanding or biliopancreatic diversion with duodenal switch had similar weight loss and reduction in co-morbidities as did patients treated with LAGB only. With moderate weight loss following LAGB, co-morbidities were cured in 50-80% or improved in 10-40% of all patients.

Laparoscopic Adjustable Silicone Gastric Banding Versus Vertical Banded Gastroplasty in Morbidly Obese Patients

To compare, in a prospective, randomized, single-institution trial laparoscopic adjustable silicone gastric banding (LASGB) with laparoscopic vertical banded gastroplasty (LVBG) in morbidly obese patients. LASGB is a simple and safe procedure, but some reports have suggested disappointing long-term results. Despite the recent widespread use of LASGB, there are no prospective nor randomized trials comparing LASGB with other laparoscopic procedures. A total of 100 morbidly obese patients, with body mass index (BMI) 40 to 50 kg/m2, without compulsive eating, were randomized to either LASGB (n = 49) or LVBG (n = 51). Minimum follow-up was 2 years (mean 33.1 months). There were no deaths or conversions in either group. Mean operative time was 94.2 minutes in LVBGs and 65.4 in LASGBs (P < 0.05). Early morbidity rate was lower in LASGBs (6.1%) versus LVBGs (9.8%) (P = 0.754). Mean hospital stay was shorter in LASGBs versus LVBGs: 3.7 days versus 6.6 (P < 0.05). Late complications rate in LVBGs was 14% (7 of 50) and in LASGBs 32.7% (16 of 49) (P < 0.05). The most frequent complication was the slippage of the band (18%). Late reoperations rate in LVBGs was 0% (0 of 50) versus 24.5% (12 of 49) in LASGBs (P < 0.001). Excess weight loss in LVBGs was, at 2 years, 63.5% and, at 3 years, 58.9%; in LASGBs, excess weight loss, respectively, was 41.4% and 39%. BMI in LVBGs was, at 2 years, 29.7 kg/m2 and, at 3 years, 30.7 kg/m2; in LASGBs, BMI was 34.8 kg/m2 at 2 years and 35.7 kg/m2 at 3 years. According to Reinhold's classification, a residual excess weight <50% was achieved, at 2 years, in 74% of LVBG and 35% of LASGB (P < 0.001). This study demonstrates that, in patients with BMI 40 to 50 kg/m2, LASGB requires shorter operative time and hospital stay but LVBG is more effective in terms of late complications, reoperations, and weight loss.

11-cm Lap-Band System placement after history of intragastric migration.

Intragastric migration (erosion) of the band after laparoscopic adjustable silicone gastric banding (LAGB) is a serious late complication. It requires removal of the entire system. Subsequent recurrence of obesity can be treated by laparoscopic placement of a larger band: the 11-cm Lap-Band System. In 727 laparoscopic gastric bandings using the 9.75 Lap-Band, 10 cases presented with intragastric migration of the band. The same complication was encountered in an additional 4 patients who had previously been implanted with an Obtech band in another hospital. Laparoscopic removal of the band was performed in all cases. In 9 cases, after a delay of 6 months, a new gastric band was placed using the 11-cm Lap-Band, because of uncontrollable recurrence of obesity. No complication was observed during the laparoscopic removal of the system. The placement of a new band required conversion to laparotomy in 1 patient who had previously received an Obtech band which had been placed using the pars flaccida technique. After a mean follow-up of 21 months, no intragastric migration of the new bands was noted. Laparoscopic placement of an 11-cm Lap-Band in patients with a history of intragastric migration is a safe procedure. It allows effective control of recurrent obesity. The laparoscopic procedure was easier in patients initially operated using the perigastric technique.

Changes in Fluid Compartments and Body Composition in Obese Women after Weight Loss Induced by Gastric Banding

Background/Aims: Surgical gastric banding procedures induce considerable and rapid weight losses in obese subjects. Nevertheless changes in lean mass and body fluids following these surgical treatments are not well known. Methods: We studied 6 obese women aged 38–42 years, before, and 8 and 24 weeks after laparoscopic adjustable silicone gastric banding (LAP-BAND^TM). Fat-free mass (FFM) and fat mass (FM) were investigated using dual energy X-ray absorptiometry (DEXA), while total body water (TBW) and extracellular water (ECW) were assessed by dilution methods. Results: The subjects showed a total weight loss of 16% of initial weight; the weight reduction was greater during the first 8 weeks. FFM decrease after 24 weeks was very limited and represented only 14% of the weight loss. The mean FFM changes per week were similar in the two periods of observation (0–8 and 8–24 weeks after LAP-BAND). TBW showed a global reduction of 2.2 ± 1.8 litres mainly due to a decline in intracellular water (ICW), while ECW remained constant during weight loss. As a consequence, the ECW/ICW ratio increased after LAP-BAND. Conclusion: LAP-BAND seems to achieve satisfactory weight losses while sparing FFM and causing only mild body fluid alterations.

Laparoscopic era of operations for morbid obesity.

The goal of this article is to review the status of the emerging field of laparoscopic bariatric surgery, to discuss developmental issues regarding technique and training, and finally, to summarize the present and future roles of laparoscopic bariatric surgery. We reviewed all published literature from 1992 to the present on MEDLINE. Articles were excludedforanalysesthatwerecasereportsorarticlesontechnicalaspectsofgivenprocedures.Laparoscopic vertical banded gastroplasty (LVBG) has reduced perioperative morbidity compared with the open approach but seems to have a low overall adoption rate, at least, in the United States. Laparoscopic adjustable silicone gastric banding (LASGB) has become firmly established in Europe and Australia. It has only recently been introduced in the United States. Laparoscopic adjustable silicone gastric banding has been proven to be an effective weight loss procedure in Europeans with morbid obesity. Laparoscopic Roux-en-Y gastric bypasses (LRYGBPs) can also be safely performed laparoscopicallywithweightlosssimilartoopenRoux-en-Ygastricbypasssurgery.Laparoscopicbiliopancreatic diversion procedures (LBPDs) have been performed safely in a few small series, but overall, experience is insufficient to draw strong conclusions. All laparoscopic bariatric procedures have significant learning curves. Laparoscopic bariatric surgery can be safely performed for all types of bariatric operations. The laparoscopic approaches to bariatric surgery significantly reduce perioperative morbidity justifying the acquisition of skills needed to perform these procedures.